(This is a blog post by the President of the Philippine Hospital Association, Dr. Ruben C. Flores. He is currently the Medical Center Chief of the Dr. Jose Fabella Memorial Hospital. This is the article he submitted to the Asian Hospital Federation for feature in their Journal to come out in the Third Quarter of 2011.)
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| Dr. Ruben C. Flores Phil. Hospital Assn. President |
Accreditation as a way to ensure compliance to quality standards and continuous quality improvement is just beginning to take root in the Philippines’ health care system.
The passage of the National Health Insurance Act of 1995 saw the establishment/creation of the Philippine Health Insurance Corporation (PHIC). Because PHIC as per RA 9241, Article 1, Section 2 is mandated to promote the improvement of quality through the institutionalization of quality assurance at all levels of the health care delivery system, accreditation was the next step.
Thus in 2002, PHIC launched its Benchbook for national application. The Benchbook standards were developed based on International standards, more particularly, the ACHS and JCI standards for hospitals adopted to the Philippine situation taking into account the local circumstances, laws and culture. This Benchbook was perceived as a new way of incentivizing hospitals to adopt quality improvement activities in order to be granted by PhilHealth an accreditation status. Accreditation is linked with PHIC reimbursement.
This PhilHealth Benchbook aims to assess the other aspects of hospital operation focusing on the process and outcome beyond mere structural standards compliance. Specifically the Benchbook look at the following areas:
1. Patient Rights and Organizational Ethics
2. Patient Care
3. Leadership and Management
4. Human Resource Management
5. Information Management
6. Safe Practice and Environment
7. Improving Performance
This Benchbook was adopted as the new accreditation standards for hospitals and was implemented in 2010. In its first year of the PhilHealth Benchbook implementation, many hospitals exerted efforts to comply with the standards and the table below shows the percentage of achievement per level:
Level of Accreditation | Number of Hospitals | Percentage |
Center of Safety | 1246 | 87.99% |
Center of Quality | 126 | 8.90% |
Center of Excellence | 44 | 3.11% |
T O T A L | 1416 | 100% |
Based on the survey results, the following can be concluded.
1. Benchbook compliance seems not a significant problem among higher level hospitals (Lavado et al, 2010)
2. Some lower level hospitals experience hardship in complying with the standards because of the administrative and financial constraints.
3. Training and educational assistance should enable the majority of hospitals to obtain accreditation in one to two years.
4. The impact of the Benchbook on improving health outcomes has yet to be established.
The Philippines can be considered unique in a sense because accreditation is being undertaken by a government instrumentality.
To further institutionalize the national accreditation initiatives, a body that will undertake the accreditation of hospitals was espoused by the Department of Health. Towards this end, a national multi-stakeholders consultation meeting was conducted last June 10, 2011.
In this meeting, the Philippine Council for the Accreditation of Healthcare Organization (PCAHO) was unanimously endorsed by the delegates to the Secretary of Health to be designated as the National Accrediting body for hospitals adopting the PhilHealth Benchbook standards as the accreditation tool.
This new development would effect a shift on the task of accreditation from being performed by government (PHIC) to one that is carried out by a private entity thru a 3rd party accreditation scheme. PCAHO is actually a multi-stakeholder organization dedicated to quality improvement initiatives and accreditation and has been in existence for almost thirteen (13) years now. PCAHO was borne out of an ADB Funded Project – Strengthening of Licensing and Regulation of Hospitals, DOH, 1995-1997 – that saw the need for Accreditation of Hospitals for the improvement of the Quality of hospital services. The Department of Health currently recognizes PCAHO as the National Accrediting Body for Accreditation of Health Facilities for Medical Tourism and the Certifying Body for the QSS of medical clinics of OFW and CDTL. PCAHO is currently an institutional member of the International Society for Quality in Healthcare (ISQua) and an Associate member of the ISQua Accreditation Federation (IAF). It is also a National member of the Asian Society for Quality in Healthcare (ASQua) and a member of the Executive Board. It has been invited to serve on the JCI Asian Pacific Advisory Council
The task ahead is Herculean. PCAHO has to gain the credibility and acceptability in the hospital community by establishing a track record for competence in accreditation at par with local and eventually international standards.
It is to be hoped that with this new development, accreditation in the country will leapfrog and thereby ensure safe, quality, and excellent health services to the Pilipino and the global community.
By: RUBEN C. FLORES, MD, MHA
PHA- President
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