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The scope and the purpose of the report
There is a large range of external evaluation mechanisms that play a role in patient safety. For the purpose of this report, however, it was decided to focus essentially on models that were applicable to health care organisations and whose objectives were to assess organisations as a whole. It was felt that this was necessary for the sake of coherence and for the identification of evolutions and trends. This report deals with external evaluation mechanisms in terms of patient safety. It should be clearly understood that there are other issues and dimensions of quality that external evaluation models, such as accreditation, are organised to address and appreciate. These include respect for patients' rights and responsiveness to patients, continuity and appropriateness of care, capacity and competency of the organisation and health care professionals, efficacy and effectiveness of care. Nevertheless, most external evaluation organisations believe that 40 to 50% of their standards address patient safety issues. The aim of this report is to give a succinct overview of the trends and issues in terms of external evaluation models for patient safety that will be helpful to health care professionals and decision makers from member states of the European Community. The identification of common principles and tools that can be used within various member states should lead to the sharing of information in terms of patient safety and may contribute to the definition of strategies for European harmonisation.
Cross-references and writing strategy of the report
A number of documents have been published recently in connection with actions to be carried out by public or private bodies to monitor healthcare policy and health care organisations (HCOs), and these documents can be used as a reference. The existence of these very recent reports and articles inevitably affects the content of this report:
- There is no point in reproducing in detail an existing, particularly well-produced list of references that details key concepts in external auditing. The most important points in these texts have been summarised in this report and readers can find more details in the source documents referred to in the text.
- Rather, the aim of this document is to produce a summary of work already done and ideas already developed and to reinterpret points which could be an obstacle to dissemination of these concepts throughout Europe.
The published documents can be divided into two groups:
- The first group of texts, which we will call "methodological", focuses on the mechanisms of external auditing, with particular emphasis on accreditation. It might appear to be a direct response to WP5 but, in fact, it is inadequate for implementing a consistent common policy at European level (it is more an aggregation of methods).
The Charles Shaw article of 2004 is an updated, simplified summary that covers all the technical points and which could be used a base document for the SIMPATIE project. HAS' French accreditation manual provides a good framework for national practice. Particular attention is drawn to the upstream work by the Australian Council on the limitations of accreditation.
- Klazinga N. Re-engineering trust: adoption and adaptation of four external quality assurance models in Western European health care systems. Int J Quality in Health Care 2000; 12: 183-9
- Donahue KT, van Ostenberg P. Joint Commission International accreditation: relationship to four models of evaluation. Int J Quality Health Care 2000; 12: 243-6.
- HAS-ANAES. Manuel d'accréditation des etablissements de santé, 2003, available here
- HAS-ANAES. Accreditation manual for health care organisations. 2nd accreditation procedure, Sept. 2004
- Joint Commission on Accreditation of Healthcare Organizations. Comprehensive accreditation manual for hospitals: the official handbook, 2004, available here.
- Canadian Council on Health Services accreditation, available here.
- 0vretveit J, Gustafson D. Qual. Saf. Evaluation of quality improvement programs, Health Care, 2002 11, 270-275
- Shaw C. External assessment of healthcare, BMJ 2001, 322:851-854
- Shaw C. Toolkit for accreditation programs. Some issues in the design and redesign of external health care assessment and improvement systems, International Society for Quality in Health Care, 2004
- Shaw C. Accreditation in European healthcare. Joint Commission Journal on Quality and Patient Safety 2006, 32(5):276-87
- Standards setting and accreditation systems in health, Australian Council for Safety and Quality in Healthcare, 2003, see here.
- World Alliance for Patient Safety available here
. - The second group of texts, which we will call "strategic", focuses on the strategies to be implemented to improve patient safety. Auditing is only one aspect, and an almost marginal one, of what this group addresses. But these texts are important for SIMPATIE as they provide a more global perspective on external auditing goals. Here again, reading the documents listed below will provide a full inventory of the current situation.
- Seven Steps to Patient Safety. National Patient Safety Agency, 2004, can be found here
- Ovretveit J. Which interventions are effective for improving patient safety: a review of research evidence. Stockholm: Karolinska Insitute, Medical Management centre, 2005
- Carthey J, Woodward S, Lewis R. Safety Management Systems, high reliability organisations and resilience engineering: Implications for strategies to improve patient safety (draft), NPSA, 2006
- Patient Safety Goals and Required Organizational Practices, August 2006, Canadian Council on Health Services
Accreditation, available here.
More punctual quotations are made along the text when needed.
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