the next frontier: hospital continuous quality … -slmta for hospital...©2014 mfmer | slide-1 the...
TRANSCRIPT
copy2014 MFMER | slide-1
The Next Frontier Hospital continuous quality improvement towards accreditation
Strengthening Hospital Management Toward Accreditation (SHMTA)
Charles Nde Awasom MD Laura Eno Barbara C McKinney MD MPH
copy2014 MFMER | slide-2
Goal for Today
To plant seeds for
ADVOCACY
and
ACTION
to move SLMTA to the entire hospital ie SHMTA
copy2014 MFMER | slide-3
For today
bull From SLMTA to SHMTA
bull Current State - Hospital Accreditation in Africa
bull Literature Review
bull Lessons Learned
bull Envision the Future State - Case Studies from Cameroon
bull Next Steps Call to Action
copy2014 MFMER | slide-4
Principles of Quality Assurance
bull Focus on the needs of the users
bull Focus on processes to increase the productivity of work
bull Use data to improve services
bull Use teams to improve quality
bull Improve communication
SLMTA Core Improvement Values
Citation
copy2014 MFMER | slide-5
SLMTA Core Components What makes SLMTA work
bull Task-based curriculum ndash focused on the desired behaviorsstandards
bull Hands-onActivity-basedInteractive curriculum delivery
bull Multiple workshops ndash dividing important content into smaller digestible sessions
bull Assigned improvement projects between workshops - implementation with accountability
bull Site visits for mentoring and coaching
bull Using an established checkliststandards for pre-and post assessment
copy2014 MFMER | slide-6
SLMTA Process Mapping
copy2014 MFMER | slide-7
Patient
Arrival
CA Prep LPN
Prep Review pt
info
Lab
Treatment Obtain
prescription
Post visit
follow-up
Pharmacy
Patient
Departure
Wait Time
Process Time
95 80 70 70 85 65
Input
pt info
Order
tests
Diagnose
Orders
Obtain
meds Call pt
10min 3min 20min 30min 40min 15min
7min 1min 55min 45min 45min 10min
First Time Quality
Data Box
Process Box
I I I I I I
DATA BOX - Total Process
Minutes Hours
Total Wait Time (WT)
Total Process Time (PT)
Total Lead Time (LT)
Value Added Percent
First Time Quality
163
118
281
272
197
468
42
20
I I
1 1 1 1 1 1
First Time Quality
Process Times
Wait Times
Information
Pull
System
Patient
Customer
Flow Queuing
Inventory PUSH
System
Information
Flow
Summary
Process Data Value Stream Mapping
copy2014 MFMER | slide-8
Value Stream Mapping V = QC
Registration Physicianrsquos Office
Laboratory X-ray Pharmacy
copy2014 MFMER | slide-9
copy2014 MFMER | slide-9
The Needs of the Patient Come Firsthellip
copy2014 MFMER | slide-10
Hospital Accreditation
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-2
Goal for Today
To plant seeds for
ADVOCACY
and
ACTION
to move SLMTA to the entire hospital ie SHMTA
copy2014 MFMER | slide-3
For today
bull From SLMTA to SHMTA
bull Current State - Hospital Accreditation in Africa
bull Literature Review
bull Lessons Learned
bull Envision the Future State - Case Studies from Cameroon
bull Next Steps Call to Action
copy2014 MFMER | slide-4
Principles of Quality Assurance
bull Focus on the needs of the users
bull Focus on processes to increase the productivity of work
bull Use data to improve services
bull Use teams to improve quality
bull Improve communication
SLMTA Core Improvement Values
Citation
copy2014 MFMER | slide-5
SLMTA Core Components What makes SLMTA work
bull Task-based curriculum ndash focused on the desired behaviorsstandards
bull Hands-onActivity-basedInteractive curriculum delivery
bull Multiple workshops ndash dividing important content into smaller digestible sessions
bull Assigned improvement projects between workshops - implementation with accountability
bull Site visits for mentoring and coaching
bull Using an established checkliststandards for pre-and post assessment
copy2014 MFMER | slide-6
SLMTA Process Mapping
copy2014 MFMER | slide-7
Patient
Arrival
CA Prep LPN
Prep Review pt
info
Lab
Treatment Obtain
prescription
Post visit
follow-up
Pharmacy
Patient
Departure
Wait Time
Process Time
95 80 70 70 85 65
Input
pt info
Order
tests
Diagnose
Orders
Obtain
meds Call pt
10min 3min 20min 30min 40min 15min
7min 1min 55min 45min 45min 10min
First Time Quality
Data Box
Process Box
I I I I I I
DATA BOX - Total Process
Minutes Hours
Total Wait Time (WT)
Total Process Time (PT)
Total Lead Time (LT)
Value Added Percent
First Time Quality
163
118
281
272
197
468
42
20
I I
1 1 1 1 1 1
First Time Quality
Process Times
Wait Times
Information
Pull
System
Patient
Customer
Flow Queuing
Inventory PUSH
System
Information
Flow
Summary
Process Data Value Stream Mapping
copy2014 MFMER | slide-8
Value Stream Mapping V = QC
Registration Physicianrsquos Office
Laboratory X-ray Pharmacy
copy2014 MFMER | slide-9
copy2014 MFMER | slide-9
The Needs of the Patient Come Firsthellip
copy2014 MFMER | slide-10
Hospital Accreditation
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-3
For today
bull From SLMTA to SHMTA
bull Current State - Hospital Accreditation in Africa
bull Literature Review
bull Lessons Learned
bull Envision the Future State - Case Studies from Cameroon
bull Next Steps Call to Action
copy2014 MFMER | slide-4
Principles of Quality Assurance
bull Focus on the needs of the users
bull Focus on processes to increase the productivity of work
bull Use data to improve services
bull Use teams to improve quality
bull Improve communication
SLMTA Core Improvement Values
Citation
copy2014 MFMER | slide-5
SLMTA Core Components What makes SLMTA work
bull Task-based curriculum ndash focused on the desired behaviorsstandards
bull Hands-onActivity-basedInteractive curriculum delivery
bull Multiple workshops ndash dividing important content into smaller digestible sessions
bull Assigned improvement projects between workshops - implementation with accountability
bull Site visits for mentoring and coaching
bull Using an established checkliststandards for pre-and post assessment
copy2014 MFMER | slide-6
SLMTA Process Mapping
copy2014 MFMER | slide-7
Patient
Arrival
CA Prep LPN
Prep Review pt
info
Lab
Treatment Obtain
prescription
Post visit
follow-up
Pharmacy
Patient
Departure
Wait Time
Process Time
95 80 70 70 85 65
Input
pt info
Order
tests
Diagnose
Orders
Obtain
meds Call pt
10min 3min 20min 30min 40min 15min
7min 1min 55min 45min 45min 10min
First Time Quality
Data Box
Process Box
I I I I I I
DATA BOX - Total Process
Minutes Hours
Total Wait Time (WT)
Total Process Time (PT)
Total Lead Time (LT)
Value Added Percent
First Time Quality
163
118
281
272
197
468
42
20
I I
1 1 1 1 1 1
First Time Quality
Process Times
Wait Times
Information
Pull
System
Patient
Customer
Flow Queuing
Inventory PUSH
System
Information
Flow
Summary
Process Data Value Stream Mapping
copy2014 MFMER | slide-8
Value Stream Mapping V = QC
Registration Physicianrsquos Office
Laboratory X-ray Pharmacy
copy2014 MFMER | slide-9
copy2014 MFMER | slide-9
The Needs of the Patient Come Firsthellip
copy2014 MFMER | slide-10
Hospital Accreditation
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-4
Principles of Quality Assurance
bull Focus on the needs of the users
bull Focus on processes to increase the productivity of work
bull Use data to improve services
bull Use teams to improve quality
bull Improve communication
SLMTA Core Improvement Values
Citation
copy2014 MFMER | slide-5
SLMTA Core Components What makes SLMTA work
bull Task-based curriculum ndash focused on the desired behaviorsstandards
bull Hands-onActivity-basedInteractive curriculum delivery
bull Multiple workshops ndash dividing important content into smaller digestible sessions
bull Assigned improvement projects between workshops - implementation with accountability
bull Site visits for mentoring and coaching
bull Using an established checkliststandards for pre-and post assessment
copy2014 MFMER | slide-6
SLMTA Process Mapping
copy2014 MFMER | slide-7
Patient
Arrival
CA Prep LPN
Prep Review pt
info
Lab
Treatment Obtain
prescription
Post visit
follow-up
Pharmacy
Patient
Departure
Wait Time
Process Time
95 80 70 70 85 65
Input
pt info
Order
tests
Diagnose
Orders
Obtain
meds Call pt
10min 3min 20min 30min 40min 15min
7min 1min 55min 45min 45min 10min
First Time Quality
Data Box
Process Box
I I I I I I
DATA BOX - Total Process
Minutes Hours
Total Wait Time (WT)
Total Process Time (PT)
Total Lead Time (LT)
Value Added Percent
First Time Quality
163
118
281
272
197
468
42
20
I I
1 1 1 1 1 1
First Time Quality
Process Times
Wait Times
Information
Pull
System
Patient
Customer
Flow Queuing
Inventory PUSH
System
Information
Flow
Summary
Process Data Value Stream Mapping
copy2014 MFMER | slide-8
Value Stream Mapping V = QC
Registration Physicianrsquos Office
Laboratory X-ray Pharmacy
copy2014 MFMER | slide-9
copy2014 MFMER | slide-9
The Needs of the Patient Come Firsthellip
copy2014 MFMER | slide-10
Hospital Accreditation
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-5
SLMTA Core Components What makes SLMTA work
bull Task-based curriculum ndash focused on the desired behaviorsstandards
bull Hands-onActivity-basedInteractive curriculum delivery
bull Multiple workshops ndash dividing important content into smaller digestible sessions
bull Assigned improvement projects between workshops - implementation with accountability
bull Site visits for mentoring and coaching
bull Using an established checkliststandards for pre-and post assessment
copy2014 MFMER | slide-6
SLMTA Process Mapping
copy2014 MFMER | slide-7
Patient
Arrival
CA Prep LPN
Prep Review pt
info
Lab
Treatment Obtain
prescription
Post visit
follow-up
Pharmacy
Patient
Departure
Wait Time
Process Time
95 80 70 70 85 65
Input
pt info
Order
tests
Diagnose
Orders
Obtain
meds Call pt
10min 3min 20min 30min 40min 15min
7min 1min 55min 45min 45min 10min
First Time Quality
Data Box
Process Box
I I I I I I
DATA BOX - Total Process
Minutes Hours
Total Wait Time (WT)
Total Process Time (PT)
Total Lead Time (LT)
Value Added Percent
First Time Quality
163
118
281
272
197
468
42
20
I I
1 1 1 1 1 1
First Time Quality
Process Times
Wait Times
Information
Pull
System
Patient
Customer
Flow Queuing
Inventory PUSH
System
Information
Flow
Summary
Process Data Value Stream Mapping
copy2014 MFMER | slide-8
Value Stream Mapping V = QC
Registration Physicianrsquos Office
Laboratory X-ray Pharmacy
copy2014 MFMER | slide-9
copy2014 MFMER | slide-9
The Needs of the Patient Come Firsthellip
copy2014 MFMER | slide-10
Hospital Accreditation
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-6
SLMTA Process Mapping
copy2014 MFMER | slide-7
Patient
Arrival
CA Prep LPN
Prep Review pt
info
Lab
Treatment Obtain
prescription
Post visit
follow-up
Pharmacy
Patient
Departure
Wait Time
Process Time
95 80 70 70 85 65
Input
pt info
Order
tests
Diagnose
Orders
Obtain
meds Call pt
10min 3min 20min 30min 40min 15min
7min 1min 55min 45min 45min 10min
First Time Quality
Data Box
Process Box
I I I I I I
DATA BOX - Total Process
Minutes Hours
Total Wait Time (WT)
Total Process Time (PT)
Total Lead Time (LT)
Value Added Percent
First Time Quality
163
118
281
272
197
468
42
20
I I
1 1 1 1 1 1
First Time Quality
Process Times
Wait Times
Information
Pull
System
Patient
Customer
Flow Queuing
Inventory PUSH
System
Information
Flow
Summary
Process Data Value Stream Mapping
copy2014 MFMER | slide-8
Value Stream Mapping V = QC
Registration Physicianrsquos Office
Laboratory X-ray Pharmacy
copy2014 MFMER | slide-9
copy2014 MFMER | slide-9
The Needs of the Patient Come Firsthellip
copy2014 MFMER | slide-10
Hospital Accreditation
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-7
Patient
Arrival
CA Prep LPN
Prep Review pt
info
Lab
Treatment Obtain
prescription
Post visit
follow-up
Pharmacy
Patient
Departure
Wait Time
Process Time
95 80 70 70 85 65
Input
pt info
Order
tests
Diagnose
Orders
Obtain
meds Call pt
10min 3min 20min 30min 40min 15min
7min 1min 55min 45min 45min 10min
First Time Quality
Data Box
Process Box
I I I I I I
DATA BOX - Total Process
Minutes Hours
Total Wait Time (WT)
Total Process Time (PT)
Total Lead Time (LT)
Value Added Percent
First Time Quality
163
118
281
272
197
468
42
20
I I
1 1 1 1 1 1
First Time Quality
Process Times
Wait Times
Information
Pull
System
Patient
Customer
Flow Queuing
Inventory PUSH
System
Information
Flow
Summary
Process Data Value Stream Mapping
copy2014 MFMER | slide-8
Value Stream Mapping V = QC
Registration Physicianrsquos Office
Laboratory X-ray Pharmacy
copy2014 MFMER | slide-9
copy2014 MFMER | slide-9
The Needs of the Patient Come Firsthellip
copy2014 MFMER | slide-10
Hospital Accreditation
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-8
Value Stream Mapping V = QC
Registration Physicianrsquos Office
Laboratory X-ray Pharmacy
copy2014 MFMER | slide-9
copy2014 MFMER | slide-9
The Needs of the Patient Come Firsthellip
copy2014 MFMER | slide-10
Hospital Accreditation
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-9
copy2014 MFMER | slide-9
The Needs of the Patient Come Firsthellip
copy2014 MFMER | slide-10
Hospital Accreditation
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-10
Hospital Accreditation
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-11
What Why bull Quality Improvement (82)
bull Commercial Carrots
bull Marketing (50)
bull Preferential Funding (41)
bull Medical Tourism (27)
bull Regulatory Sticks
bull Government Policy (53) Legislation (34)
bull Reduced Inspection (11)
bull Accreditation Programs
bull Promote Improvement
bull Apply Standards
bull Provide Feedback
Shaw C et al Profiling Healthcare Accreditation Organizations An international
survey International Journal for Quality in Health Care 2013 Vol 25 No 3
pp 222ndash231
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-12
EGYPT Why they started
bull ldquohellipCreate a self-sustaining culture of improvement in health carehelliprdquo
bull ldquoSystematic Process for monitoring amp improvingrdquo
bull ldquohellipEfforts to improve the delivery of healthcare services including standards development and implementation use of clinical guidelines and development of quality improvement systems must encompass the full spectrum of health care delivery systems Health care is a continuum and patients move back and forthhelliprdquo
Rafeh Nadwa Schwark Thomas Developing and Implementing an Accreditation
Program in Egypt (USAID) 2006
httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-13
Accrediting Organizations
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-14
ISQua Accredits the Accreditorsrsquo
Standards
Organisations
Surveyor training programmes
httpwwwisquaorg
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-15
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-16
African Hospitals Currently Internationally Accredited (35) ndash COHSASA (33) amp JCI (2)
South Africa 25
Botswana 2
Namibia 1
Nigeria 4
Rwanda 1
Lesotho 1 Kenya 1
httpwwwjointcommissioninternationalorg
httpwwwcohsasacoza
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-17
Accrediting Bodies
International
bull COHSASA
bull Joint Commission International
bull ISO 9001 Quality Management System
bull Kenya ndash KENAS
bull South Africa - SANAS
National
bull Egypt
bull East Africa
bull Tanzania
bull Kenya
bull Uganda
bull Rwanda
bull Ethiopia
bull West Africa
bull Ghana
bull Liberia
bull South Africa
bull Zambia
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-18
Accreditation Systems - Mechanics
What did they do How well did it work
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-19
EGYPT
bull National Accreditation Board ndash Develop Organizational Structure
bull Build Capacity for QI
bull Training of Surveyors Training curriculum Certification
bull Test (5-Hospital Pilot)Develop Hospital Accreditation Standards (700 standards ndash Critical Core amp Non-Core)
bull Revision of PHC standards
Rafeh Nadwa Schwark Thomas Developing and Implementing an
Accreditation Program in Egypt (USAID)
2006httpindexmedicusafrowhointiahfulltextaccreditationpdf
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-20
Ethiopia
bull Federal Ministry of Health (FMOH) Medical Service Directorate (MSD)ndash improving quality of all service levels (May 2010)
bull 128 Hospitals
bull Performance monitoring amp improvement framework bull KPIs bull Supportive supervisory visits bull Regional review meetings bull National Review meetings
bull MHA Program ndash (24 hospitals 86 standards assessed)
bull Tools bull Manual bull Database ndash hospital amp regional
Ethiopian Hospital Alliance for Quality (EHAQ)
httpwwwmohgovethospital-reform
Kebede S et al Educating leaders in hospital management
A pre-post study in Ethiopian Hospitals Global Public Health
Vol 7 No 2 February 2012 1641113088174
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-21
Liberia ndash Basic Package of Health Services (BPHS) Accreditation
bull Government Ownership - Mandatory
bull DevelopDefineCommunicate Standards ndash CHAIYale ndash 9 Assessment Categories
bull Branding Accreditation
bull Engagement of stakeholders - key MOHSW officials involved in policies amp procedures of implementation
bull Implementation logistics - information technologies - data capture and analysis
bull Assessments conducted by professional peers
Cleveland E et al Introducing health facility accreditation in
Liberia Global Public Health Vol 6 No 3 April 2011 2711113088282
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-22
East Africa ndash Emergence of Accreditation
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-23
Other National Programs
bull Rwanda ndash Performance Based Financing (PBF)
bull Zambia ndash Donor funded (USAID) Now suspended for lack of funds
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-24
Ghana
bull National Health Insurance Scheme (NHIS)
National Health Insurance Scheme (NHIS)
httpwwwnhisgovghactivitiesaspx
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-25
Hospital Accreditation
Lessons Learned
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-26
EGYPT Lessons
bull Success is entirely dependent on the commitment amp support of the Hospital Director ndash single most important factor
bull Incentives ndash Internal amp based on desire to improve
bull Test Pilot valuable
bull Credibility of the accreditation program highly dependent on the quality of the surveyors
bull Role of Teaching Hospitals critical
bull Significant effort amp political support needed
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-27
East Africa Lessons
bull Effective Sustainable amp Impartial Administrative systems critical
bull Self-funding mechanisms are critical to long-term success
bull Accreditation program independent of the MOH
bull International Accrediting programs cost prohibitive
bull National health insurance plan ndash requiring facilities to be accredited by a local independent accrediting body
bull Financial incentives to highly performing hospitals
bull Potential hazard of public authorities overseeing accreditation programs - Kenya amp Tanzania
Lane J etal The Emergence of Hospital Accreditation Programs in East Africa
Lessons from Uganda Kenya and Tanzania Global Journal of Medicine and
Public Health 2014 3(2) 1-10 httpwwwgjmedphorguploadsO9-Vo3No2pdf
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-28
Improving health system quality in low- and middle-income countries that are expanding health coverage A framework for insurance
Institute for Healthcare Improvement (IHI)
Mate K et al International Journal for Quality in Health Care
2013 Volume 25 Number 5 pp 497ndash504
Develop a conceptual framework for
insurance-driven quality improvements in
health care
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-29
Hospital Accreditation in Africa Current State
bull 35 Hospitals internationally accredited
bull Literature shares structures models funding mechanisms for national accreditation
bull National accreditation schemes vary
bull No single agreed-upon set of standards
bull Funding a major concern for sustainability
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-30
Case Studies
Dream of a Future State
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-31
Buea Hospital
0
1
2
3
4
5
6
Wait Times (Hours) Still Birth Rate () Maternal Infection Rate ()
Buea Hospital Improvements ndash Decreasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-32
0
10
20
30
40
50
60
70
80
Functioning PublicToilets ()
Staff Awareness () Patient Satisfaction()
Revenue (X10 7FCFA)
Buea Hospital Improvements ndash Increasing Metrics
BEFORE
AFTER
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-33
SLMTA Results - Bamenda
NKWAWIR S BATUMANI N MURATA T AWASOM C From grass to grace How SLMTA revolutionized the Bamenda Regional Hospital Laboratory in Cameroon African Journal of Laboratory Medicine North America 3 nov 2014 Available at lthttpwwwajlmonlineorgindexphpajlmarticleview203gt Date accessed 29 Nov 2014
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-34
Bamenda Hospital
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-35
Labor Room Theatre
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-36
Labor Room Theatre
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-37
Public Toilets
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-38
Dust Bins
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-39
Call to Action
bull What are your long-term goals in relation to hospital accreditation
bull Where will we go from here
bull What standards would we adopt
bull Who would be involved in the efforts
bull What will we do by
bull next Tuesday
bull next month
bull next year
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion
copy2014 MFMER | slide-40 copy2014 MFMER | slide-40
Questions amp Discussion