1. QUALITY AND ACCREDITATION A DIRECT LINK?
Le titre doit cibler une problématique précise: il ne s’agit pas de reprendre le nom du projet dans son entièreté ni les acronymes.
UBUZIMA BURAMBYE PROGRAM
Ministry of Health
RWANDA

2. Accreditation, in short ….
Accreditation is defined in the British Medical Journal as "A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve".
L’accreditation, la créditation, l’âcre-éditation???

3. What is Hospital Accreditation ?
Mechanisms for recognition of institutional competence
By an independent accrediting body (Usually)
Applying hospital standards for optimal and achievable performance
Hospital survey by external peer reviewers
Voluntary participation (Usually)
Emphasis on continuous quality improvement

4. Hospital accreditation as a regulatory incentive
Improve quality of health care
Patient safety and risk management
Evidence-based practice
Continuous learning and improvement
Stimulate and improve integration and management of health services
Reduce variation in care and health care costs
Strengthen the public’s confidence in the quality of health care

5. Policy Orientation - Rwanda
Vision: To provide quality and safe healthcare services meeting international standards, to ensure a healthy population for a wealthy nation.
Mission: To continuously improve delivery of safe, quality healthcare services provided to the public in collaboration with our stakeholders through quality improvement approaches and evidence-based standards towards accreditation.
Goals: To provide high quality and safe health care services to the population of Rwanda

7. QD QI QM MoH Quality Assurance Triangle Quality Defining Quality
Dvp Standards,
Clinical Guidelines,
Policies and Procedures,
etc.
Defining
Quality QD
Accreditation Facilitation
Self-assessment &
External assessment
Improving
Quality
Quality
Measuring
Quality
Time: 1 minute
Discussion points:
There are 3 points on this quality triangle: defining, measuring and improving quality.
In order to achieve quality it must be defined – this means that we need to write down what is expected. And in this case, we are writing the expectations in the form of policies and procedures. QI QM

8. Rwanda experience
MOH identified five “risk areas” on which to focus initial quality and safety improvement efforts:
RA 1: Leadership
RA2: Competent Workforce
RA3: Safe environment
RA4: Clinical Care
RA5: Quality and Safety
Core standards= Addressing systems, processes, policies and procedures
Critical standards= Required by National Laws & Regulations

9. Levels of effort
“Levels of Effort” are identified for each standard provide a means for evaluating progress in reducing risk and improving quality.
The Levels of Effort that represent progressive achievement in reaching the expectations found in a standard:
At Level 0, the desired activity is absent, or inconsistent activity related to risk reduction.
At Level 1, the policies, procedures and plans are in place to address the risk.
At Level 2, the processes are in place for consistent and effective risk reduction activities.
At Level 3, there are data to confirm successful risk-reduction strategies and continued improvement

10. Scoring system LEVEL I LEVEL II LEVEL III AVERAGE SCORE RISK AREA
≥ 75%
≥ 70 %
≥ 60%
OVERALL
AVERAGE SCORE
≥ 85%
≥ 70%
CRITICAL STANDARD MET
80%
100%

11. Example
STANDARD #6 Diagnostic imaging services available, safe, and reliable
RISK LINK
Patients are at risk when their assessment requires diagnostic imaging services and the services are not available within or outside the organization, or are not provided safely
LEVELS OF EFFORT
Level 0: Diagnostic imaging services are not consistently available and reliable to meet patient needs and/or there is no radiation safety program.
Level 1: Current radiology policies, procedures and safety manual are available.
Level 2: Diagnostic imaging services are consistently available to meet patient needs, the radiation safety program meets all legal requirements, and the tests are conducted and reported by qualified individuals in a timely manner.
Level 3: Diagnostic imaging quality control is performed for imaging tests and oversight is provided for tests performed outside the radiology department; data are used to improve accuracy of results.

12. Performance of 6 Hospitals Towards Meeting Critical Standards Q4 2015

13. Accreditation and quality? - institutional
norms and standards
High level ownership and accreditation high on MOH agenda
Quality improvement culture
Another vertical program?
No neutral agency yet - MOH led process so far ( role status, funding, scope, composition tbd)
Reference for the norms and standards: international vs local context
Budget availability not confirmed
High cost in human and financial resources
Terminology: accreditation and quality terms too often interchanged

14. Accreditation and quality? - organizational
Revitalization of Q committees at hospital levels
Quality high on agenda at facility level
Accreditation linked to PBF
High burden on the hospital staff
Numerous committees
Initial process very bureaucratic (checklist approach) – three days assessment minimum
No involvement of health insurances yet

15. Accreditation and quality? - individual
Potential with Initial targets on nosocomial infections, customer care, incident management
Patient flow?
Process in place ≠ automatic Change in quality? – to be confirmed

16. Process = signposts Output = getting where planned outcome = treated and better

17. Some Challenges Definition of standards Heavy and top down
Cost and sustainability
Independent Healthcare Accreditation Organization

18. Next steps Establishment RHAO
Development of PHC/HCs standards in June 2016
Engage private health facilities into accreditation program
Engaging health insurances schemes to accreditation
Advocacy for financial support

19. ? Approach:
through quality improvement approaches towards accreditation Vs
through accreditation approach towards quality improvement

20. Murakoze cyane