- update

The Hospital Accreditation Programme (HAP) has a proven record in promoting organisational standards in healthcare organisations.

It was set up in 1990 to monitor, assess and develop organisational standards in healthcare organisations.

HAP seeks to set standards that -

• Provide hospitals with a supportive management development tool
• Encourage hospitals to review current practices and procedures to facilitate change
• Provide supporting mechanisms for hospitals preparing for accreditation
• Improve the organisational standards in small hospitals
• Set standards that are credible, achievable, measurable, applicable and agreeable
• Train surveyors to be professional, objective and consistent in their assessment
• Establish a national Board of professional advisers to assess reports consistently
• Direct the future programme to the best interest of hospitals and Trusts in relation to macro environmental changes
• Provide a mechanism to enable participants to network
• Provide a competitive cost efficient mechanism for internal development
• Provide an overall efficient and professional service.

Approximately 300 survey visits have been undertaken in healthcare organisations within the UK, Ireland and even in some organisations abroad. Initially, HAP focussed on hospitals with less than 200 beds, mainly independent and NHS community units. More recently the programme has expanded to include accreditation in community services including Primary Care Trusts and District Nursing Services.

HAP is owned by CHKS Ltd but managed by CASPE Research. CASPE Research is a ‘not for profit’ organisation carrying out research aimed at improving the quality of care. It carries out research on behalf of the DoH and it runs the Accreditation and Development of Health Records Programme. HAP offers independent and NHS healthcare organisations an opportunity to participate in voluntary accreditation programmes. The programme aims to ensure that robust systems are in place within the organisation to delivery quality services and to support clinical and corporate governance.

Updating assessment standards
The healthcare standards used for assessment are continually monitored and reviewed in consultation with the users and with professionals to providecomprehensive up to date guidance. HAP runs a programme of organisational development to ensure participants are continually updated on new standards, changes in national policy and quality issues affecting them at a national and local level. HAP surveyors are recruited from accredited facilities and are seconded to the programme for approximately six days per year. Surveyors offer individuals the chance to visit similar facilities throughout the UK and thereby promote professional development. HAP was in fact the first accreditation programme in the UK and has set up accreditation programmes in Europe and South Africa. It is recognised by the Academy of Medical Royal Colleges, Community Hospitals Association and the Independent Healthcare Association. It also contributes to the International Society for the Quality and Healthcare Initiative to develop international principles for healthcare accreditation standards (ALPHA project).

Stakeholders
HAP’s Board has advisors from fourteen organisations including the BGS but there are members from, among others, the Royal College of Anaesthetists, RCGPs, Royal College of Midwives, RCN, Royal College of Obstetricians and Gynaecologists.

The role of the Independent Professional Board, of which I am a member, is to decide on the level of accreditation to be awarded. Board members consider all aspects of the surveyors’ report and assess whether the organisational practices are conducive to the delivery of good quality, safe care and award accreditation status as appropriate. Accreditation may be awarded for either 1, 2 or 3 years depending on the level of compliance with the standards. Members liaise with nominating organisations to promote and monitor safe practice and continuous quality improvement. I have fed in details of NSF, Essence of Care, recent BGS Bulletin information etc. as well as information I obtain in my roles as Medical Director at Basildon and Thurrock University Hospitals NHST, NSF Lead for Elderly, Manager of the Education and Training Directorate at Basildon and work on the North Thames SpR Training Committee.

Training the Board
There is formal training for Board members and surveyors at least twice a year (1 or 2 days). At this point an opportunity is taken to update Board members on accreditation processes, review standards etc. I have attended these annually and their quality is excellent. Standards are continuously reviewed and updated to ensure they are relevant and timely, and events in relation to CHI assessments, NCSC, PPU, IHA and Department of Health are taken on board.

Walk in centres
Recently standards for assessment of treatment centres and walk-in centres are being developed and included. Approximately two years ago I took part in a full review of the standards relating to the older people and these are being reviewed again this year. In addition to a constant review of the standards framework, client feedback is taken on board to improve the accreditation process.

Apart from my input in assessing the outcomes of accreditation visits and input into keeping standards for the elderly updated, I was also involved in a sub-group looking at the scoring mechanism for HAP. This mechanism has now been piloted and introduced to help support the Board in making objective decisions on accreditation with particular reference to the safety of the organisation accredited and separating “core” and “non-core” standards.

Since my time on the Board, standards applicable to community services have also been added (1999), including health visiting and district nursing services, and manuals for accreditation standards and for surveyors have been split to focus on particular sectors and healthcare structures, e.g. a document focussing on independent healthcare, one on Scottish health services and one on NHS services throughout England and Wales.

Changing times
The UKMC is of the opinion that, for the moment, the BGS should remain involved in this organisation to ensure that proper standards for care of older patients are maintained within the organisations accredited, and the standards themselves focus on clinical issues, up to date practice and excellence relating to older patients’ care.

The increased involvement of CHAI is bringing pressure on organisations involved in accreditation such as HQS and HAP. With the arrival of CHI assessment and new risk management standards including CNST etc, organisations have been less inclined to be involved in accreditation processes. This has been because much work was involved in multiple reviews along with the usual clinical workload. The BGS may need to review involvement with HAP in the future, should HAP change its focus.

Having said this, HAP does work closely with Commission for Health Improvement, the Independent Healthcare Association and the National Care Standards Commission to ensure integration. At a meeting earlier this year, CHI indicated that it was not in the business of standard setting and clearly organisations that were already subject to an accreditation process would be in a strong position. HAP may well therefore benefit from positioning itself to support such accreditation.

A catalyst for change may be the plan for quite a large group of independent hospitals to withdraw from HAP accreditation. HAP may increasingly be involved abroad and the BGS will then review the usefulness of its involvement with organisation.

Gill Jenner
BGS representative on
HAP Board