WHO/EIP/OSD/2003.1 QUALITY AND ACCREDIT QUALITY Quality and accreditation in health care services: a global review resulted from a study conducted by the International Society for Quality in Health Quality and Care (ISQua) under contract to the World Health Organization. The first of A this report’s three parts describes structures and activities at national and TION IN HEAL international levels around the world to promote quality in health care. accreditation The second part catalogues quality concepts and tools in local use in various countries. The third part outlines initiatives in health service accreditation in health care and analyses the operation of functioning national programmes around the world. The appendices include recommendations of major international TH CARE SERVICES: TH services bodies and meetings on quality assurance. A global review A GLOBAL REVIEW Evidence and Information for Policy Department of Health Service Provision (OSD) World Health Organization 1211 Geneva 27 Switzerland WORLD HEALTH ORGANIZATION http://www.who.int WHO GENEVA WHO/EIP/OSD/2003.1 Quality and accreditation in health care services A GLOBAL REVIEW Evidence and Information for Policy Department of Health Service Provision WORLD HEALTH ORGANIZATION Geneva 2003 © World Health Organization 2003 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]). 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Designed by minimum graphics Typeset in Hong Kong Printed in Malta Contents Acknowledgements ix Foreword xi Preface xiii Section 1. International and national structures and activities for improving health care 1 Summary 3 Background 3 Sources 3 Purpose and scope of Section 1 4 Methods 4 Specific elements 4 Sources used 4 International structures and activities 6 Intergovernmental organizations 6 International funding organizations 15 International nongovernmental organizations 18 Other international resources 20 National structures and activities 24 Published national strategies 24 National reviews 27 National structures for quality 29 National quality initiatives 32 National resources 35 Discussion 39 Policy 40 Structure and management 42 Quality tools and methods 42 Resources 42 Conclusion 44 References 44 Section 2. Quality concepts and tools 51 Summary 53 Management concepts 53 Standards and measurements 53 Implementing change 53 Resources for quality improvement 54 Purpose and scope of Section 2 54 Methods 54 Specific elements 54 Sources used 55 Quality concepts 56 Quality management systems 56 External assessment 58 iii Quality tools 62 Population and community 62 Consumers, users and clients 64 Staff welfare 65 Staff competence 68 Clinical practice 69 Service delivery 76 Risk, health and safety 78 Resource management 81 Communications 82 Implementing change 83 Policy 85 Organization 85 Project methods 85 Change management 86 Involving the public 88 Resources for quality improvement 89 References 90 Section 3. Health service accreditation programmes 103 Summary 105 Sources 105 Findings 105 Purpose and scope of Section 3 105 Methods 106 Sources used 106 Data collection and management 106 Health service accreditation: summaries by country 107 Argentina 107 Armenia 107 Australia 107 Austria 107 Belgium 107 Bermuda 108 Bhutan 108 Bosnia and Herzegovina 108 Brazil 108 Canada 108 Colombia 108 Czech Republic 108 Denmark 108 Dominican Republic 108 Ecuador 109 Estonia 109 Finland 109 France 109 Germany 109 Hungary 109 India 109 Indonesia 109 Ireland 110 Italy 110 Japan 110 Kyrgyzstan 110 iv QUALITY AND ACCREDITATION IN HEALTH CARE SERVICES: A GLOBAL REVIEW Lithuania 110 Luxembourg 111 Malaysia 111 Mongolia 111 Morocco 111 Netherlands 111 New Zealand 111 Philippines 111 Poland 111 Portugal 111 Republic of Korea 112 Singapore 112 Slovak Republic 112 South Africa 112 Spain 112 Switzerland 112 Thailand 112 Turkey 113 United Kingdom 113 United States of America 113 Zambia 113 Survey findings and analysis 113 Distribution of responses 114 Legal framework 115 Relationship to government 115 Year of origin 116 Programme coverage 117 Public access to standards 118 Revision of standards 119 Country of inspiration 120 Site visits 120 Public access to reports 121 Survey activity 121 Surveyor activity 122 Expenditure and costs 123 Income 125 Reflections 125 Completeness of the review 125 Accuracy 125 Observations 126 References 127 Appendices Appendix 1.1 Recommendations to Member States on quality assurance, WHO Regional Committee for Europe, 1988 131 Appendix 1.2 Recommendations of the WHO Working Group on Quality Assurance in Health Care, Kiel, 1988 134 Appendix 1.3 Recommendations of the International Consultation on Quality Assurance in District Health Systems, Pyongyang, 1992 135 Appendix 1.4 Recommendations of the Hospital Advisory Group, 1994 137 Appendix 1.5 Recommendations of the WHO Working Group on Quality Assurance, Geneva, 1994 142 CONTENTS v Appendix 1.6 Recommendations of the pre-ISQua Meeting on Quality Assurance Methodologies in Developing Countries, St Johns, 1995 144 Appendix 1.7 Recommendations of the Committee of Ministers of the Council of Europe, 1997 146 Appendix 1.8 Recommendations of the WHO/ISQua Workshop on Quality Improvement for Middle and Low Income Countries, Dublin, 2000 149 Appendix 1.9 Recommendations of the WHO Anglophone Intercountry Meeting, Kampala, 2000 150 Appendix 1.10 Questions for a national quality strategy in developing countries 151 Appendix 1.11 National societies for quality (organizations known to ISQua) 153 Appendix 2.1 Classification of quality concepts and tools 154 Appendix 3.1 Specimen survey form 156 Appendix 3.2 Responding programmes 158 Appendix 3.3 Argentina 160 Appendix 3.4 Australia, ACHS 162 Appendix 3.5 Australia, AGPAL 163 Appendix 3.6 Australia, QIC 165 Appendix 3.7 Bosnia and Herzegovina 166 Appendix 3.8 Brazil 167 Appendix 3.9 Canada 168 Appendix 3.10 Colombia 170 Appendix 3.11 Czech Republic 172 Appendix 3.12 Finland 173 Appendix 3.13 France 174 Appendix 3.14 Germany 175 Appendix 3.15 Indonesia 177 Appendix 3.16 Ireland 178 Appendix 3.17 Italy 179 Appendix 3.18 Japan 181 Appendix 3.19 Malaysia 182 Appendix 3.20 Mongolia 184 Appendix 3.21 Netherlands 185 Appendix 3.22 New Zealand 186 Appendix 3.23 Poland 188 Appendix 3.24 Portugal 189 Appendix 3.25 Slovak Republic 190 Appendix 3.26 South Africa 191 Appendix 3.27 Spain 192 Appendix 3.28 Switzerland 194 Appendix 3.29 Thailand 196 Appendix 3.30 United Kingdom, HQS 197 Appendix 3.31 United Kingdom, HAP 199 Appendix 3.32 United Kingdom, CSB 200 Appendix 3.33 United States of America 201 Appendix 3.34 Zambia 202 Appendix 3.35 Abbreviations and acronyms 203 Index 205 vi QUALITY AND ACCREDITATION IN HEALTH CARE SERVICES: A GLOBAL REVIEW Tables Table 1.1 Quality assurance review meetings for developing countries, 1993–2000 7 Table 1.2 WHO publications on quality since 1990 8 Table 1.3 WHO Regional Offices 8 Table 1.4 WHO African Region meetings on quality improvement 9 Table 1.5 WHO Eastern Mediterranean Region workshop reports and publications 10 Table 1.6 WHO European Region workshop reports and publications 12 Table 1.7 WHO South-East Asia Region selected workshop reports and publications 13 Table 1.8 Quality-related research projects of the European Union 14 Table 1.9 Selected World Bank quality improvement projects 16 Table 1.10 International nongovernmental organizations 18 Table 1.11 ISQua international conferences 19 Table 1.12 Principal Cochrane web sites 20 Table 1.13 IHI/BMJ Forum meetings 21 Table 1.14 Examples of QAP projects 22 Table 1.15 Selected international journals related to quality 23 Table 1.16 Selected major quality awards and industrial quality organizations 24 Table 1.17 Examples of legislation for quality in health care 25 Table 1.18 Examples of national policies for quality in health care 26 Table 1.19 Examples of recent reports and national reviews on quality 27 Table 1.20 Examples of national quality policy groups or councils 29 Table 1.21 Examples of national executive agencies 30 Table 1.22 Selected national societies for quality in health care 31 Table 1.23 Examples of government quality initiatives 33 Table 1.24 Selected government guides to quality 34 Table 1.25 Examples of data