Quality and origin of the Accreditation Models
In this first installment of Health Management Notes we want to make an approximation to the concept of care quality and the origin of the accreditation models.
There is no doubt that quality concerns all those who participate in the care process. Managers, professionals and patients are committed to achieving and obtaining the best results in the provision of healthcare services. For this reason, it is important to highlight the key ingredients of healthcare quality: scientific-technical quality and, especially, relational quality. Both components are essential to achieve high levels of excellence. Achieving these levels of excellence requires paying attention to multiple elements that make up the care process and requires the effective protocolization of the processes that allow for their standardization, rigor in carrying out these processes as foreseen in their design and the introduction of criteria of clinical management in healthcare decision-making. Precise compliance with all that has been stated can only be verified with instruments that allow the reality of the services offered to patients to be evaluated, comparing it with accepted and previously established standards.
The different accreditation models that are currently used identify standards of excellence that make it possible to compare the execution of processes, healthcare or not, with a reference, considered optimal, that these standards propose and that allows objectifying the level of compliance.
The first antecedent in the establishment of quality standards was the North American surgeon Ernest Codman (1869-1940), who in 1916 proposed a system to evaluate the execution of surgical activity that he called “Final results system to learn from them for the continuous improvement of new patients”. Among other proposals, this model established that all patients should have a medical history and a preoperative diagnosis, which should be followed up by the surgeon for one year after the intervention in order to identify long-term results or that surgeons and teams Surgical therapists had to review their complications at least once a month. More than a hundred years later, the figure of Ernest Codman is still current: his concern for the improvement of processes or the evaluation of medical errors, of which he was the first to speak without qualms, give him a special modernity.
His work proposals prompted the creation of the Hospital Standardization Program of the US College of Surgeons, the embryo of what in 1951 ended up becoming the Joint Commission for hospital accreditation. Today, the Joint Commission is the most recognized and widespread organization in the world in the accreditation of health institutions and its model has inspired others of national or international application.
Regardless of the model used, accrediting is recognizing that a center meets optimal levels of quality, based on an external and independent evaluation that takes standards built from a scientific-technical consensus as a reference. In particular, the Joint Commission accreditation model is structured in standards that focus on patient care, including relational elements and standards focused on the quality of processes that facilitate the care process.
Normally, in the minds of organizations, the adoption of an accreditation model implies the desire to be accredited, but can it not also be a good option for those organizations that only want to guide the Quality Improvement Program?