Accreditation of Healthcare Organizations in Saudi Arabia

Accreditation of Healthcare Organizations in Saudi Arabia

Efficiency and effectiveness are critical tools for controlling costs in healthcare organizations. Different countries around the world are increasingly striving to improve the quality of healthcare services and ensure efficiency and effectiveness. Saudi Arabia is among the countries that have undertaken dramatic steps towards strengthening their healthcare systems. Through its ambitious Vision 2030, KSA has put in place revolutionary measures aimed at enhancing the capacity of its healthcare organizations to meet the growing demand posed by the rapidly growing population and the rising number of the elderly in the Kingdom (Al-Hanawi, Khan, & Al-Borie, 2019). Part of the National Transformation Plan 2020 is the increased participation of the private sector in the healthcare sector.

With the increased involvement of the private sector in healthcare, the government must ensure that the performance of healthcare institutions in the Kingdom resonates with the established standards and support continuous improvement. This aspect requires accreditation. Desveaux, Mitchell, Shaw, and Ivers (2017) define accreditation as a quality assurance process by which an authorized external body evaluates the compliance of healthcare organizations with pre-established standards. The procedure seeks to assess, promote, and ensure that healthcare organizations uphold quality and patient safety. Saudi Arabia has a long history of accreditation, dating back to the late 20th 1990s (Qureshi & Ullah, 2012). The present discourse evaluates the impact of accreditation on Saudi healthcare organizations. The study identifies national and global accreditation agencies and the contribution of one of the agencies on the efficiency and effectiveness of organizations in Saudi Arabia.

National and Global Accreditation Bodies

Healthcare accreditation is not a new idea in Saudi Arabia. Since 1994 when Saudi Aramco instituted Medical Services Organizations Standards, both private and government hospitals have undergone scrutiny to ensure they meet pre-set standards. To date, the Kingdom works with various agencies to evaluate the performance of healthcare organizations to ensure they meet the pre-established standards.

The Central Board of Accreditation for Healthcare Institutions (CBAHI) is one of the national healthcare accreditation agencies in KSA. According to Qureshi and Ullah (2012), CBAHI has accredited more than 40 health institutions since its inception. The Ministry of Health (MOH) has made it compulsory for all healthcare organizations in KSA to acquire CBAHI accreditation.

Apart from the national agency, hospitals in Saudi Arabia have also shown commitment to receive accreditation from internationally recognized agencies. Some of these agencies include Joint Commission International (JCI), International Standard Organization (ISO), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Australian Council on Health Care Standards (ACHS), and Accreditation Canada (Qureshi & Ullah, 2012). King Faisal Specialist Hospital and Research Centre (KFSH & RC) became the first hospital in Saudi Arabia to obtain international accreditation in 2000.

The Joint Commission International has accredited more healthcare organizations in KSA than the other international bodies. Reports from some of the facilities accredited in KSA indicate that accreditation has a significant impact on patient safety practices. For instance, Accreditation Canada found that King Abdul Aziz University Jeddah had a positive effect on most of the safety indicators they assessed during accreditation. While CBAHI is a mandatory accreditation, many facilities in KSA are pursuing international accreditation willingly. These findings reveal that most healthcare organizations in Saudi Arabia readily embrace accreditation and perceive it as a critical component in strengthening quality improvement. Seeking an independent review is a demonstration of an ongoing effort towards quality improvement and operational excellence.

Description of the agency and Facilities

The Joint Commission International is the leading global healthcare accreditation agency in Saudi Arabia. This Commission was instituted in 1994 and operates globally to assist international healthcare organizations in enhancing quality and safety practices in over 100 countries. The International Society for Quality in Health Care (ISQua) endorsed JCI to serve as a safety collaboration center for the WHO. The Joint Commission International operates as a non-profit organization, a global enterprise that identifies measures and shares best practices in patient safety and quality.

Hundreds of health facilities around the world have attained a Gold Seal Approval as JCI accredited institutions. The Commission has a team of qualified and experienced international accreditation surveyors and consultants. The JCI’s mission is to improve healthcare safety and quality through education, accreditation, and certification.

JCI’s involvement in quality improvement does not end with accreditation. The Commission continues to collaborate with high performing organizations to keep pace with new standards and provide guidance on promoting performance. It publishes a set of standards on patient safety and quality improvement regularly and conducts a rigorous on-site survey for healthcare institutions for accreditation. The Commission has global experts who work with governments, ministries of health, and municipal authorities to assist hospitals in achieving their quality goals. In its accreditation, JCI accommodates socio-cultural factors within a country.

The number of JCI accredited facilities in Saudi Arabia has been increasing significantly. The commission has collaborated with academic medical facilities, hospitals, and primary care organizations to support their quest for excellence. JCI helps then healthcare leaders in these organizations to pursue quality, safety, and efficiency as a shared goal.

King Faisal Specialist Hospital and Research Centre is a model JCI-accredited organization in Saudi Arabia. KFSH&RC has received JCI accreditation since 2000 and has been re-accredited severally. In 2014, KFSH&RC became the first Saudi hospital to be accredited and achieved Academic Medical Centre status. The facility has been on re-accreditation and surveyed based on JCI 5th standards from 2017 through to 2020.

The Minister of Health, Dr. Abdullah Al-Rabeeah, confirmed that JCI accreditation had improved significantly in Saudi Arabia with more facilities seeking the certification. JCI accredited organizations are distributed in various cities in the Kingdom of Saudi Arabia. In Riyadh, King Khaled Eye Specialist and King Fahd Medical City have received the accreditation. Makkah-based organizations with JCI accreditation include Hira Hospital and Ajyad. Similarly, JCI has also accredited King Fahd Hospital in Jeddah, Saud Al-Babtain Cardiac Center in Dammam, King Saud Hospital in Onaizah, and King Abdul Aziz Hospital in Taif.

Effectiveness of the Agency on Efficiency and Effectiveness

JCI accreditation is an essential step towards ensuring hospitals’ commitment to quality improvement and patient safety. The agency is a custodian of patient safety and compliance with pre-established performance standards. The Commission focuses on helping healthcare organizations confirm correct patient identification, maintain effective communication between the patients and medical staff, and encourage high-alert medication administration. Accordingly, healthcare organizations receiving JCI accreditation are obliged to uphold high-quality standards and ensure patient safety.

Good governance of healthcare organizations suffices as evidence of quality, effectiveness, and efficiency both to the users and the funders (Tabrizi, Gharibi, & Wilson, 2011). Participation in quality assurance programs such as that of JCI enables healthcare organizations to identify gaps and embrace strategies for enhancing performance.

The MOH applauds Joint Commission International for promoting standards and specifications that meet internationally conceded requirements. The Commission encourages patient-centeredness and management of healthcare facilities. Regarding patient-centeredness, JCI emphasizes global objectives of patient safety, patient rights, drug management, raising patient awareness, access and sustainability of healthcare services, evaluation of patients, and sterilization and surgical care (MOH, 2012).

Within the domain of management of healthcare facilities, the Joint Commission International assesses healthcare organizations against pre-set standards on the management of health institutions (MOH, 2012). The agency focuses on quality improvement of care services, infection control, and management, safety measures in the workplace, information management, and communication as well as the qualification and training of health workers.

Accreditation is one of the measures that healthcare organizations are embracing towards improving quality and cost-effectiveness. According to Corrêa et al. (2018), accreditation identifies factors that affect quality management for sustainable performance. The authors argue that accreditation agencies provide healthcare managers strategies and management tools for enhancing competitiveness, reducing errors to reduce costs and wastages, and meeting customer expectations to improve the overall organizational performance (Corrêa et al., 2018).

Joint Commission International provides control standards for reducing hospital infections, which in turn leads to significant cost-reduction. Some of the existing studies, including Mumford, Greenfield, Parkinson, and Braithwaite (2016), have demonstrated that hospitals with high accreditation scores have lower infection rates. A survey by Thurneysen, Plank, and Boes (2016) indicates that healthcare accreditation promotes safety culture, encourages implementation of hospital-wide complaint management, reduces liability cases, and improves the image of the organizations. These aspects are directly linked to significant cost reduction and improved performance.

The JCI provides valuable supportive knowledge to healthcare organizations through its publications, technical assistance, and education. It offers internationally recognized standards that reflect the full scope of managerial and clinical functions suitable for modern healthcare systems. Engaging JCI assessment and review also increase teamwork and promotes learning from experienced reviewers. Moreover, involving the Joint Commission International in auditing healthcare operations leads to improved hospital reputation and consumer satisfaction.

Accreditation from the aspect of involved stakeholders

Quality improvement efforts have an impact on a broad range of stakeholders with valuable perspectives on evaluation and accreditation process. Some of the stakeholders whose perspectives on accreditation are critical include healthcare professionals, healthcare leaders, financers, and patients. This section evaluates accreditation from the aspect of involved stakeholders.

Healthcare Professionals Perspectives

Healthcare professionals have varying standpoints regarding accreditation. A study seeking to evaluate the attitude of healthcare professionals towards accreditation found that most healthcare professionals have a skeptical attitude towards accreditation. They view the process as bureaucratic and demanding. A majority of the doctors express concerns on how accreditation measures quality. They believe that accountability should remain within a professional framework and not to accreditation bodies.

Healthcare Organization Leaders

Leaders of healthcare organizations have conflicting perspectives toward accreditation. In some institutions, the attitude is positive and supportive of the process, while other leaders argue that accreditation is not worth its cost. These conflicting findings are attributable to understanding that the benefits of the accreditation have not been well established.

On the one hand, healthcare leaders perceive accreditation as a potential marketing tool. The managers approve accreditation, arguing that the process affirms the quality of services and promotes good practices, which improve the overall image of their facilities. This group of leaders believes that accreditation produces changes that are beneficial at all levels.

On the other hand, a section of the leaders remained pessimistic about this process. Some hospital owners express concerns over the significant human resources the process consumes and the cost incurred. The bureaucratic nature and the financial burden associated with accreditation remains a concern for some managers. They want accreditation to stay independent and not for profit.

Nurses’ Perspectives

Nurses perceive accreditation as a vital tool for improving quality. Nurses in re-accredited organizations attribute notable improvements in their facilities to the recommendations they receive from the accreditation bodies. Moreover, nurses also feel that accrediting healthcare facilities improve the working conditions as it addresses issues such as workload, training needs for healthcare workers, and medication management, among other issues that affect their working conditions. Therefore, nurses are increasingly embracing accreditation as a critical tool for improving the quality of care they offer to their clients.

Perspectives of the Laboratory Personnel

Most laboratory personnel prefer working in accredited laboratories. They perceive accreditation is a means for improving laboratory services because the accreditation agencies provide better health and safety procedures and ensure proper documentation.

Comparing and contrasting facilities with and without the accreditation

Given the understanding that accreditation is today widely sought in the Kingdom of Saudi Arabia, it is vital to compare the performance and reputation of a healthcare organization and with and without certification. However, it is noteworthy that the Ministry of Health has made it mandatory for any facility to acquire CBAHI accreditation to operate in Saudi Arabia. Therefore, this section considers Joint Commission International accreditation as the benchmark for comparison.

First, hospitals with JCI accreditation are rated higher than those without JCI accreditation. According to the Minister of Health in KSA, receiving JCI accreditation is a monumental step towards being a globally recognized healthcare provider (MOH, 2012). Facilities with JCI accreditation are perceived to conform to internationally-conceded patient-safety standards and healthcare requirements. Lutfiyya, Sikka, Mehta, and Lipsky (2009) reiterate this argument. The author underscores that accreditation is a vital predictor for the implementation of patient safety initiatives.

Secondly, the work environment of the accredited facilities differs significantly from those without accreditation. According to Oliveira, Dell’Acqua, and Mondini (2016), healthcare professionals in an accredited organization express greater satisfaction than those working in non-accredited organizations. Accreditation promotes compliance with internationally recognized standards, which in turn improves the working conditions for the nurses and physicians (Oliveira, Spiri, Dell’Acqua, & Mondini, 2016). As such, accredited facilities strive to address issues such as workloads, burnout, complaint management, remuneration, safety, and other critical issues that affect staff morale and their overall performance.

Moreover, the performance also differs between facilities with and without accreditation. A study on nursing homes found that accredited nursing homes showed small but consistently better performance over those without accreditation. Williams, Morton, and Yendro (2017) argue that nursing homes with accreditation are typical of more appropriate medication utilization and reported fewer medication-related adverse events compared to non-accredited nursing homes.

Joint Commission International is efficient in improving safety and quality of care in hospitals that take part in accreditation. Apart from the compulsory accreditation by the Central Board of Accreditation for Healthcare Institutions, most healthcare facilities are seeking accreditation from international agencies to help them improve their performance. The JCI offers recommendations for hospitals to respond to the population needs in a better way. It provides accredited institutions publications that continually enable them to gain a global reputation.

Conclusion

Accreditation is a widely growing concept within the healthcare system. Many countries are considering accreditation as a process for promoting the quality of patient care and safety. As noted in the discourse, the Kingdom of Saudi Arabia, has made accreditation a mandatory requirement for all the facilities operating in the country. Aware of its benefits, many organizations in KSA have resorted to external agencies such as Joint Commission International (JCI), International Standard Organization (ISO), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Australian Council on Health Care Standards (ACHS), and Accreditation Canada among others. Their involvement has impacted significantly on the performance of medical facilities in KSA.

The Joint Commission International is noted as the leading international accreditation agency whose presence in Saudi Arabia has improved healthcare quality in the Kingdom significantly. However, stakeholders still hold varied perspectives on the process, with some advocating the process as a means for enhancing operational excellence and others skeptic about the financial implications and the bureaucratic nature of the process. Overall, this study admits that accreditation is a rewarding process that keeps healthcare organizations abreast of the internationally recognized practice standards. Therefore, all Saudi healthcare organizations should strive to gain accreditation from at least one international accreditation agency.