Notes on the structure

of content

The contents of this book have been metaphorically organised into thematic pathways. The subtitle — Proximity, co-production and high reliability between accrediting organisations and health care providers in accreditation processes — alludes to the added value and applicability of the three pillars of the client-centred accreditation model in accreditation-driven service improvement projects. The aim is for the topics covered to be useful in the processes of preparing for external assessment for accreditation purposes and to serve as a reference for sustaining the improvements achieved during this period and throughout the accreditation cycle. In other words, to be a guide to the route and pathways that accrediting organisations and their clients, as well as healthcare organisations, their managers, and their staff can follow, with a clear vision of what is to be achieved, how to achieve it and how to sustain the results of their progress.

Preface

Péricles Góes da Cruz

Technical Superintendent

National Accreditation Organisation (ONA)

Brazil

Carlos Hiran’s book explores accreditation in its most pedagogical sense—understanding what you do and why to more fully understand how you do it.

The aim is precise: to provide the public in the health sector, especially hospital managers and professionals working in the field of qualification and accreditation, with a technical, operational, and strategic vision that is fundamental to improving health services.

It is important to emphasize that I consider the author to be more than a subject scholar, but a questioner who invites us to re-evaluate our practices on the basis of his ideas and ideals. More than that, I view him not only as a colleague but also as a great friend, with whom I have shared and continue to share historic moments in health accreditation, and with whom I have had the privilege of contributing to the current practices in this field in Brazil. As a result, I accepted the invitation to write this preface with the same satisfaction that I always get from our professional conversations or the informality of our friendship.

This is undoubtedly another achievement in our history.

The book divides its content into chapters titled Pathways, emphasizing the importance of gaining a deeper comprehension of quality concepts and standards. These chapters offer valuable insights that organisations can immediately implement, thereby enhancing quality and safety standards. These insights are crucial for organisations, accreditors, and healthcare institutions to successfully prepare for external evaluations and reap the benefits of accreditation programs.

After the initial deconstruction of concepts in the first two chapters, the book presents a model of preparation—the client-centred accreditation—and provides an interesting historical overview, highlighting the key facts and players that have shaped the global evolution of accreditation. The model that Carlos Hiran proposes in this book has obvious value for this contemporary moment in accreditation, when the world is looking at new studies that can improve existing schemes.

With the accelerated pace of technological change and advancing innovations in care, there is ample justification for rethinking quality and safety standards and for giving more effective formats to evaluation methodologies and processes for accreditation purposes without losing sight of the most essential element of our practice—the human experience. In this respect, the author considers the exchange of peer experience—between organisations and between the professionals in these organisations—to be a critical success factor. The classic concept of patient-centred care influences his line of thinking, and he discusses client-centred accreditation with similar principles of involvement and constant cooperation between organisations and people in a context of co-production from initial planning to the moment of external evaluation, bringing better results and higher reliability with accreditation programmes.

As a healthcare professional with experience in healthcare accreditation, even serving as the Superintendent of the National Accreditation Organisation (ONA), I have witnessed and encouraged the evolution of accreditation systems and the growing need for more holistic models. For Hiran and me, an accreditation system that ensures the client’s voice will undoubtedly promote a genuinely collaborative and sustainable improvement process.

I, therefore, invite readers to explore in each chapter the essential components of client-centred accreditation, both external and internal, and to reflect on the lessons learned not only from systems that have failed but also from the successes of organisations that have pioneered this approach. We all know that preparing a hospital for accreditation is a complex process that requires a coordinated effort and the involvement of the whole institution. I believe this book is more than just a technical roadmap; it is also a guide for everyone involved in healthcare quality and safety to look beyond accreditation standards and see the expectations in every aspect of this bridge to more compassionate healthcare.

Enjoy the read!

Presentation

Ana Maria Vaz Inácio

Hospital administrator

Quality Office Coodinator

Instituto Português de Oncologiade Coimbra Francisco Gentil, E.P.E.

Portugal

As Quality Coordinator at the IPO of Coimbra, I’m delighted to present Carlos Goes’ further contribution to redefining the model and improving the processes of continuous quality improvement in healthcare organisations.

This great pleasure is doubled by the fact that we have in its author a reference that has guided us over the last 15 years in the pursuit of our institutional objectives through the implementation of external evaluation processes and the understanding of the standards of good practice that the formal accreditation models have promoted.

For any healthcare system, it is now undeniable that patient satisfaction and experience have become critical pillars of the success of healthcare organisations’ practice efforts. Accreditation has been a wonderful opportunity for Portuguese hospitals to move in this direction. It has become an important motivational and self-evaluation guide for planning and developing our projects, always from the perspective of being part of an integrated healthcare system.

The Portuguese Institute of Oncology of Coimbra is a public hospital, part of the SNS (National Health Service), dedicated to providing oncology care in the areas of diagnosis, treatment, prevention, teaching, and research as part of the National Strategy to Fight Cancer. We first adopted accreditation more than 20 years ago through the British CHKS model, which we maintain as a strategic factor in providing safe, quality care to our patients, along with accreditation through OECI¹, ACSA², and ISO 9001 certifications.

Client-Centred Accreditation is a model derived from the author’s in-depth and highly insightful study of how healthcare institutions should structure the preparation period for each accreditation cycle. The model underscores the importance of approaching the processes that arise from accreditation programmes from the perspective of the client, as a fundamental premise. The proposal also suggests that the accrediting organisation should listen to and involve the client in its operational plans. This is a proposal for a closer relationship approach, which will tend to build stronger links of trust between the two organisations, the one that wishes to be accredited and the one providing accreditation.

Inspired by management practices and theories that place the client at the centre of all activities, this book offers a new approach to qualifying health services interested in improving their practice through accreditation. Beyond simply adhering to manual standards and requirements, the model underscores the significance of comprehending these requirements from the outset of the cycle, as this knowledge contributes to a deeper understanding of the processes, thereby facilitating their internalization and sustainability.

Organised into chapters that flow logically and progressively, the topics take us on a journey that covers the entire accreditation process, from understanding the needs and expectations of clients to implementing robust co-production processes that ensure a truly enriching experience for all involved.

Other readers may enjoy it as much as I did.

1 Organisation of European Cancer Institutes (OECI). IPO Coimbra has been accredited by this organisation as a Clinical Cancer Centre since 2011.

2 Agencia de Calidad Sanitaria de Andalucía (General Directorate of Health Model). The IPO of Coimbra has been accredited as a Reference Centre* in the area of Adult Oncology - Rectal Cancer since 2022.

Presentation

B.K.Rana

CEO of the Quality & Accreditation Institute (QAI)

INDIA

It is with great admiration that I present this book by Carlos Hiran Goes de Souza.

Carlos’ innovative ideas and approaches to accreditation processes, such as the introduction of needs-based methodologies and client-centred accreditation models, have always been a source of inspiration. This book, in particular, challenges us to reconsider our understanding of the term accreditation and the potential for greater learning and innovation in our field of work.

As the founder of the Quality & Accreditation Institute (QAI), an accreditation organisation, I have to say that I’m always looking for new methods that can set us apart and help us in our work.

Our mission is to promote better healthcare through accreditation processes, certifications, and healthcare education.

As we know, external assessment for accreditation purposes is a means of verifying the degree of compliance with established standards, usually referred to as accreditation standards. Organisations recognised and trained for this type of assessment, traditionally known as accreditation and certification entities, carry out this evaluation. However, social change’s dynamics are driving new forms of healthcare assessment, such as needs-based methodologies. The traditional system consists of an external assessment organisation, i.e., an accreditation entity, a set of standards developed by that entity, and the healthcare organisation carrying out the assessment. However, this new form of external assessment moves away from the philosophy of the traditional model and was developed based on needs. However, both conventional and needs-based systems aim to improve quality and patient safety. The World Health Organisation (WHO)/Regional Office for the Eastern Mediterranean (EMRO) is conducting a successful example of this model, which involves public and private health organisations through their respective Ministries of Health. The WHO, in collaboration with the Ministry of Health of the country involved, awards a certificate.

The client-centred accreditation model that Carlos presents directs us towards obtaining the best benefits from the application of any of these models. It is a model of the provision of accreditation services in the health sector based on managing the relationship between an accreditation organisation and its client organisations. This operational model aims to facilitate the understanding and implementation of accreditation standards and processes through dedicated attention and more meaningful interaction between the accreditation entity and its client healthcare organisations. This is an alternative model for sustaining improvements and achieving greater credibility for the accreditation organisation and any accreditation programme applied.

Carlos is to be commended not only for his professionalism but also for the friendship we have built up over the work we have done together around the world on behalf of ISQua, the International Society for Quality in Health Care.

May your book be a huge success!

Introduction

Quality, continuous improvement, and safe care are currently essential and inseparable elements in the management models of health services and the governance of care models that guide professional practice and the mission of these services. Quality culture and management have become theoretical and methodological references for the practice, reliability, and effectiveness of the care provided. In addition, they are considered crucial to the clinical responses required by the expectations and needs of those receiving care. The day-to-day management of healthcare organisations incorporates actions advocated by strategic thinking, such as planning, doing, controlling, evaluating, correcting, and improving. Monitoring and reducing avoidable clinical and non-clinical risks in the patient journey are priorities in the daily practice of safety-focused managers. The introduction of standards, the implementation of evaluation processes, and the pursuit of certification and public recognition are undeniably parts of this progressive management process. In this context, it is worth considering external evaluation based on standards for the purpose of accreditation as one of the most paradigmatic contemporary methods of interdisciplinary learning, restructuring practices, and identifying opportunities to improve the processes and environments in which a patient is cared for.

This is a concept that has come a long way, considering that just over two decades ago, accreditation was not on the social agenda of many countries and healthcare institutions. Today, all regions of the world have established accreditation entities and agencies. If we look at the map of accreditation adoption, the countries with developed economies were the pioneers between the 1950s and the 1990s. If we look at the speed with which this adoption took place, we can see a slow start in the first three decades, with a few countries adopting the innovative method. Only in the 1990s did a significant increase in the number of interested countries change this scenario. Experience from the last decade demonstrates the consolidation of accreditation