Session 6 13 - sally bell quality assurance presentation
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Transcript of Session 6 13 - sally bell quality assurance presentation
Quality assurance of
medical examiners:
an approach tailored to
maritime medicine
Dr Sally Bell
Chief Medical Advisor
UK Maritime and Coastguard Agency
What is QA?
• Agree and set standards
• Put systems in place to comply with
standards
• Evaluate to ensure that standards are
being met
• Identify areas for improvement
• Review standards
Plan
Implement
Evaluate
Review
How do non-maritime
organisations achieve QA?
• Industry and others – ISO (process
orientated)
• Some tailored programmes specific
to their organisation
• Healthcare specific standards +/- ISO
• Verify with either internal or external
audit
What does the maritime
sector want from QA?
The maritime agenda varies greatly -
• National maritime administrations
• Shipping companies/Manning agencies
• Insurance companies (P & I Clubs)
• Seafarers and unions
• Providers of maritime medical services
• Providers of accreditation services
Maritime Administrations
• Statutory requirement
– MLC
– STCW
– ILO/IMO guidelines
• Fulfils aim to ensure safety and
efficiency in ships carrying their flag,
and their own seafarers
MCA “Safer lives, Safer ships, Cleaner
seas”
Maritime Administrations
• Philippines (ISO, PCAHO)
• Some other maritime authorities to
varying degrees (eg UK, Germany and
Netherlands audit at home and visit
their overseas doctors)
• Failure of all to provide consistent QA
led to the need for shipowners and P &
I clubs to fill the gap.
Shipping companies
Manning agencies
• Compliance with of STCW, MLC
2006 and ILO/IMO guidelines
• Confidence in health care providers
responsible for certificates
• REDUCE COSTS
• Some have their own QA schemes…
P & I Club schemes
• Offer a service to members
• Reduce costs subsequent to illness
and injury
• View of costs may be skewed as
only those reaching claim status
are seen
But…
But….
• Loss of experienced crew if medical
standards over stringent or
unnecessary tests conducted
• Cost element
• Company/P & I examinations have no
statutory status
……..
…….
• Usually no appeal mechanism
• Ethics and accountability need to be
considered
• Employer/agent can be liable under
employment law if someone is fit in statutory
terms, but they are turned down because
they don't meet company criteria
Seafarers, Unions
• Fair, ethical and confidential treatment
• No discrimination – not excluded from a
job that they are fit to perform
• Confidence in their employer and
medical provider
• Job security for those who are fit to
work…. But not for the unfit
Providers of maritime
medical services
• Demonstrate the quality of their service
to clients
• Increase business whilst improving
efficiency
• Provide better care for seafarers
• Single accreditation scheme reduces
burden of multiple approval visits
• All QA involves paperwork and admin!
Providers of QA
• International providers such as companies
providing ISO – trained auditors, independent, but
standards non-specific to healthcare/maritime
• Individuals employed direct by stakeholders
– Aims tally with those of the stakeholder
• IMHA QUALITY
– Registered charity, whose objects are to improve
the quality and effectiveness of the interventions
used to prevent and treat illness in seafarers or to
improve their safety
Some aims clash, but all
want:
• Compliance with regulation -
Requirements of STCW, MLC 2006
and ILO/IMO guidelines,
• Improved crew welfare
• Clinical outcomes
–Valid, consistent and ethical
decisions
– improved fitness and safety
What is the current
situation?
• Lists of approved doctors, driven by
stakeholders
• Audit visits, by stakeholders
• Outcomes data
• Balance cost and benefit
• Patchy, national or company driven
What is the current
situation?
• Public awareness of quality assurance in
all areas has never been so high
• Changed from being an optional extra to a
foundation of practice
• Quality assurance in healthcare is
expected by patients and other
stakeholders
• Much evidence shows that accreditation is
a powerful tool for quality assurance and
quality improvement
Literature reviews
Accreditation Canada. The value and
impact of healthcare accreditation: A
literature review. July 2012
Annals of Saudi Medicine. 2011 Jul-
Aug; 31(4): 407–416 Impact of
Accreditation on the Quality of
Healthcare Services: a Systematic
Review of the Literature
Staten Island Ferry 2003
11 killed, 165 injured
What is needed for
maritime health QA?
A system that is
• Is tailored to maritime health
• Includes valid external review that is
unbiased and internationally
recognised
• Is acceptable to all stakeholders
• Includes Peer Review (not seen in
many current systems)
Peer Review
• Peer defined as “Someone you would
consider an equal in terms of role,
expertise and understanding”
• In this context, this means a maritime
health physician
• Essential in health care settings to QA
clinical decisions and processes
Peer Review
• Reviewers should be trained and competent to
make judgements regarding the compliance
against the agreed set of standards.
• The process should reflect the current range of
views and opinions of the field
• Reviewers must be impartial with no conflict of
interest
• The process should help to improve quality of
services by providing clarity around areas for
improvement and acknowledging good practice
This is why we have
developed IMHA
QUALITY
• Fulfils needs outlined above
• Can provide peer review to
internationally agreed standards from
trained assessors
• Gives an unbiased view of clinic
practice
• Will enable providers to avoid multiple
audit visits
Participation in peer reviewed
QA confirms commitment to:
• Compliance with regulation
• Improved clinical outcomes
• Risk mitigation
• Safety, efficiency, accountability
• Continuing quality improvement
Sends a powerful message to key decision-
makers and the public
What are the challenges?
• Understanding of language of quality
• Engaging and motivating different
stakeholders – who goes first?
• Who bears the cost of implementing
change?
Thank you!