The Importance of CBAHI Accreditation

Dr. Mohammed Ahmed Garout, MD

Assistant Prof. of Public Health, Medical Faculty - UQU – Makkah
IPC Specialty Team Leader - CBAHI
Saudi Arabia
Healthcare Accreditation: an overview

2
Introduction
• Healthcare accreditation is a process of external peer review
to assess the performance of a healthcare facility in relation to
agreed healthcare accreditation standards.

• Accreditation in healthcare has existed for over 100 years

(Brubakk et al, 2015).

• Accreditation has been widely adopted as an essential part of

healthcare systems in more than 70 countries (Greenfield et
al, 2013).

3
Introduction
• Accreditation is a primary driver of quality and safety
internationally (Braithwaite et al, 2006).

• Health service accreditation is an assessment of performance

against standards at a given point in time.

• It provides a snapshot of performance against standards (Swiers &

Haddock, 2019).

4
Introduction
• Accreditation is part of healthcare globally and is a reliable activity
(Greenfield et al, 2010).

• It has been found to improve patient care and support a positive culture
and effective leadership in various countries and settings (Bogh et al,
2016; Braithwaite et al, 2010; Shaw et al, 2014).

• It also contributes to continual and systematic quality improvement

changes, at a process and system level within hospitals (Greenfield et al,
2019).
Accreditation’s value

6
7
• Current literature is unable to consistently • There was no statistically significant
assess the effectiveness of accreditation association between Lebanese
(Brubakk et al, 2015). accredited hospitals and patient
satisfaction (Haj-Ali et al, 2014).
• Argument that inconsistent and
unconvincing evidence fails to demonstrate • Considerable variation within
the value of accreditation (Hinchcliff et al, accreditation categories in quality of
2012, Brubakk et al, 2015, Duckett et al, care and mortality among surveyed
2018). hospitals, which indicates that
accreditation have limited usefulness
• Questioning if the investment in in distinguishing individual
accreditation delivers sufficient outcomes performance among accredited
with desired/expected patients’ safety hospitals (Chen et al (2015).
(Øvretveit et al, 2000, Lam MB, 2018,
Griffith JR, 2018).

8
9
• Infection control performance is • Admissions at fully accredited
positively associated with accredited hospitals were associated with a lower
facilities (Sekimoto et al, 2008). 30-day mortality risk than admissions
at partially accredited hospitals
• Supportive evidence was found for (Falstie-Jensen AM et al, 2015).
using SAB rates to demonstrate the
impact of infection control programs • Admissions at fully accredited
embedded within the accreditation hospitals were associated with a
program (Mumford et al, 2015). shorter LOS compared with
admissions at partially accredited
• For IPC KPIs (VAP, CAUTI, CLABSI hospitals (Falstie-Jensen AM et al,
and SSI), the healthcare accreditation 2015).
acts as a catalyst for implementing and
monitoring positive changes (Fatima
MS and Habibur Rahman M , 2017).
10
11
Contradicted views of published research about value and
effectiveness of healthcare accreditation are expected and
could be referred to:
• Different accreditation methods.
• Different healthcare systems.
• Different study designs.
• Measures of different outcomes.
• Inability to ascertain causal relationship.
• Studies sample sizes.
• Others…
 Accreditation
Can not: Can:
• Act for the best interests of
• Guarantee absolute quality. patients and HCWs.

• Guarantee absolute safety. • Be a commitment to minimising

risks.
• Eliminate all risks. • Be a commitment to
maximising quality and safety.
• Guarantee that evidence based • Ensure/encourage the
best practice is always provided. continuous quality improvement
of the organisation.
Therefore, accreditation provides a snapshot of performance against standards while the
ongoing maintenance and improvement of this performance is the responsibility of the
accredited facility (Swiers & Haddock, 2019)
Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI)

14
 • The Saudi Central Board for Accreditation of
Healthcare Institutions (CBAHI) is the official
agency authorized to grant accreditation
certificates to all healthcare facilities operating in
Saudi Arabia.

CBAHI At A Glance • CBAHI has emerged from the Saudi Health

Council as a non-profit organization.

• The principal function of CBAHI is to set the

healthcare quality and patient safety standards
against which all healthcare facilities are
evaluated for evidence of compliance.
 The foundation of CBAHI dates back to 2001 as Makkah
Region Quality Program (MRQP).

CBAHI At
A Glance MRQP was an initiative aimed at improving quality of
healthcare delivery in Makkah Region.

In 2005, under a Ministerial Order, MRQP was developed

and named as Central Board for Accreditation of
Healthcare Institutions (CBAHI) and its jurisdiction was
expanded to the whole country.
 2006 2012 late 2013

• With the • CBAHI’s • Mandatory

assistance & 2nd edition status of
collaboration of national CBAHI
of healthcare standards for accreditation
quality hospitals was was declared
experts from certified by when a Cabinet
CBAHI At A Glance the public and the of Ministers
Decree called
private International for changing
sectors, Society for CBAHI’s
CBAHI Quality in official name to
launched the Healthcare the “Saudi
first edition (ISQua). Central Board
of national for
standards for Accreditation
hospitals. of Healthcare
Institutions”.

17
 • In 2013, the national accreditation by CBAHI was
also mandated on all healthcare facilities.

• In addition, CBAHI accreditation became a

prerequisite for renewal of the operating license – a
step towards encouraging more participation in this
ambitious national initiative.
CBAHI At A Glance
• Currently, it is mandatory for all public and private
healthcare delivery facilities (hospitals, polyclinics,
blood banks and medical laboratories) in Saudi
Arabia to comply with national standards set by
CBAHI and obtain their accreditation through a
survey process set forth by the Center.
CBAHI’s Accreditation Achievements

19
Total of 273 hospitals had undergone
CBAHI accreditation process (status till
October 2019):
• 212 hospitals had been accredited
(78%).
• 50 hospitals had denied accreditation
(18%).
• 9 hospitals with conditional
accreditation (3%).
• 2 hospitals had their accreditation
suspended (1%).

20
Out of 88 clinical laboratories, total of 56
laboratories (64%) had been accredited
(until September 2019).

21
Total of 196 Primary Health Care
Centers had undergone CBAHI
accreditation process (status until
October 2019):
• 165 PHC had been accredited
(84.2%).
• 28 PHC had denied accreditation
(14.3%).
• 3 PHC had conditional
accreditation (1.5%).

22
CBAHI Literature Review

23
• CBAHI standards need significant modifications to meet ISQua principles.
New and developing accreditation programs should be encouraged to be
published (Alkhenizan A, 2010).

• Limited number of hospitals has been accredited by CBAHI. Despite the

great efforts to improve services in health sector, number of obstacles (such
as finance and qualified staff) have not yet been overcome to achieve
effective application of quality (Almasabi MH, 2013).

• CBAHI accreditation has positive impact on healthcare environment

processes, outcome and patient satisfaction (Al Shammari M, et al, 2015).

24
Accreditation: Challenges

25
• Validity of standards.
• Reliability of assessments/surveys.
• Leadership and effective engagement of healthcare professionals.
• Transparency and accountability.
• Patient/care givers involvement.
• Quality of gathered data & proper analyses.
• Benchmarking and data share.
Summary

27
Take home message:
• Accreditation is not about ‘passing an exam, it is
about commitment.
• Accreditation is not the goal → Continuous Quality
Improvement.
• Accreditation programs guide performance and
influence organisational culture.
• Accreditation increases efficiency → health systems
need to become less accepting of errors.
29
References:
• Brubakk K, Vist GE, Bukholm G, Barach P, and Tjomsland O. (2015). A systematic review of hospital accreditation: the challenges
of measuring complex intervention effects. BMC Health Services Research. 15:280.
• Chen, L. W., Nguyen, A., Jacobson, J. J., Gupta, N., Bekmuratova, S., & Palm, D. (2015): Relationship between quality improvement
implementation and accreditation seeking in local health departments.
• Duckett S, Jorm C, Moran G and Parsonage H. (2018). Safer care saves money: How to improve patient care and save public money
at the same time. Grattan Institute. Viewed 3 March 2019. https://grattan.edu.au/wp-content/uploads/2018/08/Safer-care-saves-
money.pdf
• Duckett S, Jorm C, Danks L and Moran G. (2018). All complications should count: Using our data to make hospitals safer. Grattan
Institute. Viewed 3 March 2019. https://grattan.edu.au/wp-content/uploads/2018/02/897-All-complications-should-count.pdf.
• Greenfield D, Pawsey M, Naylor J, Braithwaite J. (2013). Researching the Reliability of Accreditation Survey Teams: Lessons Learnt
When Things Went Awry. Health Information Management Journal, 42(1), 4–10.
• Greenfield D, Pawsey M, Naylor J and Braithwaite, J. (2009). Are accreditation surveys reliable? International Journal of healthcare
quality assurance. 22(2):105-16
• Greenfield D, Moldovan M, Westbrook M, Jones, D, Low L, Johnston, B, ... Braithwaite, J. (2012). An empirical test of short notice
surveys in two accreditation programmes. International Journal for Quality in Health Care. 24(1), 65-71.
• Greenfield D, Lawrence SA, Kellner A, Townsend K, Wilkinson A. (2019) Health service accreditation stimulating change in clinical
care and human resource management processes: a study of 311 Australian hospitals, Health policy (2019). Viewed 6 May 2019.
https://doi.org/10.1016/j.healthpol.2019.04.006.
• Griffith JR. (2018). Is It Time to Abandon Hospital Accreditation? American Journal Of Medical Quality. 33(1): 30–36.

30
• Hinchcliff R, Greenfield D, Moldovan M, Westbrook J, Pawsey M, Mumford V, Braithwaite J. (2012). Narrative synthesis of health service
accreditation literature. BMJ Quality and Safety. 21(12): 979–91.
• Miranda B Lam, Jose F Figueroa, Yevgeniy Feyman,2 Kimberly E Reimold, E John Orav, Ashish K Jha (2018): Association between patient
outcomes and accreditation in US hospitals: observational study
• Mumford V, Reeve R, Greenfield D, Forde K, Westbrook J and Braithwaite J. (2015). Is accreditation linked to hospital infection rates? A 4-
year, data linkage study of Staphylococcus aureus rates and accreditation scores in 77 Australian acute hospitals. International Journal for
Quality in Health Care. 27 (6): 479–485.
• Sekimoto M, Imanaka Y, Kobayashi H, Okubo T, Kizu J, Kobuse H, Mihara H, Tsuji N, Yamaguchi A. (2008). Impact of hospital
accreditation on infection control programs in teaching hospitals in Japan. American Journal of Infection Control. 36:212–19.
• MS Fatima and Habibur Rahman M (2017): The Impact of Joint Commission International Healthcare Accreditation on Infection Control
Performance: A Study in Dubai Hospital.
• Falstie-Jensen AM, Larsson H, ERIK HOLLNAGEL Hollnagel E, Norgaard M, Svendsen MLO, and Johnsen SP (2015): Compliance with
hospital accreditation and patient mortality: a Danish nationwide population-based study.
• Falstie-Jensen AM, Larsson H, ERIK HOLLNAGEL Hollnagel E, Norgaard M, Svendsen MLO, and Johnsen SP (2015): Is compliance with
hospital accreditation associated with length of stay and acute readmission? A Danish nationwide population-based study
• Haj-Ali, W., Bou Karroum, L., Natafgi, N., & Kassak, K. (2014). Exploring the relationship between accreditation and patient satisfaction –
the case of selected Lebanese hospitals.
• https://portal.cbahi.gov.sa/english/home

31
• Alkhenizan A and Shaw C (2010): Assessment of the accreditation
standards of the Central Board for Accreditation of Healthcare
Institutions in Saudi Arabia against the principles of the International
Society for Quality in Health Care (ISQua).
• Almasabi MH (2013): An Overview of Quality and Accreditation in
the Health Sector within Saudi Arabia.
• Al Shammari M, Al Habib S, Al Shubrami D, Al Rashidi M (2015):
Impact of Hospital‘s Accreditation on Patient Safety in Hail City,
Saudi Arabia: Nurses‘Perspective.
32