4dventisti# Healtht TsuenWan AdventlstHospltal trE*rH accreditation Trent andJCIhospital Whatfor?Andwhyboth? Report by Conference FHAM WONG Yat-cheung, MDFRCP Dr.Charles (TAS) TrentAccreditation Scheme* a recentinternational ThisarticleshareswhatI leamtfromchairing is reading.Merging thesetwosources frombackground in addition to whatwasdiscovered conference, purely personal representative and not of My views are to make this article comprehensible. essential perspective Adventist Health to theupbeat lt provides different Health(AH)or anyof itshospitals. Adventist "Return Newsletter totheBasics". Commission Intemational.*) June2007JCI(Joint Attribute of Photo: onhisleft,withtheTASTeam,and & Hospital withMsManbo MANof HKSanatorium Dr.Charles WONG, fromthePhilipines twoparticipants knowledge on TASandJCIAccreditation Limitof my personal Hospital TsuenWanAdventist to helping waslimited accreditation on hospital In the past,my knowledge surveys.This at the timeof accreditation (TWAH)paediatrics andattendance servicein its preparation therefore not that I was its chairman opportunity to learn. lt wasfortunate was an excellent conference into byresearching formeto prepare reqiiired to deliveranypearlsof wisdom.Evenso,it wasonlyprudent thesubject. . "Garingfor Patients Borders- Doingit wellandlettingpeople acrossInternational TheConference University. Management knowyoudoit well"on 14thJuly1007attheSingapore tooktheleadfortheTASteam. England, fromSheffield, Disease Consultant SteveGreen,Infectious Professor Otherswerefromthe wasfromSingapore. The largestcontingent aftended. 30 participants Roughly of TwowerefromHongKong(HK),MsManboMAN,Director BruneiandMacao. Thailand, Philippiires, were Many aftendants TWAH. (HKS&H), me from lhe and & Hospital fortheHKSanatorium Service Nursing of withvarious aspects papers position. weremainlyconnected Presenled seniornursesin management "selling' medical local medical treatment, visitors to receive in overseas to bring meaning "medical tourism", clients. tooverseas service bybothTASandJCl,may beingaretheonlyonescertified Theuniquefeatureof AH,thatitstwohospitals metochairtheConference. thatTASinvited havebeenthereason requirement andstatutory HongKongprivatehospitalaccreditation private hospitals, usingitsown andlicense to inspect is responsible Department of Health Thegovernment HongKong for legal requirement in time,HongKonghasno Atthismoment standards. setof un-published accreditation suchasJCIorTAS.Withnosuchstatutory privatehospitals anyformbf independent to undergo ofTASandJCIaccreditation. flagellation Health's double Adventist manyhavequeried requirement, accreditation ,, fe" of HongKongprivatehospital Historical background aT{"-*'E',^&"5 the suffered & Hospital According to MsManboMAN,priorto 2000aroundthetimethattheHKS{natorium and private lacking supervision were hospit{b HK unit,localmediaalleged its renaldialysis accident-at introduced providing standards.. -Sir Dr.HarryFANG,bfSt.Paul'sHospital consistent carewithout dccrediiation the Trent f6r choosing One reason partty criticisms. to rebuff thbse asa tool TASfromtheUK tosuitthe TASstandards to modify established hospitals toworkwithHKprivate wasitswillingness Scheme HKprivatehospitals, amongst ofaffordability Furthermore, duetothelargevariation localHongKongsituation. UK basedsurveyors pocket Most of the only. foroutof expenses TASagreedto chargeHKprivatehospitals body. a nonprofitmaking time.TASremains comelo HKusingtheirownvacation costoftheaccreditation shared hospitals in2000byTAS.Allprivate wereaccredited hospitals All12private for specifically evolved of standards effort, a set with this process, Conlinuing incostcontainment. resulting and reviewed to be continue Thesestandards UKTASstandards. fromestablished HongKong,adapted theTAS into account taking members, private two committee each supplying hospitals revisld,withHK Board's inout.. Hong thatgavebirthto theofficial hospitals wastheimpetus of allprivate m-operation Thisunprecedented atthis attendants thatinternational I amdelighted to report Incidentally, Association. Hospitals KongPrivate co-operation solidarity and and the of this organisation, very existance the admired unreservedly conference within. tourismfor HongKong Medical tourism of notein HK. thatthereis stillnomedical I toldtheaudience to theConference, At myintroduction I issuealtogether. Chinagivingbirthin HongKongis a different frommainland Theiunentfloodof molhers patient coinsurance co-payment, oveBeas costsupersedes service believe thatas longas HKmedical fromwealthy cover,patients insurance needto paydespitemedical payment beingtheahortfallthatpatients tourism. tocometo HKformedical areunlikely countries litigation tourismandnegligence Medical lhat most - MedicalProtection told the Conference Society(MPS)representative DoctorsBEWARE a USor Should occurred. likelylitigationwill start in the countrywherethe allegednegligence thenMPScoverdoesnotapply. citizensuein thecourtsof theusAor canada, canadian negligence of medical thequestion whoanswered solicitor by its localSingapore MpSwasrepresented patients fromabroad, international treating coverfordoctors insurance tourism? medical byJCIor TAShelpedto promote accreditation Hashospital withintheAsiaregion. mstis notcompetitive HKmedical Cunent to suggest;so. No. Thereis noevidence far frombeing"firstworld HK is class, is service world qualityandstandard of medical HongKong's Alihough price edge, - it is"firstworldservice competitive the Without atfirstworldprice". servicjatthirJworldorices" pie, medical tourism international grab very small of the a share to it wouldbefutileforl-iongKongto attempt The body. intemational or notbywhichever is accredited ourhospital oiwhether at leastfornow,irrespeciive price advantage. of because have not come tourist as medical fewwhocometoHongKong body? international byanyindependent, Sowhybotherwithaccredihtion "BothJCIandTrentAccreditation of TWAHputsit succinctly: Officer("COO") Mr.AlexLAN,ChiefOperating from andbestpractices are toolsto imprwequalityof careandpatientsafety.Experience Schemes thequalityofcare aswaysto improve standards intotheaccreditation participating areincorporating hospitals standards." andsafety of its guidingprinciples to beusefulbecause TAScontinues . lt is clinicians. byactivepracticing runonhe basisof peerreview organization TASis a non-profit inexpensive. itself.lt remains to"market" onlynowbeginning . Thereisnowa andmeasures. hospital standards localized tohelpestablish committed TASremains reviewed and being continually to HongKongwhichis thatisspecific andmeasures setof slandards uodated. . in HK's toworkTASoutof itsparticipation is unlikely andmeasure standards ofhospital Localisation between competition of healthy level remains a certain there because surveys accreditation hospital andfaimess. neutrality TASguaranteed whichis-befH bytheindependent hospitals localprivate tu^9",*; Participating for theirout of pocketexpenses. are not paidbut onlyreimbursed TASsurveyors and fortraining expense hospital's theirownstaffat theparticipating to supply arerequired hospitals hospitals. different of equivalence "exchange latter standardize The helps to of examiners". eventual Personal on best practice. "Exchange of knowledge also resultsin exchange of Examiners" for exchange from this potential interests of conflict on this issuetells me that knowledge senseof HKmedical of thegoodcommon because carehavenotoccurred of patient improvement professionals. andnursing withcontinual ownhospitals, at thesurveyors' allyearroundstationed surveyors of trained Presence have local hospitals of different surveyors between contactwiththeTASBoard,andcommunication alike, andhospitals surveyors allparties, benefited notonlyfromtheUKto HK, freshperspective introduces surveyors in byoverseas brought Experience butalsoviceversa. WhyTASas wellas JCI? of June2007didnotreveal JCINewsletter to theBasics" Thorough studyof alleightpagesof theAH"Return Onthisissue,Mr, TAScertification. achieved on JCIafterhavingsuccessfully forembarking the reasons pushed for previous JCIonthebasis administration of the that the CEO explained AlexLAN,COOof TWAH, thanTAS,andalsobetterknownthanTASworldwide.The reasonfor higherstandard thatit demands agreed systemuniversally is thatthe latteris an assessment undergoing bothJCI and TAScertification may hospital pulling by any out of thisagreement andunilateral all HongKongprivatehospitals between private system. accreditation hospital upsetthisSAR-wide TASis UK based,thatAmerican fromthe USAwhereas alsoworthnotingJCI originated It is probably in theUS, hadlivedandworked AH CEO then Hospitals, Adventist two founded the Adventist missionaries in the USA,the Organisation Accredited of a JointCommission thenwasex-staff of Nursing the Director is in the USAandthe list the Churchheadquarter wasthenAmerican, Director lmprovement Performance g o e s0 n. . . . . . of Theprocess is notthecertification. thatthe reasonto gainTASor JCIaccreditation Mr.LANstressed patient and services thehospitals' to improve to bethemechanism is acknowledged accreditation achieving covered have preparation to is likely for JCI TAS, than is more stringent JCI thatsince safety.He reasoned doesnot arise. AH administration certification of redundant thereforethe question TAS requirements, planned for both expansion to the impending will be applicable standards intended that suchimproved processes and of as withany seriousinwardexamination and not surprisingly, hospitals.In practice, safety. service andpatient clinical procedures, is indeedimproved theoutcome JCI forchoosing insurers. Onereason negligence UShospital amongst to TAS,JCIis wellknown Incontrast known are accreditation JCI of the outcomes Some provides standards, measurable veryclearand is thatit thefollowing: Theseinclude to mebyhearsay. ' insurance negligence on hospital 25%discount thattherewillbe an automatic The assumption in theUSA,didnotturnout hospitals accredited Commission) premium, to JACO(Hospital applicable forHK. to beautomatic . g0 downafterinsurers cameto inspect premium costdideventually insurance negligence Hospital passed theirJCIaccreditation. afterthehospitals firsthandforthemselves thehospitals accreditation to achieve of improvement of tellingstaffthattheprocess education extensive Despite noonewantsto beculprit because outbytheJCIsurveypreparation wastheaim,staffwasstressed thatit is a student of telling futility to the is analogous This foraccreditation. forfailinganassessment andtheself is in thelearning thevalueof theexamination scorethatcounts; nottheexamination process thattookplacebeforehand. improvement thatof TAS. fargreater remains inevitably Costof JCIaccreditation include currentlocalHKdevelopment O(herrelevant, . publichospital is usingitsownstandards service, massive HongKong's operating Authority, Hospilal plantogofor Thereis noimmediate andmeasurements. cbupbdwithJCIstandards andmeasures, (hearsay). fullaccreditation independent, formal, . JCI. isalsoaftempting Hospital TheHKBaptist . scheme anAustralian withTAS,butadding continuing accreditation, double iscontemplating HKS&H . toTAScertification. inaddition ISO9000standard haveacquired andUnionHospital BothMatilda onthis moreknowledgeable - Hospital is hereto stay.As HongKongbecomes accreditation FUTURE re'evaluation. continual wanants issue,coshbenefitand in particularduplicatedaccreditation, asthiswill ruinthehardearnedsolidarityof theHongKong BreaiingawayfromTASis unthinkable Hospitals, of Private Association tochairthisC'onference. theautholstripto Singapore suppofted financially TWAH Declaration: of JCI/TAS: summary Overview JCI - http://www.jointcommissioninternational.com/ 23.08.2008 TakenfromJCIwebsite of andquality improve thesafety istocontinuously International "Themission ofJointCommiss:on and services andconsultation ofeducation theprovision through community careintheinternational United in the careorganizations ofhealth accreditor thelargest ......Today accreditation intemational programs a voluntary through health care 20,000 nearly surveys states, theJointcommission corporations." not-for-profit both process. are anditssubsidiary TheJointCommission accreditation for scope institution, JCIstatesitsspecific ofthehealthcare departments note:Fordifferent Author's andMeasureable process Intent intotwosections, theaccreditation andthendivide thatdepartment, Elements. .. TAS - http://www.trentaccreditationscheme.org/ 23.08.2008 Taken fromTASwebsite the fromwithin andmanagers bypractitioners hasbeendeveloped Scheme TheTrentAccreditation evolve to is continuing its users and by andownership credibility capability, ensuring TrentRegion develoo. and Benefits Scheme andproviders staff,commissioners topatients, ofservice thequality o assures ofstandards a benchmark o provides information quality monitoring o provides n o o B of people andorganisations facilitates thedevelopment for change environment a dynamic creates provides networking opportunities contacts. overseas CoreElements o peerreview Board awards byanindependent o accreditation tr newsletter opportunities andnetworking in thescheme andsurveyors tr training eventsforparticipants visits tr pre-survey if desired fortheorganisation tr mentoring process of development a continuous fromthoseof theUnited different note: Healthcare institutions of HongKongareinherently Author's enables the in itsCoreElements TAS'builtinflexibility country. Kingdom, thescheme's originator partners, specific set of evolve a to adapt then its Kong with Hong with continual consultation TAS, standards applicable to HongKong.