Of all the external methods of healthcare quality assessment, accreditation is the most reliable and popular worldwide. Accreditation standards introduce important (from the point of view of the health policy) requirements concerning e.g. control and reduction in hospital infections, analyses of unwanted events, including perioperative deaths, reduction of risks connected with surgical treatments, safe pharmacotherapy. They promote solutions and tools for safe and effective care that meets patient expectations and results in their satisfaction.
In Poland accreditation is voluntary. An entity that provides health services can apply to the Minister of Health for accreditation through the accreditation centre. The principles and procedures concerning the process of granting accreditation are laid down in the Act of 6 November 2008 on accreditation in healthcare.
Accreditation is granted by the Minister of Health, on the basis of recommendations from the Accreditation Council, in the form of an accreditation certificate, after evaluating the entity that provides health services. The evaluation procedure consists in an inspection of the healthcare entity in terms of compliance with accreditation standards. In order to be granted accreditation it is necessary to obtain a score of at least 75%. Accreditation is granted for the period of 3 years. The current list of accredited hospitals and primary health care units is available on the accreditation centre websites.
Accreditation allows hospitals to reduce the total amount of insurance against adverse medical events per one hospital bed by 10%. Having a valid accreditation certificate awards extra points from the National Health Fund in bidding competitions. The entity’s participation in the inspection also provides a possibility of external evaluation (evaluation of external experts), whose results are extremely valuable for the constant improvement of the entity’s activity. Confrontation with external experts enables the entity to look at its activity from a different perspective and exchange experiences with the inspectors. This benefit is repeatedly emphasised by the evaluated entities.
Since the beginning of hospital accreditation (1998) more than 500 visits have been paid, and in nearly 80% of all the cases they ended in granting accreditation to the evaluated institutions. Of all the hospitals which have decided to undergo inspection in recent years nearly 50% were entities that did it for the first time.
The functions of the accreditation centre are performed by the National Centre for Quality Assessment in Healthcare, which is a unit subordinate to the Minister of Health responsible for monitoring the quality of health services.
National Centre for Quality Assessment in Healthcare is a national institution operating since 1994. The Centre is the first institution of this type in Central and Eastern Europe. One of the main tasks of the Centre was to prepare an accreditation programme for hospitals. The first accreditation standards for hospitals were developed in 1998 on the basis of cooperation and exchange of experience with the Joint Commission on Accreditation of Healthcare Organisations (USA), one of the most recognised accreditation institutions worldwide.
Since 2006 the Centre has cooperated with the World Health Organisation (WHO) (as a WHO Collaborating Centre for Development of Quality and Safety in Health Systems).
The competencies of the Accreditation Council are determined by the Act of 6 November 2008 on accreditation in healthcare and by the Executive Act of the Minister Health of 6 August 2009 on the Accreditation Council.
One of the two basic tasks of the Accreditation Council is to cooperate with the accreditation centre (the National Centre for Quality Assessment in Healthcare based in Kraków) and the Minister of Health in developing accreditation standards.
The second important function performed by the Accreditation Council regards the process of granting or refusing accreditation by the Minister of Health. Based on recommendations from the Council, the Minister of Health decides about granting accreditation to a given entity.
In addition, the specific responsibilities of the Council include:
- cooperation with national and foreign entities in activities aimed at improving the quality of health services and the efficiency of the entities who provide them;
- popularisation of the idea of accreditation.
The Accreditation Council consists of 12 people, appointed and dismissed by the Minister of Health. The term of office of the Accreditation Council members lasts 4 years, counting from the date of their appointment. The same person cannot be a member of the Council for more than two terms.
The first accreditation standards for hospitals were drawn up in 1998 on the basis of cooperation and exchange of experiences with the Joint Commission on Accreditation of Healthcare Organisations (the USA), one of the most recognised accreditation institutions in the world.
Gradually, the scope accreditation was extended. In 2009, accreditation standards for hospitals were reviewed and supplemented with new requirements, in 2011 accreditation standards for primary health care were prepared and introduced, and in 2013 the same was done for stationary units dealing with addiction treatment. At present, work is being carried out on the development of accreditation standards for outpatient specialist care.
The Surgical Safety Checklist is the leading initiative of the campaign „Safe surgery saves lives” initiated by the World Health Organisation under the World Alliance for Patient Safety. The Surgical Safety Checklist was prepared with the intention of limiting the number of unwanted events, especially perioperative deaths, on the global scale. The Checklist is a tool for supporting the adopted and adapted activities regarding:
- safety of patient care,
- promotion of effective communication,
- good collaboration within multidisciplinary teams.
The Surgical Safety Checklist was prepared in a tabular form, with a layout that facilitates its completion by the surgery team. It describes the steps that should be taken by the surgery team. The Checklist divides the surgical treatment into three phases or stages, each of which corresponds to individual stages of the procedure implementation. These are subsequently: pre-anaesthetic phase (Commencement), post-anaesthetic phase before scission (Counting) and the phase during or just after the „closing” of the wound, but prior to the removal of the patient from the operating theatre (Completion).
Keeping the Surgical Safety Checklist is optional for hospitals, however, it is recommended by the Minister of Health. The validity of the problem is emphasised by the introduction of the requirement of keeping the Surgical Safety Checklist as an accreditation standard for hospitals. Hospitals can also be actively involved in this initiative by declaring the use of the Surgical Safety Checklist.
Currently work is being carried out aimed at the adaptation of the template of the Checklist to selected medical specialisations, particularly: cardiac surgery, neurosurgery, child surgery, orthopaedics, gynaecology and midwifery.
Poland is currently implementing a programme created by the World Health Organisation „Clean Care is Safer Care”, which is focused on the reduction in infections related to healthcare and their consequences by promoting hand hygiene at all levels of care worldwide.
Poland joined the countries that signed the declaration of support for activities aimed at preventing infections related to healthcare. This declaration expresses the Minister of Health’s support for conducting systematic and coordinated activities aimed at reducing infections related to healthcare, including development of programmes and campaigns promoting hand hygiene among the medical staff, monitoring infections and promoting best standards, practices and principles of conduct designed to reduce the risk of infections related to healthcare.
The signed declaration was given to Ms. Paulina Miśkiewicz, Office Director of the World Health Organisation in Poland by Mr. Sławomir Neumann, Secretary of State in the Ministry of Health during the 17th National Conference entitled „Quality in Healthcare”, which was held on 20 and 21 May 2013 in Kraków. Thus, Poland joined the 132 countries that also signed the declaration.
The Performance Assessment Tool for Quality Improvement in Hospitals (PATH) was initiated by the World Health Organisation in order to support hospitals in monitoring and improving the quality of patient care. PATH supports hospitals in evaluating their activity by means of a set of approved quality indexes.
As part of cooperation with 21 hospitals in Poland, description and data collection sheets have been adapted and prepared for indexes concerning caesarean sections, hospital mortality due to recent heart attack and stroke, use of the operating theatre and surgical antibiotic prophylaxis (for scheduled operations on colorectal cancer, femoral joint endoprosthesis, hysterectomy). Guidelines have also been prepared for surgical antibiotic prophylaxis in the above procedures.
The benefits of participation in PATH are the following:
- control of the hospital’s own clinical activity through a comprehensive approach to its evaluation;
- provision of a tool for initiating and supporting internal quality improvement activities;
- use of significant, so far unused data;
- obtaining educational materials and technical support for hospitals in performing the assessment;
- in the future, development of a hospital network: benchmarking and exchange of experiences.
In Poland PATH is managed by the National Centre for Quality Assessment in Healthcare.