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Propuesta de perfil competencial uniforme para los evaluadores que integran los procesos de acreditación de sistemas sanitarios
Abstract
The Accreditation Organizations with more experience and prestige as the Joint Commission on Accreditation of Healthcare Organizations or the Canadian Council on Health Service Accreditation, point to the necessity of defining the competency profile of the surveyors in order to get a well done survey process with high credibility. This necessity of trained “accreditors” is also included in projets for global developements in accreditation programs as the ALPHA projet of the International Society for Quality in Health Care.
The present work aims to approach a definition about an homogeneons and global competency profile of Healtcare accreditation bodies. Our experience in Spain with the Accreditation Program for Teaching Hospitals shows that is neccesary to include trained surveyors in the accreditation process, in the same way that are doing the International Accreditation Organizations wiht experience in surveyors selection.
It is proposed a competency profile which includes basis psychological aptitudes (professional maturity, independence, objectivity, stamina, observation and synthesis capacity, communication, empathy, approachability, teamwork), technical ability (in doing samples, interviews, oral presentation, drawing up reports) and the need of training and previous experience.
... Desde el punto de vista etimológico, la palabra calidad proviene del latín qualitas o qualitatis, que significa perfección [1]. La calidad de la atención en salud es un concepto reconocido en la literatura por su multidimensionalidad [2]. En un sistema de salud se deberá procurar la mejora de todas las dimensiones de calidad, pero en especial en aquellas más sentidas por la población o de mayor impacto económico. ...
... El alcance de este trabajo llegó a la fase de evaluación, la cual consistió en un plan piloto de auditoría interna que usó como herramienta de calidad la medición de indicadores seleccionados en la fase previa. Para iniciar dicho proceso fue requisito seleccionar un auditor cuyo trabajo, como está definido en el contexto asistencial consistió en obtener información precisa y completa sobre actividades específicas y realizar juicios determinantes sobre ellas [2,12]. La implementación de un SGC no debe entenderse como el fin de un camino, sino como la oportunidad de establecer nuevas alternativas para mejorar la calidad de las prestaciones en salud [6,13]. ...
The aim of the present study was to analyze the methodology used in external assessment for accreditation of specialized healthcare training in Spain, as well as to review the experiences of national and international accreditation agencies. Because of the substantial quantitative increase in the evaluations performed, these evaluations must be analogous, perfectly delimited and identified by uniform procedures. This enables the attainment of homogenous results in similar situations, integrated in a manual-guide of the process, which includes verification tools and sources of evidence. Its use in the accreditation of specialized healthcare training has been fundamental in obtaining greater effectiveness and in preserving rigor when inspecting performance.
The aim of the present study was to analyze the methodology used in external assessment for accreditation of specialized healthcare training in Spain, as well as to review the experiences of national and international accreditation agencies. Because of the substantial quantitative increase in the evaluations performed, these evaluations must be analogous, perfectly delimited and identified by uniform procedures. This enables the attainment of homogenous results in similar situations, integrated in a manual-guide of the process, which includes verification tools and sources of evidence. Its use in the accreditation of specialized healthcare training has been fundamental in obtaining greater effectiveness and in preserving rigor when inspecting performance.
Background
The aim of this article was to determine’Spanish healthcare managers’ opinion about quality assurance and healthcare accreditation.
Method
A semi-structured ad-hoc questionnaire was sent to managers by electronic mail for completion. We performed a descriptive analysis, showing the results of the qualitative variables in percentages, and those of the quantitative variables in ranges and percentiles.
Results
The response rate was (59) 24.1% for the total number of persons included in the study and was 28.7% for the group of hospital managers. Seventy percent believed the issue to be highly topical. Ninety-eight percent believed that accreditation should be a requirement for private healthcare settings that are contracted by the public sector. Fifty-four percent (vs 34%) believed the process should be mandatory. Seventy-five percent of the managers who completed the questionnaire were in favor of a single accreditation model for the whole Spanish state. Most managers (76.8%) believed that the results of the accreditation process should be published so that patients and healthcare professionals could be aware of them.
Conclusions
Unlike the modus operandi in the United Kingdom, USA and Canada, Spanish managers believe that the accreditation process should be mandatory, as in France. Three-quarters of managers agree with the criteria of the Parliamentary Sub-commission for the Consolidation and Modernization of the National Health System, published the 18 December 1997, which expresses “the need to stimulate continuous quality improvement in healthcare through a general accreditation system of healthcare centres and services agreed by the Inter-territorial Board”. Nevertheless, one-third of the managers surveyed approves the use of additional models such as the ISO or EFQM.
Objectives
To establish a procedure to periodically evaluate the nursing activities included among the objectives of the hospital quality program and to use the information obtained to monitor compliance with this program, distribute the results among health care professionals, establish corrective measures, and monitor changes in the indicators.Methods
Audits to evaluate the quality objectives using data from direct patient observation, analysis of medical records and interviews conducted with nursing professionals were performed. A stratified sample of inpatients with a length of hospital stay of more than 2 days and interviews with the entire nursing staff on the morning and afternoon shifts were carried out. Information was collected and entered into a Microsoft Office Access database, and statistical analysis was performed using the SPSS software package. Indicators were determined and data were grouped in dimensions concerning relationships with patients, completion of records, and information in nursing. Cluster analysis was used to study nursing units by classifying them according to the rate of problems per dimension. Differences between indicators and rates were assessed using a chi-squared test to compare percentages.ResultsAfter the pilot trial, performed in November 2001, 3 audits were carried out (2 per year) to improve aspects concerning both function and results. In the last two evaluations, the problem rates were 9% to 11% for relationships with patients, 21% to 25% for completion of records and 3% to 19% for information in nursing. The overall study of the 16 indicators employed indicated that five of them improved significantly. The dendrograms constructed for classification indicated homogeneity, with slight differences, among the set of nursing units. The dendrogram corresponding to the month of March identified 2 lower-quality units, advances in 5 units that reached a higher level and confirmed the situation of the other 3, which remain in the lower-level group.DiscussionThe auditing procedure undertaken to evaluate nursing objectives was found to be an effective tool for improving the quality of work in nursing units. The overall hospital results obtained at the start were generally acceptable and, in the third evaluation, showed significant improvement in information in nursing, appreciable improvement in record completion and no improvement in relationships with patients. The classification study performed in the nursing units indicated overall homogeneity, with most units meeting quality requirements, revealed critical situations, and identified those in which the results could clearly be improved.
Organizational ethics is viewed as the second stage in the development of bioethics because this branch of ethics seeks to transcend the casuistic framework of clinical bioethics, which is based on the patient as an individual, and concentrates on how the structure and functioning of healthcare organizations conditions ethical problems or causes new ones to arise. Organizational ethics first appeared in the 1990s in the USA as a result of the combination of several factors such as the growth of managed care, the failure of the Clinton Plan, the influence of business ethics, and the redundancy of the traditional Ethical Committee model. In 1995 the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) added new standards to the Accreditation Manual that dealt with organizational ethics and, in doing so, created this new branch of bioethics.
This article analyzes the history of the development of organizational ethics, describes the most pertinent literature in the field and discusses certain concepts such as the systemic paradigm within which organizational ethics is viewed, the various definitions of the term “ethics of healthcare organizations” and its possible contents, and introduces its tools with emphasis on the challenges that this new framework poses to ethical committees. Finally, we discuss the relevance of organizational ethics to the Spanish healthcare system and the conditions required for its development.
To gather data on how accreditors manage surveyors, to compare these data and to offer them to the accreditors for improvement and to the scientific community for knowledge of the accreditation process and reinforcement of the credibility of these processes.
The data were gathered with the aid of a questionnaire sent to all accreditors participating in the study.
An important finding in this comparative study is the different contractual relationships that exist between the accreditors and their surveyors.
Surveyors around the world share many common features in terms of careers, training, work history and expectations. These similarities probably arise from the objectives of the accreditors who try to provide a developmental process to their clients rather than an 'inspection'.
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