Ensuring quality is a very critical component of high‑performing health systems

Ensuring quality is a very critical component of high‑performing health systems. There is a general awakening on this topic throughout the world, which has prompted the need to improve in terms of actual patient care and patient safety, the quality of healthcare (Verma, 2022).
The healthcare facility undergoes an examination of its systems, processes, and performance by peer reviewers or surveyors to ensure that all is conducted in a manner that meets applicable predetermined and published standards (JCI, 2021). Before the external evaluation, i.e., the survey visit, the healthcare facility is expected to conduct a comprehensive self-assessment to decide on the level of its preparedness and how far or how close it is from achieving full compliance with the standards. Accreditation, therefore, represents a public recognition by the healthcare accreditation body of satisfactory achievement of accreditation standards by a healthcare facility(CBAHI, 2018).
Several factors have driven the healthcare sector to implement programs for improving the quality of healthcare services. These factors include healthcare costs, number of adverse events, complexity of new technologies, aging population, and rapid dissemination of transmissible diseases across the globe (Saut et al., 2017).
Benefits of accreditation in healthcare
Preparing for accreditation can be a long, intensive process. It requires collaborating with administrators and leaders to update policies, procedures, and training materials. But accreditation is a worthwhile investment. In the end, achieving accreditation in healthcare can have many important benefits for your organization. The following are benefits for accreditation: Improved quality of care, increased community confidence, better operational efficiency and processes, reduced liability insurance, gain competitive advantage and obtain insights and transparency through external review (PowerDMS, 2020).
Describe the steps and processes you will initiate and implement over a one-year period in preparation:
There are up to seven key steps in the process to become an accredited healthcare organization as following (JCI, 2022);
Step one: undertaking a self-assessment: Healthcare organization will undertaking a thorough self-assessment should support an applicant to be prepared for the next steps in the accreditation process and assist in making an application for accreditation.
Step two: making an initial application: The applicant must be confident of meeting all the accreditation requirements and applications must be made supplying all available information requested.
Step three: desk-based document review by the accreditation body: Once an application has been made to the accreditation body, it will conduct a desk-based documentation review of the information provided. This will include reviewing the policies, procedures and systems that will support the applicant’s delivery of building control functions.
Step four: on-site, pre-assessment meeting: The purpose of the pre-assessment meeting is to discuss the next steps in the accreditation process which involves an initial, on-site full assessment. It provides an opportunity for the accreditation body and the applicant to have a shared understanding of the assessment process.
Step five: initial, on-site full assessment: The accreditation body will undertake an initial, on-site full assessment of the applicant.
Step six: grant of accreditation: After the initial on-site assessment process, and the applicant satisfactorily addressing any non-compliance, the accreditation body will determine whether it is satisfied that the applicant has met the accreditation requirements or there is limitations of scope that might be applied to the applicant.
Step seven: follow up, on-site assessment: The accreditation body may undertake a follow up on-site assessment, within a six-month timeframe of the initial assessment, of an accredited organization.
Include any key personnel and the risk prevention procedures you would be sure to put in place as well as your performance and quality improvement plans:
Improvement work invariably involves work across multiple systems and disciplines within a practice. The quality improvement team or committee is the group of individuals within a practice charged with carrying out improvement efforts. To be effective, the team should include individuals representing all areas of the practice that will be affected by the proposed improvement, as well as patient representatives (AHRQ, 2015). The Institute for Healthcare Improvement (2022) recommends that every team include at least one member who has the following roles :
Clinical leadership: This individual has the authority to test and implement a change and to problem solve issues that arise in this process.
Technical expertise: This individual has deep knowledge of the process or area in question.
Day-to-day leadership: This individual is the lead for the QI team and ensures completion of the team’s tasks, such as data collection and analysis and change implementation.
Project sponsorship: This individual has executive authority and serves as the link to the QI team and the organization’s senior management.
The optimal size of a QI team is between five and eight individuals, although this may vary by practice. The most important requirement is not size, but diversity of the participants. The team needs a diverse group of individuals who have different roles and perspectives on the patient care or other processes under consideration. This group should include whenever possible input from the end user of health care, the patient(AHRQ, 2015) .
Potential members of a QI team might be : Chief executive officer, Medical directors, Physicians, Nursing staff, Physician assistants, Medical assistants, Patient representatives, Operations manager or director, Health educators, Community health workers, Peer mentors, Patients, Community representatives, Directors of clinical services, Practice managers, Medical records staff, Receptionists and Lab technicians (AHRQ, 2015).
The risk prevention procedures:
The healthcare sector is both high-risk and heavily regulated (AHRQ, 2015). If your firm makes a medical error or has a compliance issue, you might be sued for millions of dollars, or perhaps forced to close. To be ready for certification, you need to take a close look at every aspect of your company. This helps you identify potential trouble spots. A lack of compliance can be spotted, or it may be determined that a change in process is required to make a given activity safer. By taking preventative measures, we may reduce the likelihood of errors occurring during our procedures and so improve safety (PowerDMS, 2020).
References
AHRQ. (2015). Primary Care Practice Facilitation Curriculum Module 20: Creating Quality Improvement Teams and QI Plans. https://www.ahrq.gov/sites/default/files/wysiwyg/n…
CBAHI. (2018). About Accreditation. CBAHI. https://portal.cbahi.gov.sa/english/accreditation/…
IHI. (2022). Quality Improvement Team Member Matrix Worksheet | IHI – Institute for Healthcare Improvement. Www.ihi.org. https://www.ihi.org/resources/Pages/Tools/Quality-…
JCI. (2020). Prepare for Accreditation | Joint Commission International. Www.jointcommissioninternational.org. https://www.jointcommissioninternational.org/produ…
JCI. (2021). Hospital Accreditation | Joint Commission International. Www.jointcommissioninternational.org. https://www.jointcommissioninternational.org/accre…
PowerDMS. (2020). Impact of Accreditation on Quality in Healthcare. Www.powerdms.com. https://www.powerdms.com/policy-learning-center/im…
Saut, A. M., Berssaneti, F. T., & Moreno, M. C. (2017). Evaluating the impact of accreditation on Brazilian healthcare organizations: A quantitative study. International Journal for Quality in Health Care, 29(5), 713–721. https://doi.org/10.1093/intqhc/mzx094
Verma, M. (2022). Accreditation of healthcare organizations and its role in improving and maintaining quality patient care. Contemporary Clinical Dentistry, 13(4), 295. https://doi.org/10.4103/ccd.ccd_489_22
this is was question
Assume that you are a Healthcare Quality Specialist at a healthcare facility/organization preparing for an initial Joint Commission International accreditation visit in one year.
Discuss the value that accreditation brings to an organization.
Describe the steps and processes you will initiate and implement over a one-year period in preparation.
Include any key personnel and the risk prevention procedures you would be sure to put in place as well as your performance and quality improvement plans.