Accreditation and Quality Assessment
In 1974 a voluntary national hospital accreditation program was introduced, modelled on the US Joint Commission and the Canadian programs, by an organisation widely representative of health care peak bodies and Government, initially titled the Australian Council on Hospital Standards (ACHS), but subsequently called the Australian Council on Healthcare Standards (same acronym) as the program was extended to other health care facilities as well as hospitals. Accreditation can now be obtained through other organisations in this country but the ACHS remains the major organisation involved, and currently over 90% of Australian public and private hospitals are accredited (Australian Hospital Statistics, 2011-12). The acronym HCOs (Health Care Organisations) may be used from hereon as an alternative to hospitals for it encompasses other facilities such as Day Procedure Centres.
In the early 1980s the presence of a quality assurance process within a hospital became a requirement for ACHS accreditation. However at that time the clinicians’ view of the accreditation program was that it did not reflect patient outcomes and its concentration was on administrative processes. It was also evident that in some circumstances a hospital could be fully accredited and yet on-site surveys had failed to identify poor clinical outcomes, as there were no accessible documented measures of clinical care.
The purpose of a hospital is to treat compromised people i.e. patients, not clients. A client can make a decision to purchase or not purchase a service or item depending on price etc., but a compromised person has to “purchase” the service which should, hopefully, correct or reduce their compromised state. Compromised people can, for many disorders, be treated in primary care or in the specialist’s office, but other disorders may require multidisciplinary management in a facility which provides access to complex investigative and treatment pathways. The ACHS accreditation program, as such programs did, was ensuring that the environment, i.e. the processes and management in the facility, were appropriate. However, it had no system in place by which to determine the success, or otherwise, of the management of a compromised person.