In 2021, the UMIT Oncological Tomotherapy Center passed an international accreditation by the Joint Commission International (JCI), a recognized world leader in healthcare accreditation.
Healthcare accreditation is a form of external comprehensive evaluation that demonstrates that a healthcare provider complies with the rules and standards set by an international accreditation organization.
The importance of accreditation in the healthcare sector can hardly be overestimated. Of course, every medical organization fulfills national requirements and sets internal standards. But imagine that a medical organization is accredited by a world-renowned independent organization. This means that the clinic meets the highest international standards and best practices.
International accreditation in healthcare is not just a reputation. When a medical organization prepares and passes the accreditation process, it optimizes its business processes, improves the service quality and strengthens the trust of patients - both domestic and foreign.
We are talking with Zhanat Shurenovna Nurazkhanova, an expert in medical services quality management. Zhanat Shurenovna – is a hematologist, the highest category doctor, highest category health professional, candidate of medical sciences, professor at the National Scientific Medical Center. Dr. Nurazkhanova has almost 40 years of experience in medicine, she has implemented national accreditation standards and international ISO standards, standards of the European foundation for quality management in medical organizations. Under her leadership, the UMIT Oncological Tomotherapy Center in Nur-Sultan has successfully completed the process and received the JCI certificate.
As it is stated on the JCI website, “The Joint Commission International (JCI) is an independent, non-for-profit organization, accredits and certifies healthcare organizations and programs across the globe. In over 100 countries, JCI partners with hospitals, clinics and academic health centers, health systems and agencies, government ministries, academic communities and international human rights defenders to promote strict care standards and provide solutions to maximize productivity.”
- JCI is a nongovernmental organization based in the USA, Chicago, which assesses medical organizations for compliance with international quality standards. This commission has been already working for 70 years. Today, JCI accreditation is the most prestigious in the world. It is difficult to obtain it, and this is an objective recognition of the medical services quality and safety, - explained Zhanat Shurenovna.
To receive accreditation a medical organization must confirm the compliance with the established standards, which cover all aspects of work - from approaches to treatment and patient care - to data storage and equipment maintenance. After adapting the approaches of international standards in relation to the organization, all this is carefully checked by experts, they identify areas that need improvement. The management of the organization can then make changes to ensure that the structures comply with the rules and standards.
Once the organization is prepared, external inspectors will conduct an on-site survey to decide if the organization is eligible for the JCI accreditation.
To maintain the JCI accreditation, an organization will need to be audited every three years to ensure continued compliance.
- Due to the pandemic, the JCI commission conducts an online accreditation, and because of this, it is much more difficult to get accredited now, '' added Zhanat Shurenovna. - Imagine that an expert who sits on the other side of the ocean watches an employee online, who needs to show every corner of every premise, for example, climb onto the roof, go outside. And for the whole process to go smoothly, it is necessary that all the methods of information technology involved are at the proper level. We had to go through online accreditation.
- Let me give you the following fact: at the end of the last year, JCI accreditation was introduced only in four medical organizations of the Russian Federation, and here, in Kazakhstan, in seven medical organizations. The UMIT Oncological Tomotherapy Center became the eighth this year, - said Dr. Nurazkhanova. - At the end of the last year, the JCI accredited 1 083 organizations in 71 countries worldwide.
Most of all, the JCI is being implemented in the UAE (205), Saudi Arabia, China, Turkey, South Korea, Israel - this makes it possible to develop medical tourism, since patients trust the quality of services of accredited clinics.
- The JCI is focused on patient care and safety. She does not put forward requirements, but assesses approaches to solving certain problems, meeting the requirements of international standards, the interlocutor, - the doctor added.
The patient confidence is very important in healthcare. Patients confide their personal health - and often their lives - to the hands of medical personnel. The JCI accreditation shows patients that they can confide their health to the clinic. It also demonstrates to the society that the organization is committed to providing the highest quality services.
When patients see that the organization is accredited, they understand that the medical organization has voluntarily passed a strict evaluation to ensure compliance with high standards. This increased confidence not only attracts more patients, but also helps build partnerships with the community.
The JCI accreditation arranges the work system in such a way that the clinic quarterly and annually analyzes all of the activity areas and develops indicators for priority areas.
- If we have get on the path of fulfilling the JCI standards, then we must constantly improve the quality of services using the tools that the JCI offers. Much attention is paid to risk management. For example, we are often involved in correcting mistakes that have already been made, while in medicine it is important to determine the risks in advance and prevent them. Assure in advance about the building safety, about the care quality, about information security, - explained Zhanat Shurenovna. We also identify areas for improvement, prioritize tasks, what needs to be done right away, what can wait, and work on the indicators selected for problem areas. We also do not forget about outsourcing: we check the quality of the services that are outsourced. The JCI accreditation also takes into account the legal, religious, cultural, financial factors that affect the receipt of quality services. During accreditation, a special attention is paid to the education received by doctors, qualification upgrade courses, internships abroad, as well as the personal attitude of medical and administrative personnel towards patients.
In addition, one of the JCI's top priorities is patient safety.
Medical errors affect one in ten patients worldwide. How does the UMIT Oncological Tomotherapy Center solves the patient safety issues? Back in 2006, the JCI developed six International Patient Safety Goals (IPSG). IPSG compliance is monitored at all JCI accredited hospitals:
1. Identify patients correctly
Correct patient identification means that the right procedure must be performed for the right patient at the right time. It is important to constantly verify the identity of the patient and compare the data on treatment procedures throughout the patient's stay in the healthcare organization.
- In medicine, there can be errors in patient identification. For example, there are different patients with the same surname, the same date of birth. Imagine if they are given the wrong medication or the wrong procedure? Therefore, it is prescribed to check each time the full surname, name, patronymic and full date of birth: day, month, year. This is called dual identification. If such double identification is carried out at each stage of the services provision, then errors are reduced to zero. For the same purposes of correct identification, bracelets are used that are worn on the patient's hand upon admission to the clinic, - the doctor listed.
2. Improve effective communication
When a patient is transferred from one department to another, or from one hospital to another, incorrect communication can lead to delayed delivery of the care the patient needs. The JCI standards help minimize risks and improve safety.
- When, for example, we transfer a patient to a high-risk procedure (in our case - radiation therapy), then the transfer is carried out according to a certain system. The transferring side briefly describes the entire patient situation to the receiving side. For this purpose, a form has been developed - how to transfer, how to receive, this process is controlled by the service quality indicator, - Zhanat Shurenovna explained.
3. Improve the safety of high-alert medications
High-alert medications are drugs that are most likely to cause significant harm to a patient, even when used as indicated. Any medication used inappropriately can cause harm. But high-alert medications cause harm more often, and the harm they do can be more severe, leading to patient suffering and additional costs associated with caring for these patients.
- Many people around the world suffer from incorrect or misuse of high-alert medications. According to the JCI standards, a medical organization must strictly follow specially developed rules for the safe use of such medications, for their marking and storage, - the doctor said.
4. Ensure safe surgery
To ensure surgical safety, it is checked whether it is the right patient, the right procedure, or the right part of the body - before any high-risk manipulation or surgery.
- One of the serious questions is the identification of the surgical area - in our case, it is to identify the area of tumor irradiation. Before carrying out the procedure, the team stops and the doctors, operators take a timeout - they check whether the patient is the right one, and whether the area irradiated is correct. This increases the patient safety, - said the doctor.
5. Reduce the risk of health care-associated infections
Correct hand hygiene is the most important, easiest and the least expensive way to reduce the prevalence of health care-associated infections and the spread of antimicrobial resistance. Hand washing by healthcare professionals can prevent the spread of microorganisms, including antibiotic-resistant ones, that are difficult, if not impossible, to treat.
6. Reduce the risk of patient harm resulting from falls
Elderly and fragile patients with fall risk factors are not the only people who can fall in healthcare organizations. Any patient of any age or physical ability can be at risk of falling due to physiological changes caused by health conditions, medication, surgery, procedures or diagnostic tests that can weaken him.
- Fall prevention in hospital and on the territory of the medical organization is also very important. For example, there may be such a factor as slippery floors after washing, or the condition of the patient himself suggests a high risk of falling. There are rules for preventing falls. If the patient has a high risk of falling, then after registration he puts on a special bracelet, he is provided with a support for moving inside the clinic and for procedures, he is also placed in the ward closer to the nurse's post, the personnel checks the serviceability of the nurse call buttons, which should be in places visited by the patient - the expert listed.
The main benefit of the JCI accreditation is the creation of a culture in which employees are willing to report problems and potential mistakes without fear of punishment, and where employees are given the opportunity to learn and overcome these problems and situations.
- We, at the UMIT Oncological Tomotherapy Center, have implemented an incident management system. As soon as the staff saw that something went wrong, they fill out an incident report. Such a report does not require a detailed explanation, there is no need to write a lot, it is just necessary to note what went wrong, in what place,” the doctor explained. – The service for quality control and patient safety independently conducts investigation, analyzes the incident, and tries to find out the root cause of the incident. Often, the causes of an incident are not the fault of the staff, but the wrong organization of a process or procedure. And when we identify the cause of an incident, we develop corrective and preventive actions. What follows the admission of an error? This will be immediately followed by personnel training in accordance with the developed internal rules for the implementation of procedures.
An important topic is the ethical aspects of incomplete medical care. For example, a patient does not complete treatment for some reasons.
- It is very important in tomotherapy - a patient does not undergo the required number of radiation therapy sessions. Usually in our organizations such a patient can be released. According to the JCI system, it is obligatorily to investigate the reasons why the patient does not want to continue treatment. The reasons may be of a family nature, there may be hidden complications that the patient does not want to talk about. We have to ask ourselves why he does not want to? Either it is connected to the equipment, or there was a poor contact with the medical staff, or there is a lack of information about the benefits and dangers of tomotherapy. It so happens, that a patient loses confidence in the medical organization and begins non-traditional methods or expresses a desire to be treated abroad. The ethical aspects of such a refusal from treatment are now considered by the medical-control and ethical commission, to which the patient himself or his representative is invited, - said Zhanat Shurenovna.
Accreditation is a long-term process that requires commitment. Large preparatory work is being done and more work is required to ensure that accreditation standards are met. Organizations that receive and maintain the JCI accreditation are committed to providing the best possible service level to their patients. Potential patients or partners are more likely to choose an accredited healthcare organization rather than an unaccredited one. As accreditation improves the care quality, it also increases patient satisfaction. And satisfied patients spread information about the clinic and return when they need additional medical care, or recommend it to friends.
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The UMIT Oncological Tomotherapy Center (Nur-Sultan, Kazakhstan) is the first medical center in Kazakhstan and Central Asia for cancer treatment, where the most effective type of radiation therapy in the modern world - tomotherapy - is used to combat oncological neoplasms.
The UMIT Oncological Tomotherapy Center accepts patients from near and far abroad, both adults and children, for the treatment of oncological diseases, providing high treatment standards, highly qualified human resources, advanced achievements in science and technology, and safe practices with proven clinical efficacy. Read more here: Why foreigners go for treatment at the UMIT Oncological Tomotherapy Center?
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