New protocol for hospital accreditation: NIAHO. Includes ISO 9001

[Sidney Vianna]

This press release states:

DNV’s innovative NIAHO accreditation program has passed the rigorous evaluation process, and the US Centers for Medicare & Medicaid Services (CMS) today announced its approval of DNV Healthcare Inc. to become a new hospital accreditation organization. This is the first new hospital accreditation organization in more than 40 years.

DNV’s hospital accreditation program has met all CMS requirements to deem hospitals in compliance with the Medicare Conditions of Participation. The program is called NIAHOSM (National Integrated Accreditation for Healthcare Organizations) and has been successfully implemented in multiple hospitals across the US demonstrating its effectiveness as well as DNV’s readiness to deliver it on a broad scale.
“The World Health Organization is actively promoting the concept of accreditation for all hospitals,” says Yehuda Dror, president of DNV Healthcare Inc. “The optimum solution, we believe, will provide a clear foundation of best practices but also allow for local innovation. That is precisely the design of our new NIAHOSM program. Now hospitals can choose to integrate proven quality systems into an annual accreditation process that is less complicated to administer,” he continues.

The new hospital accreditation program encourages innovation within individual hospitals while helping them take advantage of system-wide best practices. It is the first hospital accreditation program in the United States that integrates the internationally recognized ISO 9001 Quality Management System with the Medicare Conditions of Participation, making it the first and only hospital accreditation program that requires continual quality improvement.
As part of the development of the program DNV has cultivated highly-motivated field surveyors. Working in tight-knit teams comprised of clinicians, generalists and life safety specialists, DNV NIAHOSM surveyors will visit hospitals annually to ensure progress and help hospitals meet their quality goals. In addition, all DNV surveyors have been cross-trained as ISO 9001 lead auditors.
“It’s not just their surveying skills, it’s their collaborative approach that makes the difference,” says Mr Dror. “Accreditation surveys in the past have become somewhat combative. We have shown that surveyors can be collaborative and still hold hospitals accountable. We are confident that hospitals will find DNV accreditation teams to be a welcomed change from what they’re used to.”

[MIREGMGR]

Very interesting. This creates a business-competitive context for JCAHO (pronounced "jay-co"), the predominant operational-regulatory organization for hospitals and other similar medical care providing organizations in the US.

JCAHO's regulations are very unlike 9001, and are very procedurally prescriptive. A few US hospitals in the past have decided not to participate in JCAHO, and instead have implemented local 9001-based QSs, but that approach has not generally caught on for two reasons: because there's been a dearth of understanding as to how to proceed given that 9001 isn't really structured for various hospital-specific missions and tasks, and because as much of a pain-in-the-backside as its surprise inspections and very prescriptive rules are generally considered to be, there's also a general recognition that objectively, maximal JCAHO conformance and superior patient outcomes are strongly positively correlated, and that the organizational rigor that leads to the former is causitive of the latter.

JCAHO participation is expensive...perhaps competition will lead to decreased costs, which will provide some relief for small hospitals and those with chronic cost struggles due to unreimbursed care. On the other hand, perhaps JCAHO's demand for rigor will be softened due to a desire not to be "harder" than the competition...the "local innovation" marketing phrase from DNV possibly being marketing-code for "unlike JCAHO, we won't hammer you if you choose to do something a different way that's less expensive to implement and maintain"...and perhaps as a result of a competition to be easier and less costly to implement, health care quality overall will be decreased.

It'll be interesting to see how this shakes out.

[Sidney Vianna]

Originally Posted by MIREGMGR

It'll be interesting to see how this shakes out.

I should add that DNV succeeded in attaining this approved status, after a long assessment process. Others have tried and failed.

It would be very interesting to monitor the patient-safety performance indicators of hospitals accredited under both protocols. For comparison purposes.

[MIREGMGR]

Originally Posted by Sidney Vianna

It would be very interesting to monitor the patient-safety performance indicators of hospitals accredited under both protocols. For comparison purposes.

I certainly hope that many parties will be interested in doing just that...quality organizations, academics, hospital groups, and of course CMS, perhaps in combination with the GAO. As NCAIO infers on their website, it's certainly possible to question whether very high levels of health care spending necessarily result in the best care, if quality-system optimization isn't also part of the solution.

On the other hand, NCAIO also commits on their website...prominently, and twice...to only auditing hospitals annually. One of the strongest criticisms of JCAHO since they went from scheduled to surprise/random-interval audits several years ago, is that it's so expensive and difficult for hospitals to actually operate correctly all the time, in order to be ready for an audit all the time. The clear context of those complaints has been that if JCAHO would go back to scheduled audits, hospitals could save a lot of money and staff angst by going back to slacking off until two weeks before the scheduled audit. If NCAIO is tapping into that rejection of quality values in order to market itself, a lessening of quality will result.

[MIREGMGR]

Maybe it would be desirable for the Cove to set up a "NCAIO and JCAHO" subforum. Sometime soon there'll be increasing numbers of US-hospital regulatory and quality people, not fully up to date on 9001 workings, who will be expected by their management to be familiarizing themselves with what would be involved in creating a 9001 implementation for their operations. Hospitals are complicated businesses...anyone with that task, not being a 9001 expert, is going to need help. They'll want a place to discuss those kinds of issues with their peers, and perhaps have access to 9001 and 13485 implementors in other fields for purposes of information sharing.

[Sidney Vianna]

I agree we could have a forum on health care, one of the most dysfunctional and mismanaged sectors around the World. There are a number of Covers who have demonstrated interest in this field.

[MIREGMGR]

Certainly it may become a productive market for suitably qualified consultants. It's interesting to contemplate a gap analysis between JCAHO and 9001, since they're so differently focused.

[MIREGMGR]

Something germane to the 12:53 post above that I realized I had on file:

An article in 24x7 magazine, a trade journal for biomedical and clinical engineers and technicians, entitled "When Any Day Could Be Joint Commission Day...Experts Share What To Expect, How To Prepare, And How To Stay Sane In A State Of Continuous Compliance".