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
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
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
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
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
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
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
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
How many accreditations are you doing a year?
About half a dozen, we’d like to
do far more.