Questioning Accreditation’s Role in Ensuring Patient Safety and Quality Care
The premise of accreditation in healthcare, once perceived as a guarantor of quality care and patient safety, is now under scrutiny. Despite hospitals attaining accreditation status, incidents such as the tragic fire at AMRI Hospital in Kolkata which was accredited by NABH India. Ninety-two persons died in the fire at AMRI hospital, Kolkata, on 9 December 2011. This highlight the limitations of accreditation in safeguarding patient safety. These events prompt a re-evaluation of the efficacy of accreditation processes in delivering on their purported objectives.
The Indian Medical association made a submission to the Parliamentary Standing Committee on the BNSS. According to the submission, the IMA reported around 98,000 deaths per year due to medical negligence in contrast with 52 lakh medical negligence cases filed against doctors.28 Dec 2023. A significant numbers complaint against accredited Hospital
Questioning Accreditation’s Role in Ensuring Patient Safety and Quality Care: The global landscape of quality accreditation is witnessing a pivotal shift, marked by the increasing privatization of accreditation bodies. This trend, while offering new opportunities, also presents profound challenges to the core objective of quality assurance in health, safety, and environmental protection. The essence of accreditation, designed to instill confidence in hospital services, is at risk of being overshadowed by commercial motives.
Commercialization Threatens Accreditation Integrity The increasing privatization of accreditation bodies introduces commercial motives that may compromise the integrity of the accreditation process. Hospitals, driven by profit-centric approaches, prioritize accreditation as a marketing tool rather than a means to uphold rigorous quality standards. This profit-driven ethos risks diluting the value of accreditation and eroding public trust in certified healthcare facilities.
Challenges in Compliance and Ethical Practices Compliance with accreditation standards does not always translate to adherence to clinical protocols or ethical practices. Hospitals, motivated by revenue generation, may overlook critical aspects of patient care, leading to instances of medical negligence and unethical behavior. The lack of stringent monitoring and oversight exacerbates these challenges, allowing lapses in compliance to persist unchecked.
The efficacy of accreditation in ensuring patient safety and quality care faces formidable challenges, as highlighted by practical experiences in healthcare settings:
Elaboration of Major Barriers to Accreditation’s Effectiveness:
The efficacy of accreditation in ensuring patient safety and quality care is undermined by several key barriers identified through practical experience:
Failure to Implement Strict Adherence to Clinical Safety Protocols: One major barrier to accreditation effectiveness is the failure of hospitals to implement strict adherence to clinical safety protocols, particularly concerning consultant clinicians and surgeons. In many instances, hospitals prioritize increasing bed occupancy without considering patient welfare, compromising the quality of care provided.
Unethical Practices and Ties with Pharmaceutical Companies: Another significant barrier is the prevalence of unethical practices and ties with pharmaceutical companies within healthcare facilities. Some hospitals engage in unethical relationships with pharmaceutical companies, compromising patient care for profit.
Inadequate Staffing Levels and High Turnover: Inadequate staffing levels and high turnover rates further exacerbate the challenges faced by accredited hospitals. Staff shortages lead to increased workloads and stress, compromising patient safety and the quality of care delivered.
Adoption of Practices to Increase Bed Occupancy: Hospitals often adopt practices to increase bed occupancy without regard for patient welfare. This may include ignoring intensive care admission and discharge criteria in favor of profit interests.
Hiding of Risks and Safety Concerns: There is a tendency among some hospitals to hide risks and safety concerns to maintain accreditation status. This lack of transparency undermines patient trust and compromises the effectiveness of accreditation processes.
Lack of Unbiased Medical and Clinical Audits: The lack of unbiased medical and clinical audits is another barrier to accreditation effectiveness. Some accredited hospitals fail to conduct honest and meticulous audits, leading to lapses in compliance and compromising patient safety.
Inadequate Safety Audits Due to Cost Concerns: Safety audits are often inadequate due to cost concerns. Hospitals may cut corners to save money, compromising patient safety and the quality of care provided.
Hospital-Acquired Infections and Non-Compliance with Antibiotic Policies: Issues related to hospital-acquired infections and non-compliance with antibiotic policies further hinder the effectiveness of accreditation. Hospitals may fail to implement adequate infection control protocols, leading to preventable infections and adverse outcomes.
Lack of Post-Accreditation Monitoring and Control: The absence of post-accreditation monitoring and control by accreditation bodies is a significant barrier. Accredited hospitals may manipulate data and engage in unethical practices without fear of repercussions.
Absence of Monitoring by Healthcare Regulatory Bodies: In some regions, the absence of monitoring by healthcare regulatory bodies exacerbates the challenges faced by accreditation systems. Without oversight from regulatory bodies, hospitals may flout regulations and compromise patient safety.
Withholding of Safety and Negligence Data: Some hospitals withhold safety and negligence data from public scrutiny and accreditation bodies. This lack of transparency undermines the effectiveness of accreditation processes and erodes patient trust.
Lack of a Feedback Mechanism in Accreditation Bodies: The absence of a feedback mechanism in accreditation bodies further compounds the challenges faced by healthcare facilities. Without a mechanism for collecting patient feedback and addressing concerns, hospitals may overlook areas for improvement.
Insufficient Expertise and Monitoring in Accreditation Assessments: The lack of expertise and monitoring in accreditation assessments is a barrier to accreditation effectiveness. Accreditation bodies must ensure that assessors are adequately trained and monitored to maintain the integrity of the process.
Lack of Uniform Competence Criteria and Guidelines for Clinical Care: The lack of uniform competence criteria and guidelines for clinical care is another challenge. Accreditation bodies must establish clear standards and guidelines to ensure consistency and fairness in accreditation assessments.
Infrequent Surveillance by Accreditation Boards: Infrequent surveillance by accreditation boards further undermines the effectiveness of accreditation processes. Regular and surprise inspections are essential to ensure ongoing compliance with standards and guidelines.
Absence of Regulatory Compliance Surveillance: The absence of regulatory compliance surveillance is a significant barrier to accreditation effectiveness. Regulatory bodies must work closely with accreditation bodies to ensure that healthcare facilities adhere to relevant laws and regulations.
Failure to Directly Monitor Patient Feedback Data: The failure to directly monitor patient feedback data is a missed opportunity to improve patient care. Accreditation bodies must incorporate patient feedback into their assessments to identify areas for improvement and ensure patient satisfaction.
Concerns About the Involvement of Private Accreditation Bodies: Concerns about the involvement of private accreditation bodies in compromising standards highlight the need for greater oversight and accountability. Accreditation bodies must address these concerns and ensure that all accredited facilities adhere to rigorous standards.
The Profit Paradox: The profit paradox, where non-profit accreditation bodies engage in lucrative transactions, raises questions about their motives and integrity. Accreditation bodies must operate with transparency and integrity to maintain public trust and confidence.
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Country-Specific Concerns and the Call for Reform: Nations such as India and the USA face a surge in private accreditation bodies driven by profit motives, raising concerns about the integrity of the accreditation process. This underscores the need for enhanced regulatory oversight and reforms to preserve accreditation as a reliable indicator of quality care and patient safety.
ISQua’s Imperative for Action: Amidst this evolving landscape, ISQua’s reluctance to regulate the proliferation of privatized accreditation entities is concerning. The organization’s silence calls into question its commitment to upholding accreditation integrity. Urgent action is required to reassess policies and implement measures that uphold rigorous standards and transparency in the accreditation process.
Strategies for Upholding Quality Standards: To combat the impact of privatization on accreditation integrity, several strategies emerge:
- Promotion of National Single Accreditation Boards: Advocating for a unified approach to accreditation within each country can mitigate competition-driven compromises in quality.
- Restriction on For-Profit Accreditation Entities: Implementing stricter membership criteria prioritizing quality over profit is essential.
- Enhanced Transparency and Global Coordination: Establishing a global portal for accreditation feedback and introducing a rating system for accredited organizations can foster accountability and informed decision-making.
Recommendation: Enhancing Transparency Through Liability Declarations To address the complexities of healthcare accreditation and provide clarity on its purpose and limitations, the adoption of liability declarations alongside accreditation symbols is recommended. This declaration explicitly communicates that accreditation serves as a capability assessment by accrediting bodies and does not guarantee quality care or patient safety.
Conclusion: A Call for Renewed Commitment The integrity of quality accreditation is fundamental to ensuring patient safety and quality care. As privatization reshapes the accreditation landscape, stakeholders must confront these challenges with renewed commitment. By tackling issues of commercialization, compliance, and oversight, accreditation bodies can reaffirm their role as guardians of excellence in healthcare delivery.
This article is very important for regulator councils. Thank you for writing it.