d ay 2 3_imhaquality for ncmm sally bell[1]
TRANSCRIPT
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The IMHA Quality Assurance and
Accreditation Programme for Maritime
Clinics
Dr Sally Bell
Clinical Quality Consultant
IMHA Quality Executive Secretary
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• Why have a Quality Assurance
Programme?
• Development
• Implementation
• Benefits
• The Future
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Why have a Quality
Assurance Programme?
Generally - Increasing relevance of Quality
Assurance to modern practice worldwide.
Specifically - Requirements of MLC and newly
drafted fitness standards for seafarers.
The best clinics and doctors provide a high
standard of service to seafarers and the
maritime sector but some clinics and doctors
do not.
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What are the problems
• Lack of training or experience
• Poorly maintained or inappropriate
equipment
• Inaccurate test results
• Poor clinical decision taking
• Premises unhygienic, infection control
risk
• Cost cutting or corruption
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Consequences of poor
service
• Seafarers who need treatment do not get the right
treatment.
• Seafarers may return to sea when they are not fit to
do so.
• Seafarers may be unreasonably denied employment
that they are capable of undertaking.
• Preventative medicine may not be used to the full.
• Time, money and seafaring skills are wasted.
• Lack of trust in providers
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Who sees the problems
(if they look…)?
Maritime authorities
• Inconsistent fitness decisions may be taken
• Unethical standards of practice
Ship operators
• Loss of skilled crew
• Avoidable illness and safety risks at sea.
Seafarers’ organisations
• Denial of employment that is within a person’s capabilities
• Poor care for their members
Insurers
• Who end up paying the bills – but only if they are above
the relevant deductible
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What are the solutions?
• Adoption of good practice criteria e.g. ILO/IMO
guidelines on medical examinations including QA
recommendations
• Audit and accreditation of doctors and clinics as
mark of quality for all users of the service.
• Already done to varying extents by some authorities,
ship operators, insurers or seafarers’ organisations
but programmes are not all to the same level, and
criteria may be ill defined.
• More effective to have a single definitive system
acceptable to all stakeholders – such as IMHA
Quality
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IMHA Quality or ISO?
• ISO system
– good standards for management
– not adapted for the delivery of medical
care
• IMHA Quality Standards
– designed to ensure high quality provision
of maritime medical advice
– able to interact with stakeholders
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The process of development of
Quality Assurance standards
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Standards needed in a
number of areas:
• Medical fitness examinations – first priority
• Occupational Health Advice
• Port Health Clinics
• Repatriation and rehabilitation
• Telemedical advice.
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Medical Fitness
Examinations
• Standards have been developed to
define best practice and provide
straightforward goals.
• Assessment against these standards
will provide the basis for accreditation
and help to drive continuous quality
improvement.
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How did we develop
them?
• The standards had to be easily understood,
comprehensive, and endorsed by an
approved accreditation body.
• We chose to work with CHKS, a London
organisation specialising in healthcare
accreditation worldwide.
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What is covered by the
standards?
• Each standard addresses an area of work
or activity and is made up of a number of
criterion statements.
• Criteria are designed to be measurable
and set out what needs to be achieved.
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Areas included in the
standards
• Clinic Management,
• Staff, Clinic Facilities, Clinical Practice
• Diagnostic Services
• Health Records and IT
• Infection Control, Health and Safety
• Quality Improvement Activities
296 criteria in all
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Examples of standards:
• STAFF: The service is managed and staffed
effectively and efficiently in order to achieve
its objectives.
• CLINIC FACILITIES: The environment,
facilities and equipment ensure safe, efficient
and effective care for seafarers and staff.
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Examples of specific
criteria for staff:
• The doctors performing seafarer
examinations have occupational health
qualifications, knowledge or experience.
• Staff using specialised equipment are
trained and competent in its use.
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• The standards were reviewed and
approved by the CHKS accreditation
committee.
• They will continue to be improved and
refined at intervals in order to ensure
that they continue to reflect current best
practice.
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The implementation of
the programme
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Quality improvement and
accreditation
• Application and Self-assessment
– Listed as IMHA QA member
• Working towards compliance with standards
– Advisor from IMHA QA
• Assessment visit when ready (time limit)
– Peer review
• Accreditation decision
– Listed as IMHA QA Accredited Clinic
• Continuing quality improvement
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www.imhaquality.net
• Public and member information
– Allows all to register an interest in the
programme
– All information about the programme
– Information regarding those accredited, and also
those working towards accreditation
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www.imhaquality.net
• The virtual office of IMHA QUALITY
– Allows registration details to be entered on line
– Messaging facility for communications between
IMHA Quality staff and clinics
– Securely store accreditation information
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Accreditation committee
• Endorses recommendations on
accreditation
• Composition
– Members from Stakeholder Advisory Group
– IMHA representatives
• Appointment by IMHA Board
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Stakeholder
Correspondence Group
• All interested parties will be kept informed
– Governments
– Shipowners
– Seafarers
– P&I clubs
– Classification societies
– NGOs
– Crewing agencies
– Shipping agents
– Maritime Clinics
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Stakeholder Advisory
Group
This group will be composed of selected
members of the Stakeholder
correspondence group, and will be
consulted throughout the programme on
matters of policy and procedure.
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Quality Assurance of the
programme
• External training for assessors
• External advice from a recognised
accreditation body (CHKS are UKAS
accredited)
• External review of assessments by
outside auditors
• Regular review of standards by
independent advisors.
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Benefits of the
programme
• Clinics
• Maritime Authorities
• Seafarers and Maritime Trade Unions
• Employers, Agents, Insurers
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Clinics
• IMHA Quality provides a quality assured and
internationally recognised system of QA
• Will help to achieve quality goals
• Potential clients will be aware of commitment to
quality
• Can demonstrate by accreditation that they can
provide valid and fair seafarer assessment
• Accreditation will assist in achieving approval from
other bodies, whether maritime authorities,
shipowners or P & I Clubs.
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Maritime Authorities
• ensure procedures comply with STCW and MLC
• meet the recommendations of the ILO/IMO
International Guidelines to provide a QA system for
seafarer medical examinations
• does not interfere with discretion to set national
standards but will confirm that these are being
correctly applied.
• assist with mutual recognition of medical certificates
• help authorities to decide which providers to approve
(particularly internationally)
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Seafarers, Trade Unions
• Reduce concerns about justification or fairness of
seafarer fitness decisions.
• Ensure fair conduct of medicals (as per the ILO/IMO
Guidelines on Seafarer Medical Examinations )
• Ensure commitment to sound ethical standards
• Ensure seafarers provided with full information about
reasons for fitness decisions,
• Ensure referral if a new illness is found
• Maintain confidentiality of medical information.
• Ensure that only seafarers who cannot work safely or
effectively or who may have their health endangered
by doing so are prevented from working.
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Employers, Agents,
Insurers
• Ensure seafarers can work safely and effectively
• Reduce risk of requiring evacuation, treatment or
repatriation.
• Ensure providers are committed to following the
detail of decision-taking requirements whether
national or in house.
• Reduce costs of in house clinic assessment or audit
• Minimise the inefficiency of multiple assessments of
the same provider by different users.
• Ensure providers are fit for purpose and acceptable
to seafarers, maritime authorities and other groups
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The Future
• Later phases of the programme will
develop standards for other services:
– Occupational Health Advice
– Port Health Clinics
– Repatriation and rehabilitation
– Telemedical advice.
• This should involve only a small
increment in development work and
costs.
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Contact
• General inquiries
• Manager
• Executive committee members
• Supervisor
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www.imhaquality.net