Hospital accreditation: lessons from low- and middle-income countries.

The growth of accreditation programs in low- and middle-income countries (LMICs) provides important examples of innovations in leadership, governance and mission which could be adopted in developed countries. While these accreditation programs in LMICs follow the basic structure and process of accreditation systems in the developed world, with written standards and an evaluation by independent surveyors, they differ in important ways. Their focus is primarily on improving overall care country-wide while supporting the weakest facilities. In the developed world accreditation efforts tend to focus on identifying the best institutions as those are typically the only ones who can meet stringent and difficult evaluative criteria. The Joint Learning Network for Universal Health Coverage (JLN), is an initiative launched in 2010 that enables policymakers aiming for UHC to learn from each other's successes and failures. The JLN is primarily comprised of countries in the midst of implementing complex health financing reforms that involve an independent purchasing agency that buys care from a mix of public and private providers [Lancet 380: 933-943, 2012]. One of the concerns for participating countries has been how to preserve or improve quality during rapid expansion in coverage. Accreditation is one important mechanism available to countries to preserve or improve quality that is in common use in many LMICs today. This paper describes the results of a meeting of the JLN countries held in Bangkok in April of 2013, at which the current state of accreditation programs was discussed. During that meeting, a number of innovative approaches to accreditation in LMICs were identified, many of which, if adopted more broadly, might enhance health care quality and patient safety in the developed world.

Improving health system quality in low- and middle-income countries that are expanding health coverage: a framework for insurance.

PURPOSE: Low- and middle-income countries are increasingly pursuing health financing reforms aimed at achieving universal health coverage. As these countries rapidly expand access to care, overburdened health systems may fail to deliver high-quality care, resulting in poor health outcomes. Public insurers responsible for financing coverage expansions have the financial leverage to influence the quality of care and can benefit from guidance to execute a cohesive health-care quality strategy. DATA SOURCES: and selection Following a literature review, we used a cascading expert consultation and validation process to develop a conceptual framework for insurance-driven quality improvements in health care. RESULTS OF DATA SYNTHESIS: The framework presents the strategies available to insurers to influence the quality of care within three domains: ensuring a basic standard of quality, motivating providers and professionals to improve, and activating patient and public demand for quality. By being sensitive to the local context, building will among key stakeholders and selecting context-appropriate ideas for improvement, insurers can influence the quality through four possible mechanisms: selective contracting; provider payment systems; benefit package design and investments in systems, patients and providers. CONCLUSION: This framework is a resource for public insurers that are responsible for rapidly expanding access to care, as it places the mechanisms that insurers directly control within the context of broader strategies of improving health-care quality. The framework bridges the existing gap in the literature between broad frameworks for strategy design for system improvement and narrower discussions of the technical methods by which payers directly influence the quality.

Establishing national goals for quality improvement.

BACKGROUND: For a number of reasons, it has been difficult to garner public interest in the need to improve the quality of care delivered nationally. One possible reason for this is that the concept of quality has different meanings for different stakeholders. To make the problems of suboptimal quality more concrete and potential solutions more compelling, the Strategic Framework Board (SFB) recommended developing a set of national goals for quality improvement. OBJECTIVES: To describe the criteria by which national goals should be selected, illustrate the analytic methods that should be used to support the development of such goals, and describe and illustrate a process by which national goals could be formulated. RESEARCH DESIGN: Targeted review of literature and discussions among members of the SFB. FINDINGS: National goals have played a key role in making progress under the Healthy People 2000 and Health People 2010 initiatives. The recommended process will involve assembling key evidence as well as engaging in a consensus process. CONCLUSIONS: Developing a set of national goals for quality improvement is a key activity for a national quality measurement and reporting system to undertake. The steps outlined here represent a feasible and productive method for accomplishing this objective.

The clinical context of technology assessment.

KIE: A major factor in the rise of health care costs has been the rapid dissemination of new medical devices and procedures without regard to cost effectiveness. The new reimbursement systems designed to reduce health expenditures will place the burden of evaluating technological advances on local decision makers, and an increased demand can be expected for reliable methods of assessing the costs and benefits of new technologies. Smits presents a simple, clinically-based model for determining a technology's potential for offering diagnostic and therapeutic benefits. She also discusses the role that factors such as cost, physician preference, and consumer demand play in singling out a new technology for study.^ieng