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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 4  |  Page : 1071-1078

Compliance of Monshaat Sultan Family Health Center with the current Egyptian Primary Health Care Accreditation Standards


1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Quality, Ministry of Health and Population, Cairo, Egypt

Date of Submission16-Aug-2015
Date of Acceptance02-Sep-2015
Date of Web Publication21-Mar-2017

Correspondence Address:
Nora A Khalil
Department of Family Medicine, Faculty of Medicine, Menoufia University, 49 Zaki Shabana Street, El Bar El Sharki, Shebin El Kom, Menoufia Governorate, 32511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.202514

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  Abstract 

Objective
The aim of the study was to assess degree of compliance of Monshaat Sultan Family Health Center (FHC) with current Egyptian Primary Health Care (PHC) Accreditation Standards.
Background
Evaluation of healthcare quality is an essential component of health system research; all healthcare-related activities should be evaluated. The main purpose of quality assessment is to improve performance. More accurately, it is to identify points of weakness that call for strengthening and strengths for better use of them.
Methods
This is a cross-sectional descriptive study conducted on Monshaat Sultan FHC. The study used the PHC Accreditation Program Standards, designed, tested and finalized in February 2001 by the Egyptian Ministry of Health and Population, to assess the compliance rate of Monshaat Sultan FHC with these standards, where all activities were reviewed during the period from May 2014 to August 2014. The quality of performance of these activities was analyzed and the results were reported from September 2014 to April 2015.
Results
The study revealed that the overall compliance of Monshaat Sultan FHC with current Egyptian PHC Accreditation Standards was 33.64%. Among the eight dimensions of quality, patient care showed the highest compliance (46.65%), and quality improvement program showed the lowest compliance (12.12%). Patient rights compliance was 13.73%, safety was 38.70%, support services was 43.89%, information management was 23.81%, family practice model was 24.07%, and organization management was 12.82%.
Conclusion
Monshaat Sultan FHC is now only 33.64% compliant with current Egyptian PHC Accreditation Standards, whereas it was 80.18% in the year 2004. Lack of continuous evaluation and training is the leading cause of this low compliance.

Keywords: accreditation, assessment, primary healthcare, quality, standards


How to cite this article:
Farahat TM, Alkot MM, Khalil NA, Fouda ME. Compliance of Monshaat Sultan Family Health Center with the current Egyptian Primary Health Care Accreditation Standards. Menoufia Med J 2016;29:1071-8

How to cite this URL:
Farahat TM, Alkot MM, Khalil NA, Fouda ME. Compliance of Monshaat Sultan Family Health Center with the current Egyptian Primary Health Care Accreditation Standards. Menoufia Med J [serial online] 2016 [cited 2020 Apr 6];29:1071-8. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/1071/202514


  Introduction Top


Evaluation of the quality of healthcare is an essential component of health system research [1]. The main purpose of quality assessment is to promote the improvement of performance [2].

Accreditation has been defined as an external evaluation mechanism that assesses the performance of healthcare organizations by investigating their compliance with a series of predefined, explicitly written standards [3].

Accreditation and compliance with standards aims to improve patient safety and strengthen the quality of healthcare, as improvement in quality is believed to result in fewer mistakes, shorter delays, improvements in productivity, increased market share, and lower costs [4].

The Egyptian Ministry of Health and Population (MOHP) has successfully developed and implemented an accreditation program including standards for Primary Health Care (PHC) centers [5]. More than 2500 family health units (FHUs) and centers (FHCs) out of 4500 FHUs and FHCs in Egypt were accredited between the years 2001 and 2014 according to these standards [6].

Monshaat Sultan FHC is a unique center. It is the only PHC center affiliated to University Hospitals, Menoufia University Hospitals – and not to the MOHP's centers. It was accredited in the year 2004 and its accreditation has now expired [6].


  Methods Top


This study was a cross-sectional descriptive investigation to assess the current healthcare compliance standard of Monshaat Sultan FHC, Menoufia Governorate, on the basis of current PHC Accreditation Program Standards. It was conducted from May 2014 to May 2015.

The tool used for assessment was the Egyptian PHC Accreditation Program Standards, designed, tested, and finalized by MOHP in February 2001 [7], which is the tool that has been used since 2001 by the General Directorate of Quality (GDQ)/MOHP and Executive Committee for Accreditation/MOHP.

During the formulation of these standards, MOHP divided standards into eight chapters; each of them expresses a dimension of quality. The selection of these dimensions is based on their relative importance in defining the quality of services in Egypt:

  • Patient rights: Emphasizing the rights of patients to be respected, to be assured of confidentiality, to privacy, and to know about their health with assessment of their satisfaction
  • Patient care: Checking whether patients receive appropriate care: appropriate diagnosis, assessment, treatment, follow-up, and patient counseling
  • Safety: Assessing the extent to which the organization provides clinical and environmental safety to its patients, staff, clients, and community
  • Support services: Measuring organizational compliance with a wide range of structural and functional standards in support services
  • Management of information: Measuring the availability, completeness, and accuracy of health records, and the organization's information system
  • Quality Improvement (QI) Program: Assessing the organization's system to improve the quality of care
  • Family practice: Ensuring continuity and comprehensiveness of care
  • Management of the organization: Assessing managerial capabilities in the area of planning, resource allocation, delegation, and human resource development.


Each dimension was given a weight based on its relative importance.

Each of the dimensions has one or more subarea(s). These subareas are also assigned different weights based on their relative importance.

Each of the subareas includes a number of standards expressing the acceptable performance level at this specified area. Each standard was assessed using one or more of these assessment methods and techniques:

  1. Observation: The hospital environment, infection control (IC) measures, patient care, staff communication, and patient rights issues were examined.
  2. Record review: Both medical records and administrative records were reviewed, including the organization's policies and procedures, guidelines, committees' minutes, routine reports, training plans, indicator measurements, and human resource development files.
  3. Personal interviews: The focus of the interview was to verify the activities carried out. The interview process complemented information obtained from the record review process and from on-site observation.


The assessment process for the organization's compliance with each standard used an ordinal scoring system as follows:

A score of 0, which is the least score, indicated absolute noncompliance with all requirements of the standards.

A score of 1 indicated partial compliance, where most of the performed activities under this standard were not complete or had not been achieved at an acceptable level of quality.

A score of 2 also indicated partial compliance, but where most of the performed activities under this standard were complete and had achieved an acceptable level of quality.

A score of 3, which is the perfect score, indicated that the standards were fully met.

Not applicable (NA)

This applies to tasks or activities that are not applicable to the organization. The 'not applicable' scores were excluded from the calculation of the average or aggregate scores.

Calculation of score

After assessment and scoring of each standard, all scores were entered into the accreditation program's specified computerized program.

After assessment, the organization's score was used to determine its accreditation status, which would one of the following.

  1. Denial of accreditation: This is the status when the organization scores less than 50% of the total score.
  2. Provisional accreditation: This is granted when an organization scores between 50 and 79% of the total score. It is awarded for a period of 1 year from the day of the accreditation.
  3. Full accreditation: This is granted when an organization scores from 80 to 100% of the total score. Full accreditation is granted for a period of 2 years.


At the end of the 2 years for full accreditation or 12 months for provisional accreditation, a reassessment survey of the organization is conducted upon request of the organization itself. If this time period passes and the organization does not request a reassessment survey, its accreditation expires, which is the current situation of Monshaat Sultan FHC.


  Results Top


Among the eight dimensions of quality, patient care showed the highest compliance with standards (46.65%), and QI Program showed the lowest compliance (12.12%). Total percentage of compliance with standards for the center was 33.64% ([Table 1] and [Figure 1].
Table 1 Total result of assessment of compliance of Monshaat Sultan Family Health Center with standards and total results of each one of the eight quality dimensions

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Figure 1: Among the eight dimensions of quality, patient care showed the highest compliance with standards (46.65%) and Quality Improvement Program showed the lowest compliance (12.12%).

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Among the seven subareas of patient care, general cases showed the highest compliance with standards (72.32%), and the Integrated Management of Childhood Illnesses (IMCI) program showed the lowest compliance (0.00%). Immunization services were not applicable to the center. The center's total subarea percentage of total score in patient care was 13.72%, whereas the weight of patient care dimension of total standards was 29.41%. Hence, the score of the center's patient care dimension was 13.72/29.41 (46.65%) ([Table 2]).
Table 2 Percentage of compliance with standards for each dimension and each subarea

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General cases showed highest compliance with standards in treatment (95.00%), whereas the lowest compliance with standards was in patient education (60.00%) [Figure 2]. Antenatal care showed the highest compliance with standards in diagnostic tests (66.67%), whereas the lowest compliance with standards was in referrals and follow-up (00.00%) [Figure 3].
Figure 2: Among the components of general cases the highest compliance with standards was in treatment (95.00%), whereas the lowest compliance with standards was in patient education (60.00%).

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Figure 3: Among the components of antenatal care, the highest compliance was in diagnostic tests (66.67%), whereas the lowest compliance with standards was in referrals and follow-up (00.00%).

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Hypertension cases showed highest compliance with standards in diagnostic tests (52.38%), whereas the lowest compliance with standards was in referrals and follow-up (00.00%) [Figure 4]. Diabetes cases showed the highest compliance with standards in treatment (100.00%), whereas the lowest compliance with standards was in referrals and follow-up (16.67%) [Figure 5].
Figure 4: Among the components of hypertension cases assessment the highest compliance was in diagnostic tests (52.38%), whereas the lowest compliance with standards was in referrals and follow-up (00.00%).

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Figure 5: Among the components of diabetic cases assessment, the highest compliance was in treatment (100.00%), whereas the lowest compliance with standards was in referrals and follow-up (16.67%).

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Family planning cases showed the highest compliance with standards in diagnostic tests (100.00%), whereas the lowest compliance with standards was in patient education (42.42%) [Figure 6].
Figure 6: Among the components of family planning, the highest compliance was in diagnostic tests (100.00%), whereas the lowest compliance with standards was in patient education (42.42%).

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Among the four subareas of safety dimension, environmental safety showed the highest compliance with standards (57.41%), and the employee health safety program showed the lowest compliance (0.00%) ([Table 2]).

[Table 2] also shows that among the subareas of support services dimension, pharmacy showed the highest compliance with standards (58.33%), and the emergency department showed the lowest compliance (17.78%); kitchen services were not applicable to the center.

Medical records had higher compliance with standards than the Management Information System/Reporting, at 38.1%. It also showed that among the subareas of family practice model dimension, referral displayed the highest compliance with standards (38.89%) ([Table 2]).


  Discussion Top


Compliance with standards and attainment of accreditation promotes high quality and safety [8]. Evidence shows that accreditation programs improve the process of care provided by healthcare services. There is considerable evidence showing that accreditation programs improve clinical outcomes of a wide spectrum of clinical conditions [9].

Assessment of the current situation of the previously accredited Monshaat Sultan FHC (its accreditation became invalid on 3 April 2006) was done using the 2001 version of Egyptian PHC Accreditation Standards.

The center was accredited with a total score of 80.18% on 3 April 2004, but its current overall compliance with standards was only 33.64%.

As a part of 'The Family Health Units Accreditation Preparation Program', a Joint program between WHO country office of Egypt and Egyptian MOHP/GDQ, a study was conducted in the year 2013–2014 that assessed the current situation of 35 previously accredited – and now expired – FHUs and FHCs in two Egyptian governorates, Menoufia and Alexandria. The assessment was done using the current Egyptian PHC Accreditation Standards.

The study included 23 FHUs and FHCs in Menoufia Governorate, in Shebin El Kom District. The rest of the 35 previously accredited FHUs and FHCs of the study were in Shark District, in Alexandria Governorate.

The results and current situation of Monshaat Sultan FHC were similar to those of the studied Menoufia Governorate FHUs and FHCs. These Menoufia Governorate FHUs and FHCs had been accredited with scores ranging from 71 to 91%, but their current assessment revealed scores between 37 and 45% of the total score.

In contrast were the results and current situation of the selected Alexandria Governorate FHUs and FHCs. They had been accredited with scores ranging from 80 to 93% but their current assessment revealed scores of 67 and 82% of the total score. The main strengths of the selected Alexandria Governorate FHUs and FHCs were in adoption of family medicine and quality principles as a work system, regardless of accreditation with regular supervision and assessment of compliance with standards.

Regarding compliance of patient rights with standards, Monshaat Sultan FHC scored only 13.73%, which was consistent with what was reported in the GDQ and WHO study, in FHUs and FHCs of Menoufia Governorate, where the scores in patient rights ranged between 19 and 26%.

The results of Monshaat Sultan FHC were in variance with the results of FHUs and FHCs of Alexandria Governorate, who achieved higher scores ranging between 58 and 90% of total patient rights scores. The main reasons for this low percentage in Monshaat Sultan FHC were lack of supervision and evaluation and lack of training on communication skills, customer satisfaction, family planning, and patient rights.

Studies show that accredited centers received greater patient satisfaction ratings compared with nonaccredited centers [9]. Accreditation has been linked to improved staff satisfaction [10]. Even structural elements like presence of a complaints box is improved with accreditation [11].

Regarding compliance of patient care with standards, Monshaat Sultan FHC achieved a compliance of 46.65%. This was similar to the results of the study conducted by GDQ and WHO in FHUs and FHCs of Menoufia Governorate, which found total patient care compliance ranging between 48 and 53%.

Results of patient care in the selected Alexandria FHUs and FHCs in the same study ranged between 73 and 82%, where the use of recent and updated medical record forms, routine medical record reviews, and physicians trained in IMCI were the main strengths. In contrast, in Monshaat Sultan FHC there were old medical record forms not complying with standards and skilled physicians mainly depend on their experience and do not adhere to clinical practice guidelines and lack training in IMCI.

Accreditation has been proven to improve patient care [3], to lead to better diagnostic follow-up [12]. In PHCs, follow-up of diabetes, hypertension, and antenatal care improved with accreditation [11].

As regards compliance of safety dimension with standards, Monshaat Sultan FHC achieved a score of 38.70%. This result was similar to those of the study conducted by GDQ and WHO in FHUs and FHCs of Menoufia Governorate, where their total safety results ranged between 40 and 45%. IC results (21.43%) were also consistent with those of another study conducted in Shebin El Kom District, Menoufia Governorate, and showed that standards of IC practices were not optimum at family healthcare settings [13].

The results of Monshaat Sultan FHC were in variance with the results of the selected Alexandria FHUs and FHCs, where safety results ranged between 65 and 85%. In Monshaat Sultan FHC there was very poor clinical safety, poor IC and employee health programs, and defective environmental safety; the fire alarm system did not cover the entire center and the fire safety plan is not ready.

Accredited facilities were found to be more likely to have staff dedicated to risk management and environmental safety [10].

There is consistent evidence from several studies to support a positive impact of general accreditation programs on different specific clinical outcomes, including IC [9]. Even structural elements like a functioning alarm system are better in accredited centers and units [11].

Regarding the compliance of support services with standards, Monshaat Sultan FHC scored 43.89%. This result agreed with that of the study conducted by the GDQ and WHO in FHUs and FHCs of Menoufia Governorate, where compliance with support services ranged between 39 and 43%. However, it was in variance with the results of the selected Alexandria FHUs and FHCs where compliance of support services ranged between 59 and 88%. In Monshaat Sultan FHC there was deficient training in cardiopulmonary resuscitation, emergency equipment in the emergency room had no oxygen support, and there was scarcity of medicines.

Accreditation has a positive impact on patients' current medication processes [14]. It also enhances the reliability of laboratory testing [15].

In Monshaat Sultan FHC, the dimension of information management scored 23.81% compliance with standards. This result was similar to that of the study conducted by the GDQ and WHO in FHUs and FHCs of Menoufia Governorate, where the total information management results ranged between 32 and 38%. However, this was in variance with the results of the selected Alexandria FHUs and FHCs where safety results ranged between 70 and 86%. In Monshaat Sultan FHC there was neither a system for reviewing medical records nor an information system to transform raw data into useful information.

Completeness of medical records and improvement in quality are the result of accreditation [4].

QI in Monshaat Sultan FHC scored the lowest compliance with standards (12.12%), as quality control activities had been suspended since years, which resulted in all other weaknesses. This is consistent with studies that proved that if there is no ongoing performance management system, a decline may set in, which may last until the next initiation of reaccreditation [16].

Accreditation results in better monitoring of the effectiveness and quality of services and the process of continuously improving these services to achieve the greatest impact. Accreditation results in better frequency of QI projects. Accreditation also confers a greater likelihood that health centers have integrated specific QI activities into their daily operations [12].

Regarding compliance of family practice with standards, Monshaat Sultan FHC scored 24.07%. This was consistent with the result of the study conducted by GDQ and WHO in FHUs and FHCs of Menoufia Governorate, in which total family practice results ranged between 16 and 33%.

The results of the selected Alexandria FHUs and FHCs ranged between 69 and 77%. In Monshaat Sultan FHC there was large noncompliance in antenatal care visits. According to Egyptian standards the number of antenatal care visits should be 14, whereas it was only one in Monshaat Sultan FHC. The number of ladies visiting the center was also low; only one lady visited during the three months prior to assessment.

Regarding compliance of management of the organization with standards, Monshaat Sultan FHC scored only 2.82%, which was consistent with the reports from the GDQ and WHO study in FHUs and FHCs of Menoufia Governorate, where their scores in compliance of management of the organization ranged between 28 and 32%.

The results of Monshaat Sultan FHC were in variance with the results of FHUs and FHCs of Alexandria Governorate whose scores ranged between 46 and 82% of total patient rights score. In Monshaat Sultan FHC the role of management was very unsatisfactory in planning, implementing, monitoring, and evaluating.

Studies show that accreditation and compliance with accreditation standards lead to better staff training and education and competency verification [12]. Accreditation also promotes an understanding of how each person's job contributes to the healthcare organization's mission and services [17].


  Conclusion Top


Monshaat sultan FHC was only 33.64% compliant with current Egyptian PHC Accreditation Standards, whereas it was 80.18% in the year 2004.

Lack of training, follow-up of quality, and lack of continuous assessment are the leading reasons for the low rate of compliance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

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