Posted by: burusi | November 10, 2018

Managers Opinion About the Implementation of Hospital Accreditation in Georgia

Managers Opinion About the Implementation of Hospital Accreditation in Georgia

Teona Gorgadze1, Otar Vasadze2

The University of Georgia, School of Health Sciences and Public Health

1PhD student, Public Health; 2Supervisor, MD, PhD, Associate Professor

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Abstract

In healthcare system of Georgia is not implemented accreditation of medical organizations, which is well approved tool for quality management. In 2010 “Independent Hospital Association of Georgia”, which united only 12 hospitals at that time, tried to conduct self-assessment of the hospitals, but only five of them took part in it. The aim of the current study was to assess the prospects of implementation of the hospital accreditation system in Georgia through studying the opinion of managers employed in hospitals. 66 different levels managers from 46 hospitals took part in the survey.  97% of the managers think that accreditation is necessary, 84,8% – that accreditation should be obligatory and should meet international requirements, but only for 51,5% of managers was known accreditation requirements of  any country. Only 17,4% of hospitals had an attempt to obtain any kind of accreditation, 75 % from them were successful and 25% were unsuccessful. Based on the analysis of the results of the study we can conclude that without active intervention and regulation from the Government hospital accreditation process will not be able to start.

Abbreviations: JCI – Joint Commission International Accreditation;  KTQ – Kooperation für Transparenz und Qualität;  ISO – International Standartization Organization.

Keywords: accreditation, certification system, quality of healthcare, hospital accreditation.

აბსტრაქტი

მენეჯერების აზრი საავადმყოფოს აკრედიტაციის დანერგვის შესახებ საქართველოში

თეონა გორგაძე1, ოთარ ვასაძე2

საზოგადოებრივი ჯანდაცვის დოქტორანტი, საქართველოს უნივერსიტეტი, ჯანმრთელობის მეცნიერებების სკოლა

2 მედიცინის მეცნიერებათა დოქტორი, ასოცირებული პროფესორი, საქართველოს უნივერსიტეტი, ჯანმრთელობის მეცნიერებების სკოლა

საქართველოს ჯანდაცვის სისტემაში ჯერ კიდევ არ არის დანერგილი სამედიცინო ორგანიზაციების აკრედიტაცია, რომელიც ხარისხის მართვის კარგად აპრობირებულ ისტრუმენტს წარმოადგენს. 2010 წელს დამოუკიდებელ ჰოსპიტალთა ასოციაციამ, რომელიც  იმ პერიოდში მხოლოდ 12 საავადმყოფოს აერთიანებდა, სცადა საავადმყოფოთა თვითშეფასების ჩატარება, მაგრამ მასში მხოლოდ 5-მა  საავადმყოფომ მიიღო მონაწილეობა. ჩვენს მიერ ჩატარებული კვლევის მიზანს წარმოადგენდა საქართველში საავადმყოფოთა აკრედიტაციის სისტემის დანერგვის პერსპექტივების შეფასება უშუალოდ საავადმყოფოებში დასაქმებული მენეჯერების აზრის შესწავლის გზით. კვლევაში მონაწილეობა მიიღო 46 საავადმყოფოში დასაქმებულმა 66-მა სხვადასხვა დონის მენეჯერმა. გამოკითხულთა 97% თვლის, რომ აკრედიტაცია საჭიროა, 84,8%-ის აზრით ის უნდა იყოს სავალდებულო და შეესაბამებოდეს საერთაშორისო მოთხოვნებს, თუმცა, მხოლოდ 51,5%-თვის არის ცნობილი რომელიმე ქვეყნის აკრედიტაციის მოთხოვნები. კვლევაში მონაწილე საავადმყოფოებიდან რომელიმე ტიპის აკრედიტაციის მიღების მცდელობა ჰქონდა მხოლოდ 17,4%-ს, რომელთაგან 75% წარმატებული, ხოლო 25% წარუმატებელი იყო.  კვლევის შედეგების ანალიზის საფუძველზე შეიძლება დავასკვნათ, რომ მიუხედავად იმისა, რომ საავადმყოფო სექტორი მხარს უჭერს აკრედიტაციის პროცესის დაწყებას, სახელმწიფოს აქტიური ჩარევისა და რეგულირების გარეშე ის ვერ დაიწყება.

Introduction

Development of quality management systems and implementation of its control are vital for all countries, especially for developing countries with limited resources providing the population with the minimally necessary medical services. Quality oriented health care is a safe, effective and efficient medical service, that will respond the health care requirements. These requirements are complex that has been achieved by implementing accreditation of hospitals in a number of countries.  (Ashish, Epstein, 2010; Chassin, O’Kane, 2011).

Implementation of quality management policy has great importance for Georgia. Patient should be provided with safe, effective and affordable medical care with the limited resources available in the country.  So it is very important to provide the quality of medical care as a state, as well as at a separate hospital level (Sasania, 2010).

The aim of the study was to assess the prospects of implementation of the hospital accreditation system in Georgia through studying the opinion of managers employed in hospitals.

Methodology

A questionnaire with 17 questions has been developed and analyzed. 66 Managers fully answered the questionnaires. The managers have been interviewed in 2017.

Results

46 hospitals took part in the study, 28 (60,9%) were from Tbilisi and 18 (39,1%) were from different regions of Georgia. According to the capacity 28 (60,9%) hospitals had more than 50 beds and 18 (39,1%) hospitals had less than 50 beds. 32 hospitals (69,6%) were multi-profile and 14 (30,4%) hospitals were mono-profile (Illustration 1).

Illustration 1. Location, capacity and profile of hospitals.

Picture1

Source: study results.

According to the capacity, hospitals having more than 50 beds were 19 (67,9%) in Tbilisi and 9 (32,1%) in regions. Hospitals having less than 50 beds were 9, from total amount (18 hospitals) in Tbilisi and 9 hospitals were in regions. There were 17 (53,1%) multi-profile hospitals in Tbilisi and 15 (46,9%) multi-profile ones in regions. 11 (78,6%) mono-profile hospitals in Tbilisi and only 3 (21,4%) hospitals in regions took part in the study (Illustration 2).

Illustration 2. Location, capacity and profile of hospitals.

Picture7

Source: study results.

97% of managers participating in the survey consider that it is necessary to implement the accreditation process in Georgia, while for 3% of managers was difficult to answer the question (Illustration 3). The data is statistically significant (chi-square=12,5;  df=2;  P<0.05).

Illustration 3. The need to introduce  accreditation process in Georgia.

Picture9

Source: study results.

84,4% of managers thinks that accreditation process of hospitals should be mandatory. 13,6% of them don’t agree this opinion, while for 1,5% of managers it was difficult to answer the question (Illustration 4).  The data is statistically significant (chi-square=13,4; df=6;  P<0.05).

Illustration 4. Should accreditation process be mandatory in Georgia.

Picture11

Source: study results.

Positive answer about correspondence of international and local requirements, in case of implementation of accreditation process mentioned 85% of managers, negative answer mentioned only 2% of managers, and for 14% of managers it was difficult to answer the question (Illustration 5). The data is statistically significant (chi-square=8,96; df=4;  P<0.05).

Illustration 5. Correspondence of international and local requirements.

Picture13

Source: study results.

53% of managers say that they use international quality indicators, 42,2% of managers work according to the  local indicators, 5% of managers answered that she/he doesn’t use any kind of indicators (Illustration 6). The data is statistically significant (chi-square=32,3; df=6;  P<0.05).

Illustration 6. Use of quality assessment indicators

Picture17

Source: study results.

31(47%) managers from 24 hospitals (52,7% of hospitals taking part in survey) confirmed the opinion whether their hospital meets the requirements of any country or international accreditation. 8 (12,1%) managers think, that the hospital doesn’t meet the requirements of any country or international accreditation, while for 27 (40,9%) managers, from 14 hospitals it was difficult to answer the question. 54,1% of managers in Tbilisi and 34,5% managers in regions say, that their hospital meet the requirements of any country or international accreditation. 10,8% of managers in Tbilisi and 13,8% of managers in regions  negatively assessed the question. For 35,1% of managers in Tbilisi and for  51,7% of managers in regions it was difficult to answer the question. 55,8% of managers, working in hospitals with the capacity of more than 50 beds and 28,6% of managers working in hospitals with the capacity of less than 50 beds say that their hospital meets the requirements of any country or international accreditation. 11,6% of managers working in hospitals with the capacity of more than 50 beds and 14,3% of managers working in hospitals with the capacity of less than 50 beds say that their hospitals do not meet the requirements of any country or international accreditation. For 32,6% of managers working in hospitals with the capacity of more  than 50 beds and for 57,1% of managers working in hospitals with the capacity of less than 50 beds it was difficult to answer the question. 41,7% of managers in multi-profile hospitals answered the question positively, 14,5% of managers answered negatively and for 43,8% it was difficult to answer the question. 61,1% of managers in mono-profile hospitals answered the question positively, 5,6% of managers answered negatively and for 31,3% it was difficult to answer (Illustration 7).

Illustration 7. Opinion of managers that the hospital meets the requirements of any country or international accreditation.

Picture19

Source: study results.

8 (17,4%) from 46 hospitals had an attempt to get accreditation. Only 33,3% of managers from 24 hospitals, who think that their hospital meet the requirements of any country or international accreditation had an attempt to get accreditation. 25% of hospitals (7 hospitals from 28 ones), with more than 50 beds had an attempt of accreditation. 5,6% of hospitals (1 hospital from 18), with less than 50 beds had also attempt of accreditation. 25% of hospitals in Tbilisi (7 hospitals from 28) tried to get the accreditation. 5,6% of hospitals (1 from 18 hospitals) in regions have also attempt to get accreditation. From 32 multi-profile hospitals only 6 (18,7%) confirmed attempt to get accreditation. From 14 mono-profile hospitals 2 (14,3%) of them confirmed the attempt (Illustration 8).

Illustration 8. Attempt to get accreditation according to location, capacity and profile.

Picture20

Source: study results

In accreditation process 75% of hospitals (6 hospitals from 8) got positive result, while 25% (2 hospitals from 8) had negative one. According to the location in Tbilisi 71,4% of hospitals got positive result and 28,6% of hospitals  got negative result in accreditation process. Only one hospital in region had an attempt and got also positive result. Both hospitals, that were not successful in accreditation process were in Tbilisi. A similar statistical data result was observed according to the capacity of hospitals. 28,6% of hospitals having more than 50 beds got negative result. Both hospitals were multi-profile (33,3%) (Illustration 9).

Illustration 9. Results of accreditation process according to the location, capacity and profile.

Picture21

Source: study results.

According to the survey one hospital had got “Joint Commission International Accreditation -JCI”, one had got “Kooperation für Transparenz und Qualität- KTQ” and 4 hospitals had got “International Standartization Organization- ISO”.  2 hospitals which were not successful in accreditation process did not answer the question about the reasons for the failed results. 7,6% of managers who did not participate in accreditation process answered the above mentioned question. 2 respondents answered that the main result of unsuccessful attempt is  “insufficient involvement of governing units”, 1 respondent meant – “insufficient work of quality department in hospital” and 2 hospitals said that the hospital was new.

33,3% of managers answered that it took them one year to get positive result in accreditation, 16,7% of managers circled the answer- “more than 2 years” and 50% did not answer the question (Table 1).

Table 1.  What time did it take to achieve the positive results of the accreditation process?

Time Number %
6 months
1 year 2 33.3%
2 years
More than 2 years 1 16.7%
No answer 3 50%

Source: study results.

Managers who did not answer or it was difficult to answer the question, whether their hospitals meet the requirements of any country or international accreditation, had possibility to answer the question about time, needed to carry out the work to meet such demands.  85,7% of managers (30 managers from 35) answered the question. 7 (20%)  managers’ answer was 6 months, 8 (22,9%) managers answered 1 year, 9 managers answered 2 years, 6 managers –more than 2 years and 5(14,3%) managers did not answer the question (Table 2).

Table 2. What time is it necessary to achieve the positive results of the accreditation process?

Time Number %
6 months 7 20%
1 year 8 22.9%
2 years 9 25.7%
More than 2 years 6 17.1%
No answer 5 14.3%

Source: study materials.

Conclusion

As the result of the survey we established that the managers of hospitals in Tbilisi as well as in different regions of Georgia have positive views about the accreditation process. The hospitals are ready to ensure the compliance of international accreditation process requirements with local ones. Managers in hospitals in regions are interested in accreditation process, more than the ones in hospitals in Tbilisi. It is very important to make promotion of advantages of accreditation system in Georgia. Accreditation system in Georgia should be established based on a well-proven and operating system. It is necessary to create integrated regulatory system in Healthcare with all mechanisms having defined functions, significance and area of action. Healthcare system in Georgia should clearly define quality assessment indicators.

References   

  1. Ashish J., Epstein A., (2010) – Hospital Governance and the Quality of Care – http://content.healthaffairs.org
  2. Gzirishvili D., (2012) – Independent Georgia – Social and Health Care Systems. Analytical Review  – Tbilisi.
  3. JCAHO / Joint Commission, camh. (2006) – Comprehensive Accreditation Manual for Hospitals.
  4. Sasania I., (2010) – The Quality of Healthcare Structure –  http://www.insurance.org.ge/

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