Introduction of Accreditation Process of Australian Council on Healthcare International

            Accreditation is part of Australia’s healthcare quality and safety framework. The Evaluation and Quality Improvement Program (EQuIP) of the Australian Council on Healthcare Standards (ACHS) is a key element in the effort to establish high levels of quality and safety. This paper evaluates the Australian Commission on Safety and Quality in Health Care (the Commission) to determine whether the patient journey accreditation survey method is better than the usual method of surveying and whether and the extent to which, the patient journey survey method adds value to the existing survey method. The patient journey methodology, a specific type of methodology based on tracer techniques, is tested as an accreditation method for a 70 years old female patient who is undergoing hip replacement. The patient journey method is effective for assessing clinical standards but less so for assessing corporate or support standards. Feedback collected from staff, surveyors and patients participating in the patient journey survey indicated that the majority believed the patient journey method added value to accreditation processes. The patient journey methodology has utility as a quality improvement tool, and participating stakeholders indicated that it could be usefully adopted in a range of circumstances.

ACHSI Accreditation Process for Hospitals of Accreditation Process of Australian Council on Healthcare International

        Internationally, accreditation is receiving attention from policymakers, regulators, managers, clinicians and consumers to realise its potential and improve its reach and effectiveness. The Commission’s Alternative Model for Accreditation, released in February 2008, noted that patient journey methodologies were a potential mechanism to support accreditation reform and that this was one option in a suite of potential on-site survey tools. The Commission agreed to pilot patient journey methodologies and evaluate the outcome of these pilots before considering moves to incorporate them in Australian accreditation processes. Piloting of patient journeys in accreditation was undertaken by ACHS under contract with the Commission, with the Centre as academic advisor and methodological and statistical consultant, commencing on 8 October 2008 (ACHS, 2918). To achieve accreditation, we had to conduct a self-assessment and provide evidence against nine standards and 29 criteria to the ACHS surveyors, demonstrating we have robust policies, procedures, systems and frameworks in place that are continually reviewed for quality improvement. This ensures we provide safe health services and high standard, clinically robust information to Australian health consumers (Australian Council on Healthcare Standards, 2009).

        Since the introduction of the internet and the rapid uptake of social media, the amount of health content available to consumers has grown exponentially. This makes it increasingly difficult for people to know when online health information is factual, fake or misleading. In achieving ACHS Accreditation, people using the services we provide on behalf of the governments of Australia can rest assured they are clinically safe and the health information and advice offered is credible and accurate. Formed in 2006 by the Council of Australian Governments (COAG), Healthdirect Australia has evolved from procuring and managing a single telephone triage service to being an industry leader in providing quality, accessible, remotely delivered health and related services. As our services expanded to include a digital multi-channel approach, a rigorous governance framework and robust policies and procedures were implemented ensuring the highest levels of data security and privacy. Our government shareholders can be confident we manage and mitigate service risks effectively, giving them peace of mind that a reputable, reliable and credible organisation is delivering and managing services on their behalf. Healthdirect Australia’s Information Partners can leverage our Accreditation status to strengthen their own reputation. To become an official information partner of Healthdirect Australia, organisations must first be assessed against our comprehensive clinical governance framework before we link to them as a trusted source of health information (Australian Government, 2018).

        EQuIP is the Evaluation and Quality Improvement Program developed and conducted by the Australian Council on Healthcare Standards (ACHS). It is a framework for managing health services to ensure quality and safe care and services and for achieving quality improvement. EQuIP was developed for use by Australian health services in 1996. The ACHS Evaluation and Quality Improvement Program (EQuIP) is a four-year quality assessment and improvement program developed to stimulate organisations and health services to work towards excellence in patient care. If this is achieved, accreditation will follow. It is designed to assist and support organisations and health services in their quality improvement efforts (Australian Council on Healthcare Standards, 2009).

ACHSI vs JCI Accreditation Process of Accreditation Process of Australian Council on Healthcare International

        The ACHSI accreditation meets the standards of JCI (Joint Commission International) accreditation. Both of the accreditations provide a clear, transparent, and consistent accreditation or certification and post survey compliance process to render a final accreditation/certification decision based on the approved decision rules. The final accreditation/certification decision is based on an organization’s compliance with Joint Commission International (JCI) standards. Organizations do not receive a numeric score as part of the final accreditation/certification decision. When an organization successfully meets the JCI requirements, it will be awarded an accreditation decision of Accredited or certification decision of Certified. This decision indicates that an organization is in compliance with all applicable standards and International Patient Safety Goals (IPSGs) at the time of the initial or triennial full survey or at the conclusion of a Focused Survey conducted within 120 days subsequent to the initial or triennial full survey (JCI, 2015).

            An accreditation/certification award is valid for three years unless revoked by JCI Accreditation. The award is retroactively effective on the first day after JCI completes the organization’s initial or triennial full survey or, first day after JCI completes a focused survey, if required subsequent to the initial or triennial full survey. An organization’s accreditation/certification is not automatically renewed after three years. Rather, an organization seeking to continue its accreditation/certification must again undergo a full accreditation/certification survey, resolve any follow-up conditions, and found to be in compliance with the standards and IPSGs. After an organization receives an Accredited or Certified decision, JCI Accreditation requests the organization to complete a Strategic Improvement Plan (SIP) for all Not Met and for selected Partially Met findings that could impact patient safety and quality. The SIP is due within 45 days of receiving the Official Survey Findings Report. JCI Accreditation reviews and accepts the plan; if the plan is not accepted, the organization has another 30 days to resubmit an acceptable plan; when the second SIP submission is not accepted, the organization is assigned at Risk for Denial of Accreditation/Certification classification and scheduled for a focused survey (see Focused Survey Policy). If an acceptable SIP is not submitted by 120 days JCI Accreditation recommends to the Accreditation Committee that the organization’s accreditation/certification be withdrawn (see At Risk for Denial of Accreditation/Certification Policy) (JCI, 2015).

Tracer Methodology of Accreditation Process of Australian Council on Healthcare International

        This section presents the accreditation process for ACHSI by using the tracer methodology for a 70 years old female patient who is undergoing hip replacement. Approximately 20,000 primary total hip replacements are performed in Australia. Each hip prosthesis is made up of several components. The acetabular component replaces the acetabulum (socket). The acetabular component is typically made of a metal alloy outer shell with a fitted plastic (polyethylene) or ceramic liner or it can be made completely of one polyethylene component. The femoral component replaces the femoral head. The femoral component is typically a two-piece design. This comprises the femoral stem made of a metal alloy and the femoral head that attaches to the stem. The femoral head can be made of either ceramic or metal alloy.

Assessment of patient:

        after consultation, doctor will take a history and examines the hip and relevant x-rays during her initial consultation. Dr discusses the diagnosis, non-operative and operative options of treatment. Generally, dr. discusses total hip replacement surgery if the lady had failed to improve with non-operative measures. Non operative measures include taking painkillers or anti-inflammatories or using physical aids like a walking stick. Dr. decides on the type surgical approach (anterior minimally invasive muscle sparing or mini posterior approach) and the implants for your hip replacement and he explains the risks and benefits of the operation in understandable language to patient. A pre-operative assessment is then undertaken by one of physicians and any significant health problems are corrected as far as possible before the hip replacement (Singh, 2018).

        Anesthesia and surgical care: Anesthetics contacts the patient either prior to the surgery or on the day of surgery to discuss the best type of anesthetic for patient. Depending on the time day the surgery is to be undertaken determines the time patient stop eating and drinking to ensure a safe anesthetic. Generally, the patient is advised no food or drink 6 hours prior to your surgery.

Patient and family rights:

            Patients and legal representatives for patients have the right to be protected from and free of real or perceived verbal, mental, sexual and physical abuse including injuries of unknown source, neglect, exploitation, harassment and misappropriation of property by anyone, including staff, students, volunteers or family members. Any allegations shall be evaluated, resolved timely, and if necessary reported according to law and regulation. Patient and family is informed that there are exceptions to informed consent that can include: mandated reporting by law and regulation of neglect and abuse, or reporting of communicable diseases. Patient and family are provided for a legal representative to give informed consent, and respect a legal representative’s decision to refuse care, treatment or services. All patients’ rights apply to the person who has legal responsibility to make decisions regarding medical care. Assuring that the patient, legal representative, family or patient designated representative (when chosen) will be informed about the patient’s medical condition, changes in the assessment or plan of care in order to understand and fully participate in the care. Hospital formulate advance directives. This includes designating a decision maker if you become incapable of understanding a proposed treatment or become unable to communicate your wishes regarding care. Patient or family can make complaints regarding treatment or services that have been provided or failed to be provided and the lack of respect for property or person by anyone providing HomeCare services or on behalf of HomeCare without fear of discrimination, reprisals, or unreasonable interruption of services. Patient and family are advised of federally and state-funded advocacy agencies that serve the county where the patient resides (Rady Children's Hospital-San Diego, 2018).

Prevention and control of infection:

         to reduce the risk of infection dr. prescribes antibiotics for patient to take at the time of her surgery and also two post-operative doses of antibiotics 8 and 16 hours after her surgery. Dislocation is most likely to occur in the first 6 weeks after patient surgery and may need another procedure to treat this. Patient is advised of hip precautions to take by her physiotherapist to reduce the risk

        Facility management and safety: hospital organizes a post-operative wound review approximately 10-14 days following your surgery. Dr.  will inspect patient’s wound during this appointment and remove stiches or staples. This will be an opportunity for patient to ask any further questions. A further appointment will be organized for patient at approximately 6-8 weeks later to assess your progress. Generally, patient is likely to be walking with either one or no sticks at this stage and safe to return to work and driving. She is advised to avoid stairs and told that her hip replacement will continue to heal over the course of the next 12 -18 months and Dr. will organize to see patient at 6 months and 12 months after her surgery. At these appointments, hospital will organize x-rays to assess how the bony is attaching to the components inserted into her hip. Dr. recommends working closely with an experienced physiotherapist will facilitate her rehabilitations and improve her confidence and strength back in her hip. Patients will vary how much time they will spend in hospital and the speed at which they achieve their milestones in the recovery pathway for a total hip replacement. Dr. however, generally recommends early mobilization to help reduce complications of sitting in bed.

Conclusion on Accreditation Process of Australian Council on Healthcare International

            In a nutshell, accreditation is a public recognition by a health care accreditation body of the achievement of accreditation standards by a health care organization, demonstrated through an independent external peer review assessment of that organization’s level of performance in relation to specific standards. The Australian Council on Healthcare Standards International (ACHSI) provides a range of accreditation services focused on the specific needs of each organization, utilizing internationally recognized standards that are focused on the key attributes of a health care organization that is committed to the concept of continuous quality improvement. The principles upon which the ACHSI programs are developed reflect the characteristics displayed by an improving organisation including: a consumer focus in care and service provision; effective leadership; continuous improvement; evidence of outcomes, and striving for best practice. The patient journey method is effective for assessing clinical standards. The key value of the method appears to be that it provides a more direct consumer perspective of an organization’s performance than the traditional accreditation survey method.