The Importance of CBAHI AccreditationDr. Mohammed Ahmed Garout, MD

Assistant Prof. of Public Health, Medical Faculty - UQU – MakkahIPC Specialty Team Leader - CBAHI

Saudi Arabia

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Healthcare Accreditation: an overview

Introduction• Healthcare accreditation is a process of external peer review

to assess the performance of a healthcare facility in relation to agreed healthcare accreditation standards.

• Accreditation in healthcare has existed for over 100 years (Brubakk et al, 2015).

• Accreditation has been widely adopted as an essential part of healthcare systems in more than 70 countries (Greenfield et al, 2013).

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Introduction• Accreditation is a primary driver of quality and safety

internationally (Braithwaite et al, 2006).

• Health service accreditation is an assessment of performance against standards at a given point in time.

• It provides a snapshot of performance against standards (Swiers & Haddock, 2019).

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Introduction• Accreditation is part of healthcare globally and is a reliable activity

(Greenfield et al, 2010).

• It has been found to improve patient care and support a positive culture and effective leadership in various countries and settings (Bogh et al, 2016; Braithwaite et al, 2010; Shaw et al, 2014).

• It also contributes to continual and systematic quality improvement changes, at a process and system level within hospitals (Greenfield et al, 2019).

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Accreditation’s value

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• Current literature is unable to consistently assess the effectiveness of accreditation (Brubakk et al, 2015).

• Argument that inconsistent and unconvincing evidence fails to demonstrate the value of accreditation (Hinchcliff et al, 2012, Brubakk et al, 2015, Duckett et al, 2018).

• Questioning if the investment in accreditation delivers sufficient outcomes with desired/expected patients’ safety (Øvretveit et al, 2000, Lam MB, 2018, Griffith JR, 2018).

• There was no statistically significant association between Lebanese accredited hospitals and patient satisfaction (Haj-Ali et al, 2014).

• Considerable variation within accreditation categories in quality of care and mortality among surveyed hospitals, which indicates that accreditation have limited usefulness in distinguishing individual performance among accredited hospitals (Chen et al (2015).

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• Infection control performance is positively associated with accredited facilities (Sekimoto et al, 2008).

• Supportive evidence was found for using SAB rates to demonstrate the impact of infection control programs embedded within the accreditation program (Mumford et al, 2015).

• For IPC KPIs (VAP, CAUTI, CLABSI and SSI), the healthcare accreditation acts as a catalyst for implementing and monitoring positive changes (Fatima MS and Habibur Rahman M , 2017).

• Admissions at fully accredited hospitals were associated with a lower 30-day mortality risk than admissions at partially accredited hospitals (Falstie-Jensen AM et al, 2015).

• Admissions at fully accredited hospitals were associated with a shorter LOS compared with admissions at partially accredited hospitals (Falstie-Jensen AM et al, 2015).

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Contradicted views of published research about value and effectiveness of healthcare accreditation are expected and could be referred to:

• Different accreditation methods.• Different healthcare systems.• Different study designs.• Measures of different outcomes.• Inability to ascertain causal relationship.• Studies sample sizes.• Others…

Accreditation

Therefore, accreditation provides a snapshot of performance against standards while the ongoing maintenance and improvement of this performance is the responsibility of the

accredited facility (Swiers & Haddock, 2019)

Can not:• Guarantee absolute quality.

• Guarantee absolute safety.

• Eliminate all risks.

• Guarantee that evidence based best practice is always provided.

Can:• Act for the best interests of

patients and HCWs.

• Be a commitment to minimising risks.

• Be a commitment to maximising quality and safety.

• Ensure/encourage the continuous quality improvement of the organisation.

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Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI)

CBAHI At A Glance

• The Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) is the official agency authorized to grant accreditationcertificates to all healthcare facilities operating in Saudi Arabia.

• CBAHI has emerged from the Saudi Health Council as a non-profit organization.

• The principal function of CBAHI is to set the healthcare quality and patient safety standardsagainst which all healthcare facilities are evaluated for evidence of compliance.

CBAHI At A Glance

In 2005, under a Ministerial Order, MRQP was developed and named as Central Board for Accreditation of

Healthcare Institutions (CBAHI) and its jurisdiction was expanded to the whole country.

MRQP was an initiative aimed at improving quality of healthcare delivery in Makkah Region.

The foundation of CBAHI dates back to 2001 as Makkah Region Quality Program (MRQP).

CBAHI At A Glance

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2006

• With the assistance & collaboration of healthcare quality experts from the public and private sectors, CBAHI launched the first edition of national standards for hospitals.

2012

• CBAHI’s 2nd edition of national standards for hospitals was certified by the International Society for Quality in Healthcare (ISQua).

late 2013

• Mandatory status of CBAHI accreditationwas declared when a Cabinet of Ministers Decree called for changing CBAHI’s official name to the “Saudi Central Board for Accreditation of Healthcare Institutions”.

CBAHI At A Glance

• In 2013, the national accreditation by CBAHI was also mandated on all healthcare facilities.

• In addition, CBAHI accreditation became a prerequisite for renewal of the operating license – a step towards encouraging more participation in this ambitious national initiative.

• Currently, it is mandatory for all public and private healthcare delivery facilities (hospitals, polyclinics, blood banks and medical laboratories) in Saudi Arabia to comply with national standards set by CBAHI and obtain their accreditation through a survey process set forth by the Center.

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CBAHI’s Accreditation Achievements

Total of 273 hospitals had undergone CBAHI accreditation process (status till October 2019):• 212 hospitals had been accredited(78%).

• 50 hospitals had denied accreditation (18%).

• 9 hospitals with conditionalaccreditation (3%).

• 2 hospitals had their accreditation suspended (1%).

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Out of 88 clinical laboratories, total of 56laboratories (64%) had been accredited

(until September 2019).

Total of 196 Primary Health Care Centers had undergone CBAHI accreditation process (status until October 2019):• 165 PHC had been accredited

(84.2%).• 28 PHC had denied accreditation

(14.3%).• 3 PHC had conditional

accreditation (1.5%).

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CBAHI Literature Review

• CBAHI standards need significant modifications to meet ISQua principles. New and developing accreditation programs should be encouraged to be published (Alkhenizan A, 2010).

• Limited number of hospitals has been accredited by CBAHI. Despite the great efforts to improve services in health sector, number of obstacles (such as finance and qualified staff) have not yet been overcome to achieve effective application of quality (Almasabi MH, 2013).

• CBAHI accreditation has positive impact on healthcare environment processes, outcome and patient satisfaction (Al Shammari M, et al, 2015).

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Accreditation: Challenges

• Validity of standards.

• Reliability of assessments/surveys.

• Leadership and effective engagement of healthcare professionals.

• Transparency and accountability.

• Patient/care givers involvement.

• Quality of gathered data & proper analyses.

• Benchmarking and data share.

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Summary

Take home message:• Accreditation is not about ‘passing an exam, it is

about commitment.• Accreditation is not the goal → Continuous Quality

Improvement.• Accreditation programs guide performance and

influence organisational culture.• Accreditation increases efficiency → health systems

need to become less accepting of errors.

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References:• Brubakk K, Vist GE, Bukholm G, Barach P, and Tjomsland O. (2015). A systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health Services Research. 15:280.

• Chen, L. W., Nguyen, A., Jacobson, J. J., Gupta, N., Bekmuratova, S., & Palm, D. (2015): Relationship between quality improvement implementation and accreditation seeking in local health departments.

• Duckett S, Jorm C, Moran G and Parsonage H. (2018). Safer care saves money: How to improve patient care and save public money at the same time. Grattan Institute. Viewed 3 March 2019. https://grattan.edu.au/wp-content/uploads/2018/08/Safer-care-saves-money.pdf

• Duckett S, Jorm C, Danks L and Moran G. (2018). All complications should count: Using our data to make hospitals safer. Grattan Institute. Viewed 3 March 2019. https://grattan.edu.au/wp-content/uploads/2018/02/897-All-complications-should-count.pdf.

• Greenfield D, Pawsey M, Naylor J, Braithwaite J. (2013). Researching the Reliability of Accreditation Survey Teams: Lessons Learnt When Things Went Awry. Health Information Management Journal, 42(1), 4–10.

• Greenfield D, Pawsey M, Naylor J and Braithwaite, J. (2009). Are accreditation surveys reliable? International Journal of healthcare quality assurance. 22(2):105-16

• Greenfield D, Moldovan M, Westbrook M, Jones, D, Low L, Johnston, B, ... Braithwaite, J. (2012). An empirical test of short notice surveys in two accreditation programmes. International Journal for Quality in Health Care. 24(1), 65-71.

• Greenfield D, Lawrence SA, Kellner A, Townsend K, Wilkinson A. (2019) Health service accreditation stimulating change in clinical care and human resource management processes: a study of 311 Australian hospitals, Health policy (2019). Viewed 6 May 2019. https://doi.org/10.1016/j.healthpol.2019.04.006.

• Griffith JR. (2018). Is It Time to Abandon Hospital Accreditation? American Journal Of Medical Quality. 33(1): 30–36.

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• Hinchcliff R, Greenfield D, Moldovan M, Westbrook J, Pawsey M, Mumford V, Braithwaite J. (2012). Narrative synthesis of health service accreditation literature. BMJ Quality and Safety. 21(12): 979–91.

• Miranda B Lam, Jose F Figueroa, Yevgeniy Feyman,2 Kimberly E Reimold, E John Orav, Ashish K Jha (2018): Association between patient outcomes and accreditation in US hospitals: observational study

• Mumford V, Reeve R, Greenfield D, Forde K, Westbrook J and Braithwaite J. (2015). Is accreditation linked to hospital infection rates? A 4-year, data linkage study of Staphylococcus aureus rates and accreditation scores in 77 Australian acute hospitals. International Journal for Quality in Health Care. 27 (6): 479–485.

• Sekimoto M, Imanaka Y, Kobayashi H, Okubo T, Kizu J, Kobuse H, Mihara H, Tsuji N, Yamaguchi A. (2008). Impact of hospital accreditation on infection control programs in teaching hospitals in Japan. American Journal of Infection Control. 36:212–19.

• MS Fatima and Habibur Rahman M (2017): The Impact of Joint Commission International Healthcare Accreditation on Infection Control Performance: A Study in Dubai Hospital.

• Falstie-Jensen AM, Larsson H, ERIK HOLLNAGEL Hollnagel E, Norgaard M, Svendsen MLO, and Johnsen SP (2015): Compliance with hospital accreditation and patient mortality: a Danish nationwide population-based study.

• Falstie-Jensen AM, Larsson H, ERIK HOLLNAGEL Hollnagel E, Norgaard M, Svendsen MLO, and Johnsen SP (2015): Is compliance with hospital accreditation associated with length of stay and acute readmission? A Danish nationwide population-based study

• Haj-Ali, W., Bou Karroum, L., Natafgi, N., & Kassak, K. (2014). Exploring the relationship between accreditation and patient satisfaction –the case of selected Lebanese hospitals.

• https://portal.cbahi.gov.sa/english/home

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• Alkhenizan A and Shaw C (2010): Assessment of the accreditation standards of the Central Board for Accreditation of Healthcare Institutions in Saudi Arabia against the principles of the International Society for Quality in Health Care (ISQua).• Almasabi MH (2013): An Overview of Quality and Accreditation in

the Health Sector within Saudi Arabia. • Al Shammari M, Al Habib S, Al Shubrami D, Al Rashidi M (2015):

Impact of Hospital‘s Accreditation on Patient Safety in Hail City, Saudi Arabia: Nurses‘Perspective.

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