How will this initiative reduce the burden on healthcare providers?
This work is designed to reduce the administrative burden of individual accreditation schemes by co-ordinating and standardising accreditation processes and the standards that are required to be met. The quality improvements made through accreditation should outweigh any burden placed on the system.
How will accreditation lead to quality improvement?
Accreditation drives quality improvement by setting ambitious standards for services to meet. The vast majority of services are not operating at a standard comparable to that set by accreditation. This often requires significant work for a service to meet the standards, which is what establishes quality improvement. Accreditation also creates networks of clinical services which encourage the sharing of good practice, driving quality improvement outside the formal accreditation process.
Is accreditation flexible enough to accommodate both small and large services?
Individual accreditation schemes have to allow the accreditation of the full range of services within that area of healthcare. All of our tools and guidance are designed to be generic in nature and can be adapted for schemes assessing a variety of services.
What are the drivers for accreditation?
Aside from the common goal of improving quality in healthcare, there are a number of drivers for accreditation that have been used to varying degrees. These include commissioning based on accreditation, reassuring patients, regulators and arms-length bodies that services meet a quality mark, as well as reductions in the best practice tariff for not engaging with accreditation.
What are we aiming to accredit? Individual hospitals, units or pathways?
Traditionally, accreditation has looked at discrete units within a health service. Our work differes in that we encourage accreditation to be patient-focused with a foundation formed from the point of view of the patient. This requires collaborative care across organisational boundaries.
Care across organisational boundaries is not always possible, so why should my service be prevented from achieving accreditation if I have no control over other providers?
If organisations do not work together, patient care will be compromised and opportunities to achieve value for money will be lost. So while it might seem unfair to an organisation for its service not to be accredited when it has no control over another organisation responsible for part of the service, it is also unfortunate for patients (and sometimes the taxpayer) when organisations are not able to work together. Patient focussed accreditation will act as a powerful lever on organisations to work together and create transactional processes that support doing the right thing for patients.
What do you mean by ‘Value for money’? Don’t you mean cutting costs?
Value for money refers to getting the best health outcomes for a given cost. This can be achieved by improving the quality of care, or reducing costs, or both. The ubiquitous variation in all health outcome measures and associated costs indicates there is considerable value to extract from the system. If we do not achieve best value for money, then patients are not getting the best care possible within the resources allocated to their treatment. Consequently, there is less money to invest in services because it is being wasted on less effective care.
Is this looking solely at unit accreditation or individuals within units as well?
Clinical service accreditation does not assess the performance of individuals. However, a lack of collaborative working, or an inappropriate skill mix within the workforce which affects service delivery, can mean that a service will not meet the standards required. Accreditation requires services to assess the performance of the individuals working in it.
Who carries out accreditation and do appropriate clinicians sit on the panels?
The composition of accreditation visit teams is determined by individual schemes, but generally clinicians across relevant health professions and lay members are included.
Who collects the required data and is responsible for its accuracy?
Where possible, accreditation should use pre-existing verified data. Services are responsible for submitting data to show how they meet the standards. Data is reviewed by fully trained assessor teams prior to a site visit to identify where services meet the standards, where there are gaps, and where there are areas of excellence.
Who collates and is responsible for delivering the service’s accreditation package?
Services should appoint an individual who is responsible for managing the accreditation process. Collating all information required for accreditation is a sizeable task and is generally undertaken by a service manager.
Who funds accreditation?
Accreditation schemes are generally run on a cost recovery basis. Individual services often pay an annual subscription fee, which includes periodic on-site assessment and access to applicable resources.
How frequent is assessment?
Each scheme is responsible for determining frequency but, in general, services undergo an on-site visit over three to five years. This is supported by annual monitoring processes to ensure the standards required for accreditation are being maintained.
What is the outcome for services which ‘fail’ accreditation?
Services should only be advised to apply for accreditation once they are confident that they meet or almost meet the accreditation standards. If a service is assessed as not meeting the standards, a number of outcomes are possible:
- A service close to meeting the standards may be given a timeframe to resolve issues and, if it complies, accreditation will follow.
- A service determined to be some distance from meeting the standards may be provided with detail of the areas in which it needs to improve and be asked to reapply for accreditation once the changes have been made.
- If there are concerns about patient safety and if these are not dealt with immediately, the service will be referred to the relevant regulator.