Interview with Salma Jaouni Araj, Health Care Accreditation Council (HCAC), Chief Executive Officer (CEO), Amman Jordan

Can you tell us a little bit about your organization and yourself?      
The Health Care Accreditation Council (HCAC) is Jordan and the region’s private sector not-for-profit organization focused on improving quality and patient safety through the design and provision of accreditation schemes, quality management consulting services and capacity building programs. Ever since assuming the position of the Chief Executive Officer in 2012, it was clear to me that the first order of work is to ensure that HCAC moves from a donor-funded project to a fully self-sustainable public-private organization. I brought in my government, donor and public health and administration expertise to lead the expansion of our local presence and services and reached out to the international counterparts to learn and grow. HCAC has become a key player in advocacy and service provision for quality and patient safety. We play a pivotal role in the National Vision 2025, the government’s plans and goals as well as people’s understanding of the importance and meaning of quality and patient safety. We are also very proud that HCAC is the first and foremost organization in the Eastern Mediterranean region to get and maintain the three accreditations of the International Society for Quality in Healthcare as well as be elected on their Board of Directors.

In brief, what are Jordan’s key health sector accomplishments and challenges?    
Jordan is a highly urbanized country with overall good access to health services. It has come a long way in service delivery and achieved good indicators in terms of mortality, maternal and child health care, vaccination, and proficient health care providers. The Jordanian hospital sector in all its sectors (public, private and military) is renowned for many achievements since the 70s and has been a pioneer in transplants, IVF and open-heart surgeries and laparoscopy. Jordan boasts a strong medical tourism sector led by the private sector and supported by the Ministry of Health and the Royal Medical Services (the military) as well as teaching hospitals and specialized internationally renowned centers of excellence such as the King Hussein Cancer Center.

As a lower-middle-income country, Jordan has made considerable progress in improving the health of its population despite hurdles stemming from economic, social and systems nature. Jordan has a very wide network of healthcare institutions across the country, with good access to primary healthcare and is focused on overcoming challenges of comprehensiveness of services, availability of healthcare resources and continuous quality measurement with universal health coverage at the core of advancement.

What is your opinion are the challenges faced at the international level?  
Like Jordan, our region struggles with community health infrastructure that is not highly developed, leading to community health challenges that are exacerbated by poor prioritization of prevention interventions and a fragmented primary care sector unable to act as a gatekeeper for secondary and tertiary care. From a more international perspective, healthcare is not advancing well enough to share resources, support less developed and poorer populations, boost quality improvement and benchmark with global data, nor make use of the wirelessly networked world to share the possibilities of a remote provision of services and telehealth, to increase efficiency, effectiveness, quality and equity. The world still focuses on vertical interventions that are driven by immediate needs rather than cross-sectoral and organizational growth with a focus on quality and patient safety. We also still do not have the right mechanisms to monitor, evaluate, and reward performance.

As a Full Member leader, what are your expectations from and contributions to IHF?      
HCAC in itself and as a representative of Jordan’s Ministry of Health, Royal Medical services and teaching hospitals can contribute to IHF knowledge and repository of real-life challenges and solutions from the lens of a less developed world, bringing a discussion on lower-middle-income countries, and bridging the gap between more advanced expertise and working with low resources. Additionally, we can provide simple solutions to larger problems, while benefiting from advancement in the world. Jordan would be also looking for an exchange of expertise and experiences as part of the IHF to raise the bar of performance, benefit from lessons learned and most importantly increase access to educational platforms that are based on practice and practicality.

How do you see IHF moving in the coming five years?    
IHF can play a crucial role in supporting and connecting hospitals and healthcare professionals especially those in poor resource settings, overcrowded populations, with less advanced technologies and need for advanced interventions. Additionally, IHF can host and promote teaching and learning in health care and health care delivery including but not limited to basics such as infection control, morbidity and mortality, quality measurement, performance and incentive-based growth, value-based healthcare. At HCAC, we are a great believer in the benefits of sharing systems and exchanging expertise.

How has HCAC worked with the Jordanian Health Sector and what is your portfolio of activities and current priorities?
The Health Care Accreditation Council, as a full member of the IHF, is representing Jordan’s public, military and teaching hospitals; availing this opportunity to them and ensuring they contribute to the IHF goals.

Almost 15 years since the inception of HCAC, Jordan now boasts a large number of accredited organizations, well-trained expertise in infection control, quality and patient safety as well as risk management and several programs in quality management at the organizational and diseases specific levels. Through its two distinct arms: the “Accreditor” and the “Enabler” HCAC has become the center for the design and development of quality standards, quality improvement programs, and preparation of hospitals, primary health care centers and other healthcare and social care facilities to meet standards. Additionally, HCAC designs and runs various outreach and engagement activities; such as the annual Change Day initiative, a regional Quality and Patient Safety Conference and Exhibition; a media competition; and, National Quality and Safety Goals (NQSG).

To date, HCAC has more than 10 sets of accreditation standards and programs; around 211 accredited healthcare institutions (including hospitals, health care centers, breast imaging units, labs, and specialized medical clinics); around 125 certified surveyors; more than 590 certified practitioners, including 34 certified consultants; 8 rounds of NQSGs; over 234,600 Change Day pledges; and, 5 biennial Conferences with at least 500 participants in each.

Our priorities will always focus on continuous improvement, through partnerships and the provision of tailored services. It is very important for us in the next phase to hear the voice of the patient, measure their experience, and respond to their needs by improving data for decision making and upholding accountability and advocacy.

Accreditation and COVID-19, have we learned anything?
Quality improvement is evident in hospitals that participated in the accreditation journey which has no doubt led to better preparedness to respond to any emergency, internal or external, while maintaining the provision of safer care and high-quality services, despite hardships. During the past  6 months with the COVID-19 reality and need for co-existence, HCAC looked at the readiness and resilience of accredited versus non-accredited organizations with a focus on six areas: (1) emergency preparedness; (2) infection control; (3) capacity building; (4) case management; (5) communication; and, (6) laboratory services.

The results alluded to the positive effects on hospitals have gone through the accreditation journey, with better-structured Infection Prevention and Control (IPC) Programs, stronger ability to upgrade their disaster management plans to better manage COVID-19 cases (from triage to inpatient); responsive committees that convened regularly to inform and monitor practices; complete policies and procedures that reference HCAC standards and support accurate and timely communication and decision making; trained staff on IPC, occupational safety, risk management, protocols and protocol adoption; emergency preparedness plans already in place to guide practices to safeguard the health and uphold rights; and, an inherent culture and internal systems for quality monitoring, including data collection, performance indicators, proper documentation of patient records and clinical data.

Accredited hospitals reported that they were sought after for guidance and advice on how to jumpstart systems and plans; a testament that accreditation standards served as a catalyst and roadmap during the management of COVID-19.

It is very important to use this IHF platform to call on healthcare institutions not to sideline business as usual as we have to co-exist with this pandemic and only strong systems, accountable persons, monitored performance will be able to uphold quality and patient safety.

 


 

The Health Care Accreditation Council (HCAC) is Jordan and the region’s only nonprofit ISQua accredited institution dedicated to improving the quality of health care services and promoting patient safety through accreditation, consultation and capacity building.

Established in 2007, HCAC now reaps the fruits of its experiences in driving change at the primary and tertiary care levels, through the generation of empowered teams, and by engaging a network of experts from practitioners to academia. HCAC works horizontally for overall services and vertically on specific topics such as family planning and reproductive health, non-communicable diseases, and emergency care. hcac.jo

 

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