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The role of QHA Trent in international hospital accreditation

Hospital accreditation

QHA Trent provides independent, accreditation for hospitals and clinics throughout the world.  This British-based healthcare company has a worldwide remit and works with hospitals and clinics to improve quality and reduce risk for patients, healthcare providers and the general public. Caroline Ratner of the IMTJ spoke to Dr Steven Green, Director & Company Secretary at QHA Trent about QHA’s place in the world of accreditation.

Dr Green also works in the NHS as a Consultant Physician in Infectious Diseases & Tropical Medicine and is Honorary Professor of International Health & Host Examiner for MRCP(UK) PACES and is based in Sheffield.

Where does QHA Trent fit in amongst other accreditation services and on what do you base your criteria for standards?

Unlike our competitors, we’re coming to accreditation from a British angle.  QHA Trent’s way of accrediting a hospital or clinic is based very much on the standards and expectations of how the UK National Health Service is run. In the UK we take for granted the high standards and high quality of services in the NHS and are quick to complain precisely because we have such high expectations. These standards include how doctors and nurses work, their duty of care to the patient, putting the patient first which includes the patients’ full right to complain and be heard, taken seriously, and entitled to the right of redress or to sue if something goes wrong.  This is not always the case in some parts of the world where a hospital might be privately owned or owned by the government which can lead to a conflict of interest which has at times made it difficult for us when we’ve been judging a hospital and its credibility.

Do you have different standards from other accreditation services?

We are thought to be tougher than other accreditation organisations. We maintain very high standard and expect a lot from the hospitals that we accredit even though we’re cheaper than others.  For example, people often ask me, what can you do for us if you come and inspect us? I turn it on its head and say “how can we tell you are any good? All we’ve got is your word for it, that this doctor is amazing, that your equipment is cutting edge and incredible, how do we know? How do we know you are actually any good at what you do?”

A good hospital is not one that has the best doctor in his field, or the most PET scanners or latest equipment, that’s just marketing. These things are not much use if hospitals’ standards are not up to scratch, and some aren’t. A lot of hospitals take a long time to get their governance standards up to scratch. 

Why are you less expensive than the other healthcare accreditation services?

We don’t believe there is any need to charge so much!  We rate our competition very highly and we also don’t think accreditation is helped by having just one or two companies. There should be plurality and competition to provide a better financial scheme, and I believe that some work should be pro bono.

Our team is drawn from people committed to doing this work who are remunerated on a modest per diem rate. we charge a scale of fees depending on a few factors but it does cost to run QUA Trent and we have to pay to market the scheme too but we try and keep overheads low.

Also it’s important to know that just because we are less expensive than other accreditation companies, we won’t pass a hospital if they’re not good enough; we’ll work with them to get those standards up.

Who carries out the accreditation surveys?

Our people are all doctors and medical staff, who are still working in the NHS. They are up to date clinically which means they are fully aware of current standards and criteria. There is a long experience of accreditation within the group and we’re all committed to the ideals of NHS medicine, We don’t have a problem with private healthcare, we just think standards should be very higg across the board.

Does QHA Trent accredit in the UK?

Up until last year Trent, our predecessor used to accredit small hospitals, clinics and care homes in the north of England. These were facilities that didn’t have a critical mass when it came to staffing and management to maintain quality and management which is where we came in.  We helped these smaller units maintain standards and quality.  In the UK there is the Care Quality Commission that has a duty that standards are upheld throughout the public sector and so there isn’t really much of a market in public sector accreditation because there is a system in place.  But there is a market in the private sector and it is an area that we are just beginning to work in. 

Do you have a “one size fits all” way of assessing a hospital or clinic?

No, but we’re also not talking about an unrealistic gold standard. What you’re doing when you going for accreditation is you’re ensuring that you are above a certain level and have credibility. If a hospital or clinic hasn’t passed then it needs to closely examine its credibility even if they have a team of the best doctors, or the best facilities, because as far as we’re concerned there are so many other factors that come into play here when we are asked to accredit a hospital. 

A hospital going through the accreditation process is assessed on bespoke standards but overall we have certain rigid criteria they have to fulfil and all hospitals should strive to give achieve the highest quality of standards. The Hippocratic Oath is paramount and they have to have a clinical ethics committee, or a clinical audit programme (something that is mandatory on the NHS. It’s the fundamental basis of ethics, which ensures that medicine, hospitals and doctors can’t play God.  The bottom line is QHA expects hospitals to adhere to NHS standards, transparency, and quality of care, quality of facilities, ability to have complaints addressed and redressed and so on. We take into consideration the type of hospital, its size, the mix of in and out patients, and the type of staff and so on. 

Do you see standards vary much throughout the world?

Local standards are always going to be different throughout the world but one of the bottom lines is that everyone gets the best health care they possibly can. Everyone should aspire to providing and getting the best healthcare and that’s what accreditation is about and we’ll never drop our overall standards. 

Fundamentally, for accreditation to be worth while, it has to be voluntary; facilities have to know that they can improve to get over the hurdles and reach the standards. Not everyone will pass and some will have to do a lot of work and make a lot of changes to get through our process. When they get through accreditation eventually, they have been evaluated to meet all the criteria they’ve been asked to meet. These criteria are what makes a hospital safe and fit for purpose.

Why does a hospital need to be accredited?

Many foreign hospitals need to be good to get business from foreign employers and insurance companies, not only medical tourists. There are certain less developed countries where it’s less than easy to maintain standards, but there are people from more sophisticated countries who have no choice to live and work in these countries who have high expectations of medical care, often in places like Indonesia or Kazakhstan or West Africa and other developing economies. 

Foreign employees want good health for themselves and their families.  If you are good employers then you will want to look after that aspect of their lives and this is where external accreditation can help. A group like QHA Trent can help a hospital because what we do is say that, regardless of the local law and culture, if you sign up to our system you are repeatedly assessed and we are able to give external endorsement.

How long does it take to accredit a hospital?

It may take up for two years to complete the whole process.  Firstly the people that conduct the pre-survey are not the same people who do the survey.  Once the data emerges from the survey and we look at that it is then looked at by a group called the Independent Accreditation Award Panel. To give you an example, we’ve just accredited a facility which has just passed but they have been working really hard on getting up to scratch since 2007.

Do you work with insurance companies?

We do have an MOU (memorandum of understanding) with AXA, because without health insurance there won’t be a market for foreign patients (particular expatriate employees) but we believe to be formally associated with an insurance company would represent a conflict of interest.

The insurance industries have to make a profit and can’t provide services based on altruism and have to look at cost of providing healthcare and this might affect their interpretation of what standards are acceptable compared to ours. It’s in the hospitals interests to protect themselves and it is in the interest of insurance companies to get local hospitals up to standard for a number of reasons. 

Insurance companies are supposed to provide services they can guarantee, and if they are a British company they are registered with the FSA (Financial Services Authority), and are supposed to ensure that the quality of the product they are offering is of a fixed standard. However if they devolve that to a third party (i.e. a local hospital) then the hospital has to ensure that it reaches that standard on the insurance company’s behalf.  This brings into the frame things like international assistance companies who make a profit from moving people around. It can cost hundreds of thousands of dollars to move one patient, which is a lot more than it would cost to assess a local hospital, it is in the insurance companies interest to keep patients locally without having to move them and it is in the local hospitals interest to provide high standards of services to keep its foreign patients.

Additionally insurance companies are very concerned about overbilling, if a hospital has been through our accreditation assessment and appear honest and above board you can probably assume that they will bill honestly which is a very important factor for insurers.

So, while we currently don’t work with insurance companies there is a potential, which may or not be there, and we’re looking into how to do this without a conflict of interest, it’s not yet clear.

How many accreditations are you doing a year?

About half a dozen, we’d like to do far more.


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