I worked in health care for 35 years and during that time firmly believed in the value of accreditation for hospitals. I worked hard to ensure the hospitals I was connected with over the years were accredited. I experienced the process from the point of view of a provider, but not a patient. When I look back, I realize that a large part of the process was looking at paper records and ensuring that certain standards were met. Recent experiences make me wonder whether accreditation puts enough emphasis on communication with patients. I also wonder why patients cannot see the results of their hospital’s accreditation review.
In July of 2011, I had prostate cancer surgery in an accredited teaching hospital and thus experienced the value of accreditation from the patient perspective. The nursing care was very good and certainly met standards. The surgery went well and I am happy to report that all the cancer was removed. However, the follow up medical treatment was non-existent.
The surgeon never spoke to me during rounds; never asked how I was or if I had any questions. Apparently there was a resident on the unit, but they never darkened the door of my room. The surgeon did make rounds and spoke to two of the patients in my room, but after speaking to one patient in a low voice, he said to me through the drawn curtain: “I trust you heard that because the same applies to you.” He did not hear my response that I had not heard what was said. One of the medical students who was with him did see me respond in the negative, but just shrugged his shoulders and smirked. Here I was in an accredited teaching hospital with the surgeon and two medical students in the room but, from my perspective, if had I had a cardiac arrest it would have gone unnoticed, as none of them came within three feet of my bed or seemed to care how I was.
After discharge, I got a copy of my health record. The surgical report no doubt met all the requirements of reporting on the standard procedure. On paper, I received excellent care. If an accreditor reviewed my file, he or she would not be able to tell how I was treated on that ward.
I know accreditors speak to some patients when they visit a hospital, but are they seeing enough to really get a sense of what the patient experience is like? If patient experience is bad, is that enough to tip the balance on whether or not a hospital gets accredited? If a patient has a problem, why do they speak to someone at the hospital and not the accreditation agency? And hospitals always know when they are going to be accredited, giving them the chance to gear up beforehand – are the standards maintained during the 2 to 3 years between accreditations?
Did the fact that the hospital was accredited ensure quality care? To me it did not. After the surgery I basically did not exist as far as the medical treatment team was concerned. While I continue to support the need to ensure our hospitals are providing quality care, I believe our accreditation process may not be putting enough emphasis on the most important thing in healthcare: the patient.
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Thank you for your comments Neall. As President and CEO of Accreditation Canada, I am pleased to provide a response to the important questions and comments you have raised.
First of all, our accreditation program (Qmentum) has gone through a major change since 2008. Our surveyors rarely sit in rooms interviewing teams or extensively reviewing paper records. The emphasis during the on-site survey is on ‘tracing’ the client/patient experience in the health care organization. The surveyors will actually ‘walk through’ the patient experience in the emergency department, in the OR and so on, questionning and observing throughout. The surveyors speak with staff and patients / families and many others throughout the entire survey visit. The new approach has significantly improved our ability to assess the degree to which the standards are met and the quality of care provided – both gaps and strengths.
Secondly, the new process is designed to enable the organizations to utilize the standards on an ongoing basis, not solely in preparation for the survey visit.
Thirdly, up until recently, our standards expected organizations to conduct patient satisfaction surveys (to have mechanisms to obtain feedback) however, as of this year, it is now a ‘requirement’ within acute care hospitals to conduct ‘client experience’ surveys, using the results to make improvements. You asked whether one negative patient experience will result in losing acreditation status, the answer is no. However if there is evidence of a trend of negative experiences within the program / hospital, clearly the surveyors would be very concerned and look to understanding the problem resulting in recommendations for action within the survey report.
Finally, when you say ‘did the fact that the hospital was accredited ensure quality care?’ – accreditation is not a guarantee. What it does show is a commitment to improving the quality of care; to applying national standards of quality care based on evidence. There is no guarantee that problems will not arise however if they do arise, the organization should identify those and effectively take action to address those. If care in a health care organization is deteriorating, there are a number of signals that will show this, complementing comments from patients and families.
I agree with you 100% that the focus must be on the patient. Barb in a preceding reply speaks eloquently to this.
Accreditation Canada encourages transparency and organizations are encouraged to post their survey report on their website. You may wish to check the website of the hospital within which you had your surgery. An increasing number of health care organizations are doing this.
When negative experiences such as yours occur I encourage that the individual report this negative experience to the appropriate authority within the health care organization. If there is an absence of response or inadequate response, there are further steps that can be taken, depending on the nature of the organization and the province/territory. It is important that the health care providers and decision-makers receive feedback in order to make improvements.
Wendy
Thank you Neall. What insight you have! I was recently asked to speak at a conference from the patient perspective on the topic of whether accreditation reports should be made public.
After researching this topic I was impressed by a few discoveries and reflections.
Firstly, I was amazed by the fact that many countries make their accreditation reports public. Transparency is a good form of accountability, something that is sorely lacking, in my view.
Secondly, I realized that there is enormous potential to improve safety through the accreditation system IF patients are involved at the outset and throughout the process, including the surveying. Neall, you make a great point when you described your changed perspective after having been a patient. You clearly saw accreditation through a new lens compared to when you were part of the system. This, I believe, is exactly why patients need to be involved. I appreciate that those involved in Accreditation Canada work diligently to create safe systems but despite their efforts, they might not see some things that a patient would. (By the way, Accreditation Canada has started to include patients)
Finally, in patient safety, we understand that errors are commonly attributed to the system. When patients are injured, they and their families are asked to understand and accept that it is not the fault of the nurse or doctor but the system. Yet, if the patient/family asks how they can be assured of the development of a safe system, they must accept that accreditation standards are not readily available to the public and whether or not their hospital has complied with the standards is none of their business. In my opinion, that is not acceptable.
Including patients in all areas of accreditation in which they are capable and making accreditation reports public can only make for a better, safer system for everyone.
Here are two links to NHS which regulates hospitals. http://www.cqc.org.uk/
http://archive.cqc.org.uk/_db/_documents/CQC_Choice_A5_Leaflet_TAGGED.pdf
I certainly cannot comment on the experience of the initiator of this debate, as I know nothing about the hospital accreditation process. As a Multiple Sclerosis patient, I do know first hand what it is like to experience proper health care as I am no neophyte in the area of visiting hospitals and clinics.
First, I think that patient-centred care is the only way to go. Without patients, health care would not exist. Rather than being treated as a “client”, I prefer to be treated as a person first and foremost.
Second, when launching a complaint through the health care system, it is unfathomable that a said doctor would receive a copy of my complaint, with my name, and the full details of my complaint. I recently contacted a hospital complaint department, and this is the information that was given me. I therefore did not follow through with the complaint, as this would have further ramifications on the health care I would receive in the future. I just stopped frequenting the MS clinic where I would go for follow-up. Surprisingly, I’ve never received a call, a letter or an e-mail from my neurologist or the MS nurse; not that that really matters either way.
Third, internal investigations should be less obvious when a hospital is undergoing an accreditation review. We all know that if left in the hands of the administrators, they will cherry-pick the results that they want to. I guess that’s just human nature.
That’s my opinion and experiences in health-care, for whatever they are worth.