Utilizing National Accreditation as a Tool for Building Sustainable Quality Healthcare Structures: Lessons Learned from the Saudi Arabian Experience
Fatima Javed, the primary author of this piece, is the Surveyor Affairs Manager at the Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI). Co-author Salem Alwahabi is also affiliated with CBAHI. Abdulelah Alhawsawi, the senior author, belongs both to the aforementioned board and is also associated with the Faculty of Medicine and Allied Sciences at King Abdulaziz University.
The Middle East healthcare sector is experiencing dynamic growth. Saudi Arabia, UAE, and Qatar are at the forefront integrating quality tools directed towards the development and implementation of policies related to healthcare reform in the region. Saudi Arabia is the first to establish a national hospital accreditation program setting itself as a leader and offering useful insights through its journey.
Utilizing National Accreditation as a Healthcare Tool
As a response to having one of the fastest growing populations globally, Saudi Arabia has experienced a rapid increase in the number of hospitals and demand for complex healthcare services. This rise in demand requires performance measurement and continuous quality improvement of health services. The use of healthcare accreditation has been linked to enhancing the quality of patient care, as well as providing a common language for healthcare providers. Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) is the official organization established to accredit and monitor public and private healthcare institutions operating in the Kingdom of Saudi Arabia (KSA). Since its formal inception in 2005, CBAHI has expanded from a voluntary program to a national mandatory program linked to licensure, and mandated to accredit more than five thousand facilities across the Kingdom.
Agencies like CBAHI lobby and instill healthcare reforms through the practice of quality care, while concomitantly strengthening public trust in the healthcare system.
The following salient components for providing stability emerged through CBAHI’s experience:
1) Workforce development, requiring formation of local healthcare educational, training and research centers both in quantity and quality. Additionally, inclusion and emphasis of quality improvement in the curriculum of healthcare related educational programs. Moreover offering regular training opportunities to keep abreast with national and global innovations.
2) Surveyors’ management, including an organized system for recruitment, development, performance evaluation and retention for the sizable surveyor pool.
3) Survey process, involving utilization of an evolving survey process and design, as well as improvements in scheduling, scoring and reporting mechanisms.
4) Standards development, entailing revisions of current standards and the establishment of separate facility specific standards (such as PHC, laboratory etc).
5) Establishment of healthcare accountability through transparent access to performance data of various healthcare facilities. A facility rating system could be used in the future to distinguish performance levels to cultivate positive competition for others to perform better.
6) On-going education and technical support to facilities. Intensifying pre and post accreditation support, and supplying evidence based best practices.
7) Encourage patient engagement and understanding of care through community services. Investing in public health policy will lead to educated healthcare providers and consumers, resulting in an overall elevation of healthcare literacy.
A major challenge for CBAHI regarding national policy includes its lifespan: formulation, translation, implementation, evaluation, and feedback, which are reliant on the turnover of health ministers and their cabinets. Thus systematic monitoring of healthcare quality through accreditation should be an integral component of ongoing government healthcare strategy. Governments should assist local accreditation bodies by offering financial support as well as backing healthcare quality related legislative and policy initiatives. Assistance should also be derived from national public and private sectors working in proximity to provide a more robust program for quality improvement.
Recommendations on a broader scale include establishing a regional healthcare quality society for consultations on measuring the performance of organizations to facilitate inter-country comparisons that are region specific. This will aid in institutionalizing accreditation whilst allowing for easy reporting and sharing of information within the region, at the same time, eliminating duplication of efforts by agencies in the developmental stages of accreditation programs. For developing countries with limited healthcare budgets and paucity of resources, international organizations such as WHO, USAID, and World Bank should be sought for foreign aid and assistance.
CBAHI will launch a patient safety center demonstrating its commitment to strengthening the quality and safety of the Kingdom’s healthcare system. Main objectives of the center will include engaging the public as key stakeholders in minimizing medical errors, assisting medical facilities to comply with CBAHI standards, and lastly conducting nation wide patient safety research. CBAHI will require continuous government support, on-going financial and technical assistance, and utilization of effective recruitment and retention systems. The government of Saudi Arabia must continue to acknowledge CBAHI’s role and contributions in shaping healthcare reform; assist with promoting its work, fortifying its presence, and provide collaboration on healthcare quality improvement issues nationally and regionally.
There is substantial evidence to support accreditation as a tool to improve the overall processes of care. Facilities that are accredited are better prepared for delivery of care and possess stronger infrastructures. National accreditation is not a stand-alone agent for performance improvement; it must be deployed in conjunction with other quality improvement tools and methodologies in a systematic manner. More research and evidence are required on mandatory accreditation programs and healthcare sustainability in developing countries.
Policy areas regarding healthcare reform should embrace healthcare education and training, technology, financing, accountability, and quality improvement, which all in turn jointly affect the quality and sustainability of a country’s healthcare system. The Saudi Arabian accreditation experience provides an empirical repository of valuable evidence to advance future healthcare policy within the Middle East.
- National Hospital Standards, CBAHI. Third Edition (1435-2014).
- Strategic Plan, CBAHI. Version 1. (2014-2017).
- Bukonda, Ngoyi, Tavrow, Paula, Abdallah, Hany, Hoffner, Karen, and Tembo, Joyce. “Implementing a national hospital accreditation program: the Zambian experience.” International Journal for Quality in Health Care 14, Supplement 1 (2002):7-16.
- El-Jardali, Fadi, Hemadeh, Randa, Jaafar, Maha, Sagherian, Lucie, El-Skaff, Ranime, Mdeihly, Reem, Jamal, Diana, and Ataya, Nour. “The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon.” BMC Health Services Research 14 (2014):86.
- Abdallah, Abdallah. “Implementing quality initiatives in healthcare organizations: drivers and challenges.” International Journal of Health Care Quality Assurance 27, 3 (2014):166-181.
- World Health Organization, “Quality and accreditation in health care services: A global review.” Section 1 (2003):1-44.
- Alkhenizan, Abdullah and Shaw, Charles. “Impact of accreditation on the quality of healthcare services: A systematic review of the literature,” Annals of Saudi Medicine 31, no. 4 (2011): 407-416.
- Smits, Helen, Supachutikul, Anuwat, and Mate, Kedar S. “Hospital accreditation: lessons form low- and middle-income countries,” Global Health 10, no. 1 (2014):65.