Caroline Ratner of the IMTJ spoke to Dr Sneh Khemka, MBCHB MRCOPTH, Medical Director, of leading expatriate health insurer, BUPA International about the quality assurance programme which it has developed with the assistance of Joint Commission International (JCI), the international healthcare accreditation body.
Why have you launched this programme?
We have launched this programme because until now international medical insurers have not looked at the quality and standards of hospitals they send their customers to, which is not as it should have been. We have taken a leading stance on this in order to reassure our clients that they will be treated at a good quality hospital by good doctors and be looked after really well. As an insurance company this gives us the comfort that we are working with the best hospitals in the world, and the assessments will give us an in-depth knowledge of each hospital we work with and that we can provide our customers with access to the best treatment at the best hospitals wherever they are in the world.
It is vitally important that the hospitals our customers use are of the highest standards and quality. Firstly it gives patients the reassurance that they are receiving the best treatment available in the best place and secondly it keeps management costs down. There is a huge problem with medical inflation; costs are rising all the time. If you work with good quality hospitals then you get lower costs overall as things are done right the first time and there are fewer expensive errors to correct. So even if a hospital seems more expensive up front, if they are of a high quality and have overall higher standards and track records of clinical excellence then long term costs are likely to be lower.
Why did you go into partnership with JCI?
We approached JCI to form this unique joint partnership because they are the market leaders and because our interests aligned. There is no one better for us to link up with on this project and we wanted to work with the world’s leading recognised authority to develop the standards that BUPA International use to assess the standards of the hospitals and by proxy the doctors and staff who work there.
How much does it cost to be assessed by BUPA International?
Hospitals don’t pay for this. One of the benefits of this BUPA International assessment is that it is often a very good first step to get hospitals up to the standards for JCI Accreditation. It is a pre-service.
If the hospitals don’t pay for the BUPA assessment does BUPA pay the full cost or does JCI bear some of the cost or discount the cost if they see as an attractive route to market for full JCI accreditation?
BUPA bears the full cost of the assessments. The process is an introduction point to JCI but does not change their normal accreditation process or costs in any way.
Roughly how much is BUPA International investing in the programme?
BUPA is making a significant investment to roll out this programme to all its contracted hospitals as it feels strongly about ensuring quality in the hospitals its customers access.
How have you managed to make comparisons on quality standards; and on clinical outcome data when different protocols and systems exist across the world?
Making direct comparisons is difficult and we try to compare hospitals in the same region with each other. We use outcome data where it is available, and the number of hospitals producing this data is slowly increasing over time.
How do you assess the hospitals and clinics?
The assessment standards have been developed by clinical staff from BUPA International and expert consultants from JCI. Each hospital will receive a set of assessment tools based on internationally recognised standards. Using these tools, hospitals can assess their medical facilities and clinical quality, including patient safety, clinical services, hospital management and staff, and the general environment and equipment.
BUPA do the assessments in two ways. In the first instance we send an online questionnaire, it is a very comprehensive document that asks about all aspects - from clinical facilities to comfort of rooms and catering to financial infrastructure and regulatory structure of the hospital. The questions are very detailed and comprehensive. For example, we’ll ask if they have emergency generators should power fail, access in emergency to drugs if the supply chain is interrupted. We’ll also ask questions about how often do they deep clean fridges to minimise contamination, how often do they recalibrate machines to ensure they are giving best results, so really detailed enquires are made.
Do you physically inspect every hospital?
No, not at the moment. There are 7,500 hospitals in the network but we plan to do that. We are currently only inspecting around 20-25% of the hospitals. However, if we are assessing a group of hospitals we will then send a team of clinicians to do the inspection of a range of the hospitals within a region or group once they have filled out the questionnaire.
How do you check on doctors and clinical outcomes?
We check the underlying principles of how doctors are employed and check the process of how a hospital employs a doctor. We check and monitor clinical outcomes and look into how well hospitals are performing, how many complications there are, how many infections there are and a whole range of other clinical indicators. This is all happening as a phased development, making sure hospitals are monitoring these things, getting hospitals up to speed to make sure they monitor and then getting hospitals to start providing data. A rolling programme started a few months ago.
What feedback have you had from hospitals that have been assessed?
Hospitals, rather than finding this a chore or a burden have told us that they find it a positive experience and it helps them to get their standards up. Our aim is not to be a regulator but to point to areas of improvement and to bring them up to certain standards and to give them access tools from the JCI so that they can initiate quality improvements where required.
What happens if one of your hospitals doesn’t want to make the recommended improvements?
In some rare circumstances, where hospitals are not prepared or interested in improving then we will then derecognise if we feel they are substandard.
How often are they reassessed?
Every three years.
Is it expensive for BUPA International to carry out these assessments?
It doesn’t require a large team and we see it as a very worthwhile investment. BUPA International is about giving our customers quality healthcare rather than just insurance and we see this as an important part of ensuring that our customers receive the best quality healthcare we can supply.
Do hospitals come to you?
At the moment we approach them. As the programme develops, hospitals may well start approaching us.
How do you monitor patient satisfaction in hospitals and what information do you gather and examine?
We are commencing a programme of online questionnaires that explore our customers' satisfaction with aspects of their care, including what they thought of the hotel facilities as well as the standard of care from the clinical staff.
Do you take customer feedback into consideration?
Absolutely, patient feedback is very important to us and we act upon it.
What do you do if customers start complaining about a hospital that you have assessed?
We have had a few instances of that already and when we get a customer complaint we do a further investigation into that hospital and initiate an extra quality assessment.
Will the results of these assessments be made available to BUPA customers? Can a BUPA customer compare one hospital with another?
As we gather more information we hope to present it to customers in a fair and understandable way so they can make informed choices about the hospitals they choose to use. This will develop region by region as we are able to assess more hospitals.
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