Healthcare organisations accreditation programme in France
The French accreditation programme for hospitals has been mandated by law since 1996; it aims to improve quality and safety of care through the generation of sustained changes in clinical practices and management.
HAS standards address the hospital’s performance in specific areas; they specify requirements to ensure that patient care is provided in a safe manner and in a secure environment.
The current procedure uses an accreditation handbook containing 28 standards and 82 criteria, 13 of which are focus priority topics standards related to Evaluation of clinical practices policy, Quality & security improvement programme, Risk management, Patient needs, Pain management, Patient file, Patient identification, Drug management, End of life, Infectious risk, Complaints, Emergency room, Operating room, etc
Self-assessment performed by HCO with a new design called “Quality account”
Introducing quality accounts in the French hospitals accreditation process aims:
- to improve the continuity of quality and security improvement programmes in the hospitals,
- to formalise and publish the commitment of the hospitals’ management to drive improvement plans and report on them.
An analysis of the stakeholders’ perception of the three first rounds of the French accreditation process, combined with an analysis of the results led to the design of a new model for the next round of the accreditation procedure (V2014).
The various steps to design and develop the new model are as follows:
- Analysis of the bibliography revealing interesting experiences in Great Britain and New-Zealand;
- Conducting workshops with stakeholders in order to select the most relevant themes to be addressed in the quality accounts;
- Development of a first draft of a quality account and of the analytical method;
- Performing a test among 60 voluntary hospitals and analysing the results to refine the prototype including a perception survey;
- Implementation of a communication plan;
- Development of an information system dedicated to quality accounts (web service);
- Establishing a user club with the participation of hospitals which have experienced the method to put the model in a continuous improvement approach.
The method is currently implemented with a four steps approach for each theme to be included in the quality account: an analysis of the results available; a risk based appraisal, an assessment of the margin for improvement, and involvement commitment to drive improvement plans.
On site survey
In 2014, French Authority for Health (HAS), has designed a new model for the Hospitals accreditation based on process audit and tracer methodology
A network of 500 surveyors (external peer review) are mobilised to conduct surveys with a combination of two methodologies:
- audit on key process :
- Process audits are conducted in seven steps (PDCA driven):
- P1/definition of policy
- P2/ Internal organisation, control, roles and responsibilities, resources, interface management
- D1/ Mobilisation of teams for operational implementation
- D2/ Availability of resources: skills, materials, equipment, etc
- D3/ Effectiveness of the implementation (including traceability)
- C1/ Evaluation of the efficiency of the process
- A1/ Implementation of improvement plans; communication on results
- tracer methodology (patient tracer) give information on D3 and allowed to match data.
- a range of five accreditation levels :
- accreditation with recommendations for improvement
- accreditation with mandatory improvement
- conditional accreditation due to reservations
- Public report of the decisions (web diffusion)