[email protected] https://www.aaahc.org/ About John Olsen, M.D. Dr. John Olsen is a Health Services executive with 23 years of transformational domestic and international leadership experience in public, government, private healthcare industries, and senior military roles. He has managed care and network development expertise with entitlement and self-insured product lines, and is an accomplished speaker, BOD member and team-builder — battlefield and board-room tested. About Accreditation Association for Ambulatory Health Care (AAAHC) Our parent organization, AAAHC, is a private, non-profit organization formed in 1979. (Incidentally, this is our 35th anniversary.) We are the leader in developing Standards to advance and promote patient safety, quality care and value for ambulatory healthcare through peer-based accreditation processes, education and research. A certificate of accreditation is awarded to organizations that are found to be in compliance with AAAHC Standards. AAAHC currently accredits almost 6,000 organizations in a wide variety of ambulatory health care settings including ambulatory surgery centers, community health centers, medical and dental group practices, medical home practices and managed care organizations, as well as Indian and student health centers, among others. We are also the official accrediting organization for the U.S. Air Force and the U.S. Coast Guard. With a single focus on the ambulatory care community, AAAHC offers organizations a cost-effective, flexible and collaborative approach to accreditation. About Accreditation Association for Ambulatory Health Care International (AAAHCI) AAAHC International was established in 2010 to help providers in other countries who seek to offer ambulatory healthcare services consistent with the Standards of AAAHC-accredited U.S. organizations. Similar to the process in America, non-U.S. facilities benefit from a rigorous, peer-based evaluation and onsite, interactive, consultative approach designed to meet AAAHC International Standards. AAAHC International also addresses the many differences in various countries that relate to their specific healthcare delivery systems, and offers culturally relevant responses to the differing local social and economic environments. Medical Travel Today (MTT): What is the focus of the Accreditation Association for Ambulatory Health Care International (AAAHCI)? John Olsen (JO): AAAHCI works with a spectrum of international facilities, from small ambulatory, outpatient facilities and oncology centers to hospitals (less than 100 beds). Through its accreditation processes and program, AAAHCI assists these institutions in preparing their environment and training their staff in a culture that maintains focus on patient safety and quality in the healthcare market place. It is important to mention that AAAHCI does not impact the individual decision-making processes of physicians or nurses based on their clinical expertise. MTT: What types of facilities does AAAHCI serve? JO: In Latin America, where we made our first significant impact, we target a lot of smaller hospitals that range from roughly 50 to 100 beds. As we enter different markets throughout Central and South America, we are finding that smaller hospitals have a very strong interest in accreditation. This is a development that, frankly, we had not predicted. In light of the hospital interest, we have adapted and enhanced our accreditation program accordingly to accommodate that customer segment. Of course, we maintain a very strong interest in the ambulatory surgery centers, as well, which are somewhat harder to find in Latin America than in the United States. MTT: How does AAAHCI differ from Joint Commission International? JO: Our approach provides educational, on-the-ground training and consultation – much less of the audit profile that many individuals associate with the Joint Commission, stateside and internationally. Again, following the mission of our parent organization, we believe that education and onsite, collaborative interaction between surveyor and staff allow greater growth for both the customer and the surveyors. In the future, our intention is to nurture and develop increasing participation by host nation personnel in training roles and the actual conducting of the surveys, rather than using an American team. We have already introduced this concept in Peru. MTT: How is the cost of international accreditation calculated? JO: Internationally, the pricing system is much different than in the United States. Generally, cost is based upon the size of the setting and number of surveyors needed, as well as the number of days that surveyors are on the ground. MTT: AAAHC, the parent organization, planted its roots in the U.S. market, correct? JO: Absolutely. But as far back as 2004, the Accreditation Association for Ambulatory Healthcare, the U.S. parent company, began exploratory initiatives by forming an international task force, but quickly realized there were already hospital accreditors like Joint Commission International out there. We were very familiar with an assortment of ambulatory outpatient settings right here in the United States, and we sculpted the program based on the U.S. marketplace. But as I said earlier, what we had predicted as a market, and what has become our market, is much more heavily weighted to small hospitals versus ambulatory and outpatient settings – although we have many of those types of medical and dental settings already accredited in Costa Rica and Peru, with a lot more showing great interest in pursuing AAAHCI accreditation. At our most recent Board meeting we discussed this extensively and decided to revise and adapt our set of Standards to better reflect what a small hospital accreditation program would seek in accreditation. The timing for this was perfect, as it fell during the routine updating and refinement of our core International Standards Handbook. For example, our new Standards will increasingly focus on emergency room, maternity and occupational health services – all primary components that make up smaller hospitals. MTT: How does accreditation help an institution connect with the market? JO: Regardless of location, accreditation raises the bar of quality and safety, and from an ideological standpoint, when one facility proves that it’s raised the bar, others are moved to follow. From a more pragmatic perspective, if individuals are unfamiliar with a certain facility or healthcare environment, AAAHCI accreditation provides reassurance and peace of mind. MTT: Do you look at outcomes, infection rates and patient satisfaction? JO: Yes, those are all individual Standards, and in fact, we dedicate an entire chapter to safety and infection prevention in our second edition, Accreditation Handbook. Of course, given that our mission of accreditation is based on quality and safety, we dedicated a single chapter to quality and quality studies, many of which are internal to the institution we visit. The sophistication of quality studies has increased dramatically over the last decade in the United States. We imagine this same curve will occur internationally as institutions begin to reframe the importance of developing a culture of quality and safety as a routine environment for healthcare delivery. The way we teach internal quality studies and, if possible, external benchmark studies, is with a focus on measurable outcomes – highly quantitative outcomes more so than highly qualitative outcomes. Our international teams realize that quality programs are in various stages of development throughout the region and within the facilities and view this as one of the greatest opportunities for our program. Training on quality is often a major component of a pre-assessment survey or the actual survey itself. Similar to any standards set by an accreditor, we also consider how satisfaction is gauged, measured, and what changes are put in place to improve patient satisfaction if such opportunities exist. MTT: If hospitals do not meet the expectations necessary to become accredited, are they given a chance to remediate and re-apply? JO: Yes, of course. Occasionally the accreditation committee awards a less than three-year accreditation or a three-year accreditation with a focused follow-up to emphasize specific aspects needing improvement in order to receive full terms of accreditation. Focused follow-ups occur within a certain time frame, one where AAAHCI teams will go back and review the aforementioned aspect(s) that need more attention. If the issue has been addressed, a three-year accreditation is granted. We have been fortunate to date: all facility revisits have resulted in full accreditation due to their remedial efforts on the focused concerns. MTT: What percentage of the hospitals or institutions surveyed by AAAHCI earned the full three-year accreditation on the first go around? JO: I don’t have an exact number, but I do know that there hasn’t been any facility that has completely failed a survey. Similar to what we find in the U.S. program, internationally we have had several institutions that required an interim visit and focused review following their initial accreditation survey. The focused reviews almost universally occur within the first six months following the survey. With many of these international facilities, we actually go in and do pre-assessment surveys. This may consist of a facility visit six months before an actual survey where we engage in granular discussions that prompt better performance. This is such a great environment, one in which the surveyors learn of the local challenges hospitals face, while hospital staff receive focused education and training opportunities on what will be looked at during the accreditation survey. Personally, I have been on two pre-assessment surveys – both with small hospitals in Peru. Our days were spent on the details of the Standards, as well as how to fulfill the Standards. A pre-assessment really helps both organizations – the facility and the accreditor – to become more aware of each other’s challenges and expectations. For example, here in the United States, there are often great similarities among geographically separated facilities. Institutions in Wyoming and North Carolina are compelled by similar forces of performance despite their separation, resulting in similar environments of care and expectations by their patients. But internationally, we often see much greater differences in the healthcare environment – sometimes with those differences separated by only a few kilometers between an inner-city hospital and one in the suburbs. Again, a pre-assessment gives us a really local flavor of what to expect. MTT: How many hospitals outside the United States have you surveyed? JO: We are in the range of around two dozen small hospitals, mostly located in Central and South America that are either accredited, in the process of applying for accreditation, or seeking reaccreditation. MTT: Are you going to market this program beyond Central and South America? JO: Currently, our approach is circumscribed by the caveat that we are young, limited and budget-conscious. We have chosen locations such as Peru and Costa Rica because they are easier to access and more affordable to get our surveyors there. We realize that by our measured approach, we can offer a better price point to our customer and make the cost of accreditation more attractive to a wider audience. In the near future, we will begin to look at Colombia and Mexico, as well. Of course, we have incredible interest globally – Australasia, Europe, the Mideast and Africa – but the complexity, in terms of location, for a small organization like ours will be much more challenging. We want to grow within our bandwidth.