公 益 財 団 法 人 日 本 医 療 機 能 評 価 機 構 Japan Council for Quality Health Care

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1 公 益 財 団 法 人 日 本 医 療 機 能 評 価 機 構 Japan Council for Quality Health Care URL: 1

2 1. What is JCQHC? 2. Hospital Accreditation 2-1.How does evaluation go? 2-2.What are the standards? 2-3.Who are the surveyors? 2-4.When did the accreditation program start? 2-5.How many hospitals and what kind of hospitals are accredited? 2-6.Why hospitals apply to the program? 3. Future Plan 2

3 1. What is JCQHC? 2. Hospital Accreditation 2-1.How does evaluation go? 2-2.What are the standards? 2-3.Who are the surveyors? 2-4.When did the accreditation program start? 2-5.How many hospitals and what kind of hospitals are accredited? 2-6.Why hospitals apply to the program? 3. Future Plan 3

4 JCQHC s Mission To contribute to improve Japanese health and welfare as the neutral and scientific third-party organization, JCQHC do the enterprises about improvement of quality and reliablity of health care system. 4

5 Establishment of JCQHC JCQHC was established in July, 1995 Contribution: basic fund Ministry of Health, Labor and Welfare Japan Medical Association Hospital Associations Japan Dentist Association Japan Nursing Association Japan Pharmacist Association Japanese Federation of Health Insurance etc. 5

6 Our Enterprises Hospital Accreditation ( / written in Japanese) Patient Safety Promotion ( written in Japanese) No-Fault Compensation System on Obstetrical Adverse Events ( written in Japanese) EBM medical information division ( written in Japanese) National Database of Medical Adverse Events ( with English page) Near miss Event in Pharmacy ( with English page) 6

7 Hospital Accreditation (evaluation and accreditation fee) JCQHC s Budget (as of March 2010) From Clients (Hospitals, etc.) 2,263 Million $ 22.6 Million 66.9% No-fault Compensation System (management fee included in insurance fee) Surveyor Recruitment & Training Research & Development EBM (Minds) Adverse Event Prevention No-fault Compensation System Project to Collect Pharmaceutical Near-Miss Information From Central Government (Ministry of Health) 1,120 Million $ 11.2 Million Total 3,383 Million $ 33.8 Million 33.1% 7

8 1. What is JCQHC? 2. Hospital Accreditation 2-1.How does evaluation go? 2-2.What are the standards? 2-3.Who are the surveyors? 2-4.When did the accreditation program start? 2-5.How many hospitals and what kind of hospitals are accredited? 2-6.Why hospitals apply to the program? 3. Future Plan 8

9 Hospital Evaluation & Accreditation ~JCQHC s Core Operation~ 9

10 1. What is JCQHC? 2. Hospital Accreditation 2-1.How does evaluation go? 2-2.What are the standards? 2-3.Who are the surveyors? 2-4.When did the accreditation program start? 2-5.How many hospitals and what kind of hospitals are accredited? 2-6.Why hospitals apply to the program? 3. Future Plan 10

11 Process of Evaluation 1.Application (voluntary) 2.Document Survey Self-assessment report 3.On-site Survey 4.Evaluation Committee 5.Accreditation 11

12 On-site Survey Schedule And Accreditation Fee Acute Care Hospitals 20~99 beds 100~199 beds 200~499 beds Over 500 beds Psychiatric or Long-term Care 20~199 beds 100~199 beds 200~499 beds - Composition of Surveyors 1 Leader 1 Physician 1 Nurse 1 Administrator 1 Leader 1 Physician 1 Nurse 1 Administrator 1 Leader 2 Physicians 2 Nurses 2 Administrators 1 Leader 2 Physicians 2 Nurses 2 Administrators Day 1 AM PM Day 2 AM PM Day 3 AM PM Accreditation Fee 1.2 million 1.5 million 2.0 million 2.5 million 12

13 Section (52 sections) 1 st - tier evaluation criterion (137 Criteria) 5, 4, 3, 2, 1 (or N/A) 3.3 Development of facilities and patient convenience Proper care is taken to improve the convenience of patients and visitors. ( N/A ) Hospital facilities are designed for the convenience of patients and visitors. ( a b c N/A ) The hospital provides facilities and services required for everyday life. ( a b c N/A ) The hospital provides means of obtaining information and means of communication during hospitalization. ( a b c N/A ) Appropriate guidance regarding hospital facilities is provided for the effective usage thereof by patients. ( a b c N/A ) 2 nd -tier evaluation criterion (352 Criteria) a, b, c (or N/A) (N/A = not applicable) Facilities are designed to meet the needs of elderly and disabled people. ( N/A ) Hospital buildings are designed to be barrier-free. ( a b c N/A ) JCQHC Hospital Evaluation Standard Version Facilities and equipment are designed to meet the needs of elderly people and people with physical disabilities. 13

14 Members of Evaluation Committee Healthcare Professionals ~Physician, Nurse, Pharmacist~ Lawyers Insurer Economic organization Labor organization Healthcare Consumers ~Patients~ etc. *There is no member from hospital associations. 14

15 Survey Result Report The report contains comments of the team 2. score of each middle-level items (5-1) 3. score of each minor-level items (a-c) 4. free-text descriptions of strengths and weaknesses in each areas

16 1. What is JCQHC? 2. Hospital Accreditation 2-1.How does evaluation go? 2-2.What are the standards? 2-3.Who are the surveyors? 2-4.When did the accreditation program start? 2-5.How many hospitals and what kind of hospitals are accredited? 2-6.Why hospitals apply to the program? 3. Future Plan 16

17 Health Care Quality Structure Availability of physicians, nurses, and other personnel. Physical equipment and facilities. P Process How healthcare is provided? How the system works? P Outcome Health Status Does it make a difference? (P=probability) Structure, Process, & Outcome Avedis Donabedian 17

18 Hospital Evaluation Standard Ver Administration and Roles in the Medical Organization 2. Patient Rights, Patient Safety and Quality of Health Care 3. Living Arrangement and Patient Services 4. Organization Management 5. Processes of Care for Quality and Safety Processes 6. Hospital Administration 18

19 Relationship between Hospital Function Model and JCQHC Standard Hospitality Quality 2. Patient Rights, Patient Safety and Quality of Health Care 3. Living Arrangement and Patient Services Safety 4. Organization Management 5. Processes of Care 1. Administration and Roles in the Medical Organization 6. Hospital Administration Sustainability 19

20 Hospital Evaluation Standard(Ver.6) Optional Module Standards(Ver.2) Palliative Care Rehabilitation Care Emergency Care Optional Modules Section 1~6: Base Standard Section 7: Psychiatric Care Section 8: Long-term Care 20

21 What s the difference between governmental review and our evaluation? Governmental Mandatory (legal obligation) Minimal requirement for medical care With punitive clause Annual JCQHC Voluntary Requirements for quality medical care No-penalty Every 5-year 21

22 1. What is JCQHC? 2. Hospital Accreditation 2-1.How does evaluation go? 2-2.What are the standards? 2-3.Who are the surveyors? 2-4.When did the accreditation program start? 2-5.How many hospitals and what kind of hospitals are accredited? 2-6.Why hospitals apply to the program? 3. Future Plan 22

23 Surveyor Recruitment & 1.Surveyor qualification Training 〇 Physician director of hospital 5-year experience 〇 Nurse director of nursing dept. 5-year experience 〇 Administrator director of administration dept. 5-year experience 23

24 Surveyor Recruitment & Training 2.Initial Training (Surveyor boot camp) 〇 5-day intensive training including simulation survey 3.On site training 〇 First survey: On the Job Training with expert-surveyors 〇 Second survey~: Considered full-fledged surveyor 4.Off site training 〇 Leader skill training 〇 Referee reading training 〇 Seminar for new version standard (evaluation criteria) etc. 24

25 Surveyor Recruitment & 5.Tool 〇 Handbook 〇 Support Site (Web) 〇 Bulletin Training 6.Feed back 〇 Surveyor performance review peer review / comment from hospitals 25

26 Surveyor Recruitment & Training 7.Number of Surveyors as of 1, Apr 〇 Physicians 326 〇 Nurses 245 〇 Administrators 286 total 857 All surveyors are part-time employee and paid by the survey. Some of surveyors are retired, and others still work at their own hospitals. 26

27 1. What is JCQHC? 2. Hospital Accreditation 2-1.How does evaluation go? 2-2.What are the standards? 2-3.Who are the surveyors? 2-4.When did the accreditation program start? 2-5.How many hospitals and what kind of hospitals are accredited? 2-6.Why hospitals apply to the program? 3. Future Plan 27

28 Year of Beginning Accreditation Operations 1951 USA (JCAHO) 1997 Czech Republic, Japan 1958 Canada 1998 Australia (AGPAL), Brazil, 1974 Australia (ACHS) JC International, Poland, 1979 USA (AAAHC) Switzerland 1986 Taiwan 1999 France, Malaysia, 1987 Australia (QIC) Netherlands, Thailand, 1989 New Zealand Zambia 1990 UK (HAP) 2000 Portugal, UK (CSBS), 1991 UK (HQS), US (NCQA) Philippines 1994 South Africa 2001 Bulgaria, Germany, 1995 Finland, Korea, Indonesia Italy (Marche) 1996 Argentina, Spain 2002 Ireland 28

29 (No. of surveys) The Number of Surveys Renewal Initial (Fiscal Year) Ver.2 Ver.3 Ver.4 Ver.5 Ver.6 Version of Standard (criteria) 29

30 1. What is JCQHC? 2. Hospital Accreditation 2-1.How does evaluation go? 2-2.What are the standards? 2-3.Who are the surveyors? 2-4.When did the accreditation program start? 2-5.How many hospitals and what kind of hospitals are accredited? 2-6.Why hospitals apply to the program? 3. Future Plan 30

31 The Number of Accredited Hospitals JCQHC Hospital Evaluation Program Number of Hospitals in Japan Hospitals applied for JCQHC accreditation program Number of accredited Hospitals 8,708 2,965 (34.0%) 2,518 (29.0%) ~20% ~25% ~30% ~35% >35% (Mar. 2011) 31

32 Hospital Size (No. of beds) and Accreditation Rate Number of beds under ~ ~ 299 All Hospitals 3,296 2,751 1,124 Number of Hospitals Accredited Hospitals Accreditation Rate 11.4% 37.9% 37.9% 5,000 4,000 Hospital size and Accreditation rate All hospitals Accredited hospitals Accreditation rate 100% 80% 300 ~ ~ ~ % 63.8% 72.1% No, of Hospital 3,000 2,000 60% 40% Accreditation rate 600 ~ % 700 ~ % 1,000 20% 800 ~ % over 900 Total 62 8, , % 28.9% 0 under No. of Beds over 900 0% (28. Feb. 2011) 32

33 1. What is JCQHC? 2. Hospital Accreditation 2-1.How does evaluation go? 2-2.What are the standards? 2-3.Who are the surveyors? 2-4.When did the accreditation program start? 2-5.How many hospitals and what kind of hospitals are accredited? 2-6.Why hospitals apply to the program? 3. Future Plan 33

34 What do hospitals expect for JCQHC accreditation? 病 院 機 能 評 価 受 審 の 目 的 n=303, 複 数 回 答 For staff encouragement 職 員 の 意 識 改 革 toward quality improvement To obtain objective 現 状 evaluation の 客 観 的 評 of 価 quality/performance To improve Patient 患 者 Satisfaction サーヒ スの 向 上 83.8% 81.5% 89.4% To improve financial condition 経 営 改 善 26.4% Marketing 病 院 PR 15.5% Differentiation from competitors 差 別 化 9.2% Palliative Care 緩 和 Qualification ケア 病 床 設 置 その Other 他 4.6% 6.3% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Data Source: 2007 JCQHC Client Survey, N=303 34

35 Governmental support for Evaluation and Accreditation Accreditation is required for palliative care qualification. Accredited hospitals can advertise about that. Accredited hospitals can have the director who is not a medical doctor. 35

36 Internal Incentives of Evaluation and Accreditation Hospital can evaluate the weak points of itself and improve those points. Hospital can unite as a team. Hospitals may be able to decrease errors. 36

37 What is the effect of JCQHC accreditation? Mission and basic policy are defined. 86.5% Policy about patients' right is defined. 82.7% No smoking policy are defined. Protocols of medical care and other works are made. Rules and protocols about body suppression are defined. Policies and protocols about informed concent are defined. Notices are adjusted. Protocoles of instruction and practice are difined. Infective wastes are rightly carried on. 74.0% 72.6% 72.3% 71.9% 71.4% 71.3% 70.6% 0% 20% 40% 60% 80% 100% Data Source: 2010 JCQHC questionnaire, N=

38 1. What is JCQHC? 2. Hospital Accreditation 2-1.How does evaluation go? 2-2.What are the standards? 2-3.Who are the surveyors? 2-4.When did the accreditation program start? 2-5.How many hospitals and what kind of hospitals are accredited? 2-6.Why hospitals apply to the program? 3. Future Plan 38

39 Is QUALITY really maintained throughout 5 - year accreditation period? 5 years Evaluation/Accreditation Re-accreditation Accountability: Quality Assurance Follow Up Service: Continuous Quality Improvement 39

40 Continuous Quality Improvement (CQI) & Quality Assurance (QA) Shortening of Accreditation Period e.g. 5 years (Current) 3 years? Interim Survey Quality Improvement Consultation Unannounced Survey Quality Monitoring e.g. Internal Auditors Performance measurement 40

41 Various hospital data (e.g. No.of beds, Outpatient, ALOS, etc.) Survey results Data Data stored in JCQHC 1997~ Data Utilization Information Hospital Management Public Reporting Health Policy For Clients Quality /Management Improvement Through benchmarking, etc. For patients Hospital Selection For Government / Insurers e.g. Base data for Policy making Fee schedule modification Pay for Accreditation? 41

42 Thank you. 42

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