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QA: Resource Organizations, Consultants and Finance
- Organizations that Assist Low and Middle Income Countries with QA and Accreditation Initiatives
Quality Assurance Project/Healthcare Improvement Project
Key Resource
U.S. Agency for International Development funded program for promotion of healthcare quality improvement initiatives in developing countries. Is one of the longest running and best-funded quality programs to date for developing countries. Has focused especially on “single-issue” quality assurance projects (e.g. peri-partum care, tuberculosis treatment, HIV/AIDS treatment) and accreditation systems. Recently has funded a number of projects which adapt the Institute for Healthcare Improvement’s “Breakthrough Collaborative” approach to developing countries (this approach encourages spread of effective quality assurance initiatives to multiple sites by organizing collective workshops and a virtual “community” of teams from these sites for sharing of experience and best practice). The QAP website contains multiple case reports, training materials, QA tools, monographs and manuals.
http://www.qaproject.org
An very useful evaluation of collaborative approach- Evaluating Health Care Collaboratives: the Experience of the Quality Assurance Project- was completed in June, 2008 by EnGender Health Inc.
http://www.comminit.com/en/node/273888
University Research Corps-Center for Human Services (URC-CHS)
A Washington, D.C.-based consulting firm which has contracted to do much of the work commissioned by the QA Project/Healthcare Improvement Project above, including individual QA projects as well as running multi-site improvement collaboratives. Has also developed a training course for implementing improvement collaborative in developing countries.
http://www.urc-chs.com
Management Sciences for Health (MeSH)
A Cambridge, Massachusetts-based non-profit resource and consulting firm that specializes in building health care management capacity in developing countries. Sponsors a quality improvement listserve, a “Health Manager’s Toolkit” with a variety of quality improvement-related materials, and self-study course, “A Guide for Managing Quality”
http://www.msh.org
Health Leaders Achieving Today- Tomorrow’s Excellence (HLATTE)
Key Resource
Training unit based at the University of Guam. Has conducted a Total Quality Management courses in several Pacific island jurisdictions. This course in problem-focused quality assurance covers the theory and practice of TQM while mentoring participants through a quality improvement project in their worksite. HLATTE will customize offerings based on its clients’ needs. Laurent Duenas, RN and Maria Pangelinan, MBA of HLATTE are also available for individual consultations.
http://mangilao.uog.edu/hlatte
Managers taking Action based on Knowledge and Effective use of resources to achieve Results (MAKER)
WHO program for health service managers with web page featuring selected Quality Management references and links and a quality “chat room”
http://www.who.int/management/quality/en
International Hospital Federation
Membership organization of hospitals in Europe and developing countries Sponsors a yearly International Congress with many QA topics, field study courses, hospital senior management training.
http://www.ihf-fih.org/jsp/index.jsp?lnk=000
- Organizations that Assist with Developed Country-Level Quality Assurance and Accreditation:
Joint Commission for the Accreditation of Healthcare Organizations (JCAHO, also known simply as the “Joint Commission”)
A peer review organization which in the U.S. provides the primary review of hospitals (as well as certain ambulatory and home-based health care services) for the purpose of accreditation (the Center for Medicare Services and the American Osteopathic Association are also qualified to perform accreditation surveys of hospitals in the U.S.). Many insurance companies as well as the U.S. government insurance plans, Medicare and Medicaid, require provid¬ers to have this accreditation in order to receive payment. JCAHO usually surveys orga¬nizations once every three years, sending in a medical and administrative team to review policies, patient records, professional credentialing procedures, governance and quality improvement programs. JCAHO accreditation, however, is an expensive, time consuming, painstaking process, especially for hospitals with resources that are less than most in the U.S.
http://www.jointcommission.org
The 2009 edition of the JCAHO hospital accreditation standards can be reviewed at:
http://www.jointcommission.org/Standards/SII/sii_hap.htm
Joint Commission Resources (JCR, Inc.)
Consulting firm that is a branch of the U.S. accrediting agency, the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO). Among its services, JCR offers an ongoing “subscription” service for establishing and maintaining hospital accreditation preparedness. This service offers ongoing workshops, quarterly consultant site visits, web seminars, mock surveys and a telephone help line.
http://www.jcrinc.com
Guam Memorial Hospital has been working with JCR recently (consultants: Luana Haskell, Tracy Gordy, and Steve Olsen).
Contact information: Luana Haskell: 630-268-7489, ext 7527 (LHaskell@jcrinc.com) or Janet Osgood, Client Services Manager: 630-268-7423 (JOsgood@jcrinc.com)
http://www.gmha.org/JCAHO_Files/
FINAL_Guam_Memorial_Hospital.pdf
Joint Commission International (JCI, Inc.)
This consulting firm is also a branch of JCAHO which is focused on international consulting. JCI is one of the three principal international accrediting agencies (the others are the Canadian Council on Health Services Accreditation, International and the Australian Council on Health Care Standards, International Division). JCI offers an accreditation program for non-U.S. hospitals which is patterned after that of JCAHO in the U.S. Accreditation is being promoted by health insurance companies as a way to assure quality of the services they purchase. It is also sought by hospitals that are catering to international “medical tourists”, patients from developed countries who are travelling abroad to obtain services at lower cost. By becoming JCAHO accredited, these hospitals can assure their clients that they meet cosmopolitan health service standards. JCI works with these hospitals to assist them in preparation for accreditation through such services as site licenses for a self-assessment web-based program, electronic software that assists sites with reaching compliance with standards, seminars, audio conferences, surveyor training, and assistance with the development of policies and procedures.
http://www.jointcommissioninternational.org
For preparation of a consulting proposal contact:
JoAnn Capizzano, Manager, International Services, 630-268-7437 (jcapizzano@jcrinc.com), Sherry Kaufield (SKaufield@jcrinc.com), or Nanne Finis (nfinis@jcrinc.com)
Canadian Council on Health Services Accreditation, International
CCHSA is one of the three principal international accrediting agencies (the others are the Joint Commission International and the Australian Council on Health Care Standards, International Division). The CCHSA assists countries with establishing accreditation systems, gives educational seminars to quality assurance/accreditation teams, and provides individually tailored quality assurance and accreditation consultations. Sample standards manuals look to be oriented toward sophisticated developed country health systems, but this group has done consultations in Saudi Arabia and Kuwait. Standards manual is for sale.
http://www.cchsa.ca/upload/files/pdf/International/
Brochure_Service.offerings.pdf
Australian Council on Health Care Standards, International Division
ACHS is one of the three principal international accrediting agencies (the others are the Canadian Council on Health Services Accreditation International, and the Joint Commission International). ACHS assists countries in the development of their own accreditation and quality improvement programs. The Australian standards are mainly oriented to developed country health systems, but ACHS has done some work in Bahrain, Kuwait and India. In addition to preparing host country teams for accreditation surveys ACHS designs educational programs for in-house QA teams and surveyors. Standards manuals are for sale.
http://www.achs.org.au/ACHSIprodsandservs
Institute for Healthcare Improvement (IHI)
Founded in 1991, the IHI is one of the leaders in quality improvement in health care (especially for single-issue style QA) in the U.S. The website contains information on QA methods, measures and case studies. It is set up as a “community” to facilitate collaboration among members (access and registration are free). While most of its work has been done in the U.S., it has also done several small projects in developing country hospitals.
http://www.ihi.org
Baldrige National Quality Program
An award program of the National Institute of Stan¬dards and Technology that works to enhance the competitiveness, quality, and productivity of U.S. organizations by helping them improve their quality management. The program uses the Baldrige criteria as its framework for assessing overall quality and performance of any organization (both in health care and otherwise). Seven categories make up the framework: 1) leadership, 2) strategic planning, 3) customer and market focus, 4) measurement, analysis, and knowledge management, 5) human resource focus, 6) process management, and 7) business results.
www.quality.nist.gov
European Society for Quality Healthcare
The European Society for Quality Healthcare (ESQH) is a network of national societies dedicated to the improvement of quality in health care at national and international levels. It was founded by a group of presidents and former presidents of national societies for quality in health care in Europe, under the auspices of ISQua. ESQH aims to identify, develop and exchange expertise which is particularly relevant to the developing economic and social identity of Europe, and to work in association with other organizations concerned with health care and its quality.
http://www.esqh.net/
European Quality Assurance Network for Nursing
The European Quality Assurance Network for Nursing (EuroQuan) was set up in 1992 to provide a forum for nurses across Europe who are working with issues of quality in health care. There are 15 member countries in EuroQuan, each represented by one national expert in quality. The network aims to promote quality in health care and nursing by strengthening collaboration between European nurses involved in quality improvement programs through exchange of experience, collaboration and education. Sponsors the “EuroQuan Nursing network”, workshops
http://www.fons.org/networks/eq/euroquan.htm
QQUIP- The Quest for Quality and Improved Performance
QQUIP is a 5 year research initiative of the UK-based Health Foundation. Among its other activities, it is doing a systematic evidence review of the effectiveness of various health service interventions for quality and cost effectiveness.
http://www.health.org.uk/qquip/
International Society for Quality in Health Care (ISQua)
Membership organization that publishes a Journal (The International Journal for Quality in Health Care (at http://www.isqua.org/isquaPages/Journal.html ), sponsors conferences about QA, accredits sets of country standards for health care (“Accredits the accreditors”). Addresses accreditation in both developed and developing country settings. Has published a Toolkit for Accreditation Programs which outlines budgetary considerations for implementing and maintaining an assessment program (at http://www.isqua.org/isquaPages/Accreditation/ISQuaAccreditationToolkit.pdf ).
http://www.isqua.org/welcome.html
- Organizations that Assist Public Health Agencies with QA and Accreditation
National Public Health Performance Standards Program (of the U.S. Centers for Disease Control and Prevention)
In partnership with the Association of State and Territorial Health Officials, the National Association of City and County Health Officials, the American Public Health Association (APHA), the National Association of Local Boards of Health, the National Network of Public Health Institutes, and the Public Health Foundation, the Program has produced three sets of performance assessment instruments: The State Public Health System Assessment Instrument focuses on the “state public health system,” which includes state public health agencies and other partners that contribute to public health services at the state level; The Local Public Health System Assessment Instrument focuses on the “local public health system” or all entities that contribute to public health services within a community; The Local Public Health Governance Assessment Instrument focuses on the governing body accountable for public health at the local level. Such governing bodies may include boards of health, councils, or county commissioners.
There are four guiding principles for the NPHPSP:
- The standards are designed around the ten Essential Public Health Services to assure that the standards fully cover the gamut of public health action needed at state and community levels.
- The standards focus on the overall public health system (all public, private, and voluntary entities that contribute to public health activities within a given area), rather than a single organization.
- The standards describe an optimal level of performance rather than provide minimum expectations. This assures that the standards can be used for continuous quality improvement.
- The standards are intended to support a process of quality improvement. System partners should use the assessment process and the performance standards results as a guide for determining how to make improvements.
(The standards and measures for each of the ten essential public health functions are logical, but general. These standards would be most useful for public health divisions/departments in the U.S. flag territories which already have well-functioning administrative systems but are wanting to strengthen community partnerships the alignment of their organizations with core public health functions.)
http://www.cdc.gov/od/ocphp/nphpsp/index.htm
U.S. Public Health Accreditation Board
The Board is composed mostly of state and local government sector health officials and is being financed largely by the Centers for Disease Control and the Robert Wood Johnson Foundation. The Board is working with its partner organizations, including the National Association of City and County Health Officials, the Association of State and Territorial Health Officials, the National Association of Local Boards of Health, and the American Public Health Association, in the development of a voluntary accreditation program for U.S. state, local and territorial public health departments. Presently, standards, measures, and an assessment process for applicants are under development. The formal rollout of the program will occur in early 2011. A draft set of standards is will be available for review by the end of 2008.
http://www.phaboard.org/index.html
National Association of City and County Health Officials (NACCHO)
NACCHO is a partner with the Public Health Accreditation Board in the ongoing development of an accreditation system for local and state public health departments in the U.S. It offers advice and resources to local and state health departments that are preparing for accreditation. NACCHO also offers a peer assistance network for health departments that are working on QA and/or preparing for accreditation.
http://www.naccho.org/topics/infrastructure/
accreditation/OpDef.cfm and http://www.naccho.org/topics/infrastructure/accreditation/
PeerAssistanceNetwork.cfm
NACCHO central office staff have suggested the following individuals in their network who may be especially helpful for PIHOA jurisdictions interested in working toward public health accreditation:
- Heidi Deutsch is NACCHO’s Program Manager for performance improvement has done some limited international public health work. She can be reached at: hdeutsch@naccho.org , 202-507-4214 http://www.naccho.org/mapp - Alan Kalos is in the peer network in Northern Kentucky and is very knowledgeable about the National Public Health Performance Standards Program and quality improvement. He can be reached at: alan.kalos@ky.gov
There have been several adaptations of the NACCHO local health department self-assessment and draft accreditation materials. Among the best developed of these are:
Public Health Foundation
The Public Health Foundation (PHF) is a grant-funded, U.S. non-profit organization which operates the Public Health Infrastructure Resource Center (PHIRC) web site. Among other items, the web site presents resources developed by the Turning Point's Performance Management National Excellence Collaborative, a group of seven U.S. states and five national partner organizations funded by the Robert Wood Johnson Foundation to study and promote the use of performance management systems in public health (http://www.phf.org/PMC.htm ). PHIRC web site offers a collection of U.S. style public health performance management case studies, tools and other resources.
http://www.phf.org/infrastructure/phfpage.php?page_id=52&pp_id=52
The Foundation also provides an on-line tutorial to guide users to appropriate resources available through their website.
http://www.phf.org/infrastructure/QI-Info_Tutorial.swf
Quality and accreditation in health care services, a global review
World Health Organization, Geneva, WHO/EIP/OSD/2003.1
See discussion of cost considerations on pg 89-90.
http://www.who.int/hrh/documents/en/quality_accreditation.pdf
Quality of Health Care Doesn’t Have to Cost a Lot
Disease Control Priority Project, Nov. 2007
Discussion Paper regarding QA strategies and costs vs. benefit of interventions
http://www.who.int/management/en/
Cost and Quality in Health Care, a Reference Manual. Center for Human Services
A reference manual with methods for analyzing the cost of quality assurance interventions, as well as the cost savings that can be generated by correcting health service inefficiencies using a QA approach.
http://www.qaproject.org/training/cq/ref.pdf
The Quality Assurance Kit
This kit from the Quality Assurance Project of the U.S. Agency for International Development is in CD-ROM format, available for US $20. It provides interactive and text-based information on quality assurance principles, methods, and tools. Among the QA Kit's computerized tools include a budget tool, which can be used to develop cost estimates for implementing and sustaining a QA system. (2001)
http://www.qaproject.org/QAKitorder.htm
- Listservs for QA in Health Care
QCARE
World Bank’s QCARE Electronic discussion group on improving the quality of health care services in developing countries (ongoing since 1994). To subscribe to QCARE, send a message “subscribe QCARE FirstName LastName” to: listserv@tome.worldbank.org
The U.S. Public Health Accreditation Board E-newsletter
Provides updates regarding progress toward the development of standards for local, state and territorial public health department accreditation system in the U.S. (which is aimed for completion in 2011)
http://visitor.constantcontact.com/email.jsp?m=1102084465533
AccreditNation E-newsletter
Sponsored by the National Association of City and County Health Officials (NACCHO). Provides updates and announcements for available technical assistance activities for local health departments that are preparing for accreditation.
http://www.naccho.org/topics/infrastructure/
accreditation/Newsletter.cfm
MeSH listserv
Sponsored by Management Sciences for Health Electronic Resource Center. Listserv and on-line community for health care managers. Can specify areas of interest, including one for “Quality and Clinical Services”. Free.
http://erc.msh.org/memberdatabase/registerform.cfm
Institute for Healthcare Improvement listserv:
Electronic newsletter and on-line community for single issue-style QA
https://www.ihi.org/users/login.aspx?returnURL=http%3a%2f%2fwww.ihi.org%2fusers%2fprofile.aspx
- Independent Consultants with QA Experience in Pacific Island Countries:
Mary Cowan
A nurse by training who developed the Mary Cowan model of system-wide QA over a 10 year period from the late 1990’s to 2007. Has done QA projects in Yap, Kosrae and Pohnpei in the Federated States of Micronesia
CONTACT INFORMATION
Address: 21 Chapman Street, Chapel Hill, Qld, 4069, Australia
Phone: 617-3878-9828
E-Mail: marymarmy@hotmail.com or brucemarycowan@optusnet.com.au
Josephine Lam Yuen
A practicing QA nurse at LBJ Tropical Medical Center in American Samoa with many years of hospital QA experience, is available for short-term technical assistance.
CONTACT INFORMATION
Address: LBJ Tropical Medical Center, PO Box LBJ, Pago Pago, Am Samoa 96799
Phone: 684-633-5418
E-Mail: finally_88@hotmail.com
Patricia Kalasa
Privacy/Compliance Officer at LBJ Tropical Medical Center in Am Samoa with many years of hospital QA standards and compliance experience. Is available for short-term technical assistance.
CONTACT INFORMATION
Address: LBJ Tropical Medical Center, PO Box LBJ, Pago Pago, Am Samoa 96799
Phone: 684-633-1975
E-Mail: pakalasa@yahoo.com or pkalasa@lbj.peacesat.hawaii.edu
Laurent Duenas
A faculty member of the nursing program at Univ of Guam and Director of the HLATTE program. Gives workshops and mentoring for issue-specific QA projects (see HLATTE in section I. above).
CONTACT INFORMATION
Address: University of Guam, UOG Station, Mangilao, Guam, 96923
Phone: 671-735-2648
E-Mail: hlatte05@gmail.com
Rigieta Nadakuitavuki
A nurse with 5 years of experience setting up QA and risk management systems for the Fiji Ministry of Health
CONTACT INFORMATION
E-Mail: RNadakuitavuki@health.gov.fj
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