Trent Accreditation Scheme
Encyclopedia
The Trent Accreditation Scheme (TAS), (now replaced de facto by a number of independent accreditation schemes, such as the QHA Trent Accreditation), was a British accreditation scheme formed with a mission to maintain and continually evaluate standards of quality, especially in health care
delivery, through the surveying and accreditation
of health care organisations, especially hospitals and clinics, both in the UK and elsewhere in the world.
The Trent UK Accreditation Scheme, or TAS UK, ceased to operate in May 2010, when a majority of Board members decided to end the scheme.
Subsequently, a number of independent accreditation schemes were set up, including the British-based scheme QHA Trent Accreditation.
Trent's basic mission resembled that of the USA's Joint Commission International, or JCI, and other major international healthcare accreditation
groups, although there were some significant differences in the way the different groups work.
Apart from hospital
s in the United Kingdom
, Trent also surveyed a large number of private sector hospitals in Hong Kong
. and at the time of its demise had been developing links with hospitals in Cyprus.
The approach Trent took to Clinic and Hospital Accreditation
was based on the axiom that no single healthcare system, whether European, American, Asian or otherwise in origin, has the right to claim a monopoly viewpoint over what represents acceptable quality and best clinical practice throughout the world, and no one country has the absolute right to tell another how their hospitals should be run. What is vital is that the quality of care which patients receive should be of the highest possible standard, and also that the hospitals and clinics providing that care should be independently capable when it comes to working out how best to maintain those standards and how best to respond to any new challenges which will inevitably come along. If the overall standards of a hospital or clinic can be shown to be of acceptable quality, then it is desirable, and even ideal, that local differences related to culture and to legislation should be specifically discussed and incorporated into the assessment standards in an appropriate fashion. That said, Trent was very interested in the medical ethical standards
of the hospitals it worked with.
To achieve all of this, Trent worked in close partnership with participating hospitals and clinics to generate an appropriate and mutually acceptable set of standards to survey against. Because the world of healthcare is constantly changing, the standards were constantly reviewed and up-dated through a system of working jointly with representatives of partner hospitals.
Trent developed various ways to ensure local participation, and even ownership, over the accreditation process in a locality. Trent utilised UK-sourced surveyors who were either working in the British National Health Service
, or NHS, or had retired in recent times, and hence have valuable experience and insight "at the coal face", and in Hong Kong Trent also appoints locally-domiciled surveyors (see later). Trent surveyors are drawn from a wide variety of professional backgrounds, but especially from the worlds of medicine, dentistry, nursing, the professions complementary to medicine
(e.g. physiotherapy, pharmacy
etc.) and healthcare management/administration, so as to ensure an appropriately broad portfolio of knowledge and skills are always present within the surveying teams and the wider organisation. Surveyors were all volunteer professionals rather than salaried employees.
Trent surveys were not just a matter of working through a “tick-list” of standards, a process which Trent believed might elevate standards to a certain level but nevertheless do little to inculcate a culture of “thinking for oneself” – instead, Trent surveys involved direct face-to-face conversation with all levels of staff, including clinical medical staff and senior management (for this reason, qualified medical doctors are included in all surveying teams organised by Trent) and Trent surveyors expected full freedom to go anywhere in the hospital or clinic under survey and to talk to anyone they choose to. Discussion and analysis of the data thus generated, not only by the Trent team but also by the hospital or clinic under survey, represented a major component of Trent's approach to hospital and clinic accreditation, and reflected an underlying philosophy that the whole process was about improving services to patients and the ability of an organisation to work effectively towards that aim.
Trent surveyors evaluated a vast range of modalities of a hospital's (or clinic's) activities and governance, including management, estates, equipment, clinical audit
, research, education and training, as well as clinical/medical activity. In Hong Kong hospitals, survey teams always consisted of 2 or 3 surveyors from the UK working together with (usually) 2 based in Hong Kong and who were actively working in the local hospitals. One surveyor will be nominated as the lead. The Hong Kong-based surveyors were nominated by the participating hospitals, and after receiving training they always surveyed hospitals other than their own. This approach led to unrivaled opportunity and potential for the sharing of ideas about best practice between hospitals working in the same locality, and the development of camaraderie. Also, patients were spoken to, and their views and experiences also sought.
At the end of a survey, the key findings were initially presented by the Lead Surveyor to the hospital or clinic undergoing the survey, this event taking place almost always on the last day. The findings were subsequently digested, analysed and put into a more detailed printed report, with positive virtues being highlighted as well as problems. However, because of the end-of-survey oral presentation, hospitals and clinics could start putting remedial action into place as soon as possible.
After a round of surveys, a joint meeting was held at which the printed reports of all the hospital and clinic surveys conducted in that particular round are discussed jointly and in depth by the Trent Board (which had both local and UK representation) together with senior representatives of the hospital or clinic being surveyed, and a decision was then taken as to whether or not accreditation would be granted unconditionally, or if it would be subject to conditions.
The Trent approach to accreditation ensured that the local hospitals and clinics enjoyed some ownership over the whole process, which would not be the case if all of the standards, all of the surveyors and all of the decisions regarding who was successful or not in achieving accreditation were imposed unilaterally from outside. It helped to build up the confidence of participating hospitals in their ability to develop ways to maintain and improve quality in a way that schemes which operate da more didactic approach to standards and their assessment would not. It also meant that there were Trent surveyors constantly present in the majority of the scheme’s participating hospitals.
Trent was a member of the United Kingdom Accreditation Forum
(UKAF) http://www.ukaf.org.uk/ and an institutional member of ISQUAhttp://www.who.int/patientsafety/isqua_dec08_bulletin.pdf.
, international healthcare accreditation
has increasingly grown in importance. A number of accreditation organisations sourced from a number of countries fulfil this internationally-orientated role, including:
No single accreditation scheme enjoys exclusive rights to be seen as an overall world-wide-relevant scheme, and some hospitals are looking towards multiple accreditation to achieve performance credibility in different parts of the world.
The Trent Scheme was the first accreditation scheme to survey and accredit a hospital in Asia, in Hong Kong in 2000 http://www.union.org/new/english/about_us/mission.htm. Since then others such as JCI
have entered the market, with JCI first accrediting Bumrungrad International Hospital in Thailand in 2002.
began operating.
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
delivery, through the surveying and accreditation
Accreditation
Accreditation is a process in which certification of competency, authority, or credibility is presented.Organizations that issue credentials or certify third parties against official standards are themselves formally accredited by accreditation bodies ; hence they are sometimes known as "accredited...
of health care organisations, especially hospitals and clinics, both in the UK and elsewhere in the world.
The Trent UK Accreditation Scheme, or TAS UK, ceased to operate in May 2010, when a majority of Board members decided to end the scheme.
Subsequently, a number of independent accreditation schemes were set up, including the British-based scheme QHA Trent Accreditation.
History of the scheme
International healthcare accreditation
Due to the near-universal desire for quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process...
groups, although there were some significant differences in the way the different groups work.
Apart from hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s in the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, Trent also surveyed a large number of private sector hospitals in Hong Kong
Hong Kong
Hong Kong is one of two Special Administrative Regions of the People's Republic of China , the other being Macau. A city-state situated on China's south coast and enclosed by the Pearl River Delta and South China Sea, it is renowned for its expansive skyline and deep natural harbour...
. and at the time of its demise had been developing links with hospitals in Cyprus.
The approach Trent took to Clinic and Hospital Accreditation
Hospital accreditation
Hospital accreditation has been defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”...
was based on the axiom that no single healthcare system, whether European, American, Asian or otherwise in origin, has the right to claim a monopoly viewpoint over what represents acceptable quality and best clinical practice throughout the world, and no one country has the absolute right to tell another how their hospitals should be run. What is vital is that the quality of care which patients receive should be of the highest possible standard, and also that the hospitals and clinics providing that care should be independently capable when it comes to working out how best to maintain those standards and how best to respond to any new challenges which will inevitably come along. If the overall standards of a hospital or clinic can be shown to be of acceptable quality, then it is desirable, and even ideal, that local differences related to culture and to legislation should be specifically discussed and incorporated into the assessment standards in an appropriate fashion. That said, Trent was very interested in the medical ethical standards
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
of the hospitals it worked with.
To achieve all of this, Trent worked in close partnership with participating hospitals and clinics to generate an appropriate and mutually acceptable set of standards to survey against. Because the world of healthcare is constantly changing, the standards were constantly reviewed and up-dated through a system of working jointly with representatives of partner hospitals.
Trent developed various ways to ensure local participation, and even ownership, over the accreditation process in a locality. Trent utilised UK-sourced surveyors who were either working in the British National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
, or NHS, or had retired in recent times, and hence have valuable experience and insight "at the coal face", and in Hong Kong Trent also appoints locally-domiciled surveyors (see later). Trent surveyors are drawn from a wide variety of professional backgrounds, but especially from the worlds of medicine, dentistry, nursing, the professions complementary to medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
(e.g. physiotherapy, pharmacy
Pharmacy
Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs...
etc.) and healthcare management/administration, so as to ensure an appropriately broad portfolio of knowledge and skills are always present within the surveying teams and the wider organisation. Surveyors were all volunteer professionals rather than salaried employees.
Trent surveys were not just a matter of working through a “tick-list” of standards, a process which Trent believed might elevate standards to a certain level but nevertheless do little to inculcate a culture of “thinking for oneself” – instead, Trent surveys involved direct face-to-face conversation with all levels of staff, including clinical medical staff and senior management (for this reason, qualified medical doctors are included in all surveying teams organised by Trent) and Trent surveyors expected full freedom to go anywhere in the hospital or clinic under survey and to talk to anyone they choose to. Discussion and analysis of the data thus generated, not only by the Trent team but also by the hospital or clinic under survey, represented a major component of Trent's approach to hospital and clinic accreditation, and reflected an underlying philosophy that the whole process was about improving services to patients and the ability of an organisation to work effectively towards that aim.
Trent surveyors evaluated a vast range of modalities of a hospital's (or clinic's) activities and governance, including management, estates, equipment, clinical audit
Clinical audit
Clinical audit is a process that has been defined as "a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change"....
, research, education and training, as well as clinical/medical activity. In Hong Kong hospitals, survey teams always consisted of 2 or 3 surveyors from the UK working together with (usually) 2 based in Hong Kong and who were actively working in the local hospitals. One surveyor will be nominated as the lead. The Hong Kong-based surveyors were nominated by the participating hospitals, and after receiving training they always surveyed hospitals other than their own. This approach led to unrivaled opportunity and potential for the sharing of ideas about best practice between hospitals working in the same locality, and the development of camaraderie. Also, patients were spoken to, and their views and experiences also sought.
At the end of a survey, the key findings were initially presented by the Lead Surveyor to the hospital or clinic undergoing the survey, this event taking place almost always on the last day. The findings were subsequently digested, analysed and put into a more detailed printed report, with positive virtues being highlighted as well as problems. However, because of the end-of-survey oral presentation, hospitals and clinics could start putting remedial action into place as soon as possible.
After a round of surveys, a joint meeting was held at which the printed reports of all the hospital and clinic surveys conducted in that particular round are discussed jointly and in depth by the Trent Board (which had both local and UK representation) together with senior representatives of the hospital or clinic being surveyed, and a decision was then taken as to whether or not accreditation would be granted unconditionally, or if it would be subject to conditions.
The Trent approach to accreditation ensured that the local hospitals and clinics enjoyed some ownership over the whole process, which would not be the case if all of the standards, all of the surveyors and all of the decisions regarding who was successful or not in achieving accreditation were imposed unilaterally from outside. It helped to build up the confidence of participating hospitals in their ability to develop ways to maintain and improve quality in a way that schemes which operate da more didactic approach to standards and their assessment would not. It also meant that there were Trent surveyors constantly present in the majority of the scheme’s participating hospitals.
Trent was a member of the United Kingdom Accreditation Forum
United Kingdom Accreditation Forum
Founded in June 1998 by a group of leading healthcare accreditation organisations, the United Kingdom Accreditation Forum is a London-based network of healthcare accreditation organisations formed with the intention of sharing experience regarding good practice in accreditation, as well as sharing...
(UKAF) http://www.ukaf.org.uk/ and an institutional member of ISQUAhttp://www.who.int/patientsafety/isqua_dec08_bulletin.pdf.
International Healthcare Accreditation
With the advent of medical tourismMedical tourism
Medical tourism is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care...
, international healthcare accreditation
International healthcare accreditation
Due to the near-universal desire for quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process...
has increasingly grown in importance. A number of accreditation organisations sourced from a number of countries fulfil this internationally-orientated role, including:
- Accreditation Canada International (formerly "The Canadian Council on Health Services Accreditation", or CCHSA)
- Joint Commission International (JCI), in the USA
- The Australian Council on Healthcare Standards, or ACHS
- QHA Trent AccreditationQHA Trent AccreditationQHA Trent Accreditation is a United Kingdom-based independent holistic accreditation scheme for hospitals and clinics that functions worldwide. It represents an option for healthcare providers to international accreditation schemes such as Joint Commission International from the USA...
(UK)
No single accreditation scheme enjoys exclusive rights to be seen as an overall world-wide-relevant scheme, and some hospitals are looking towards multiple accreditation to achieve performance credibility in different parts of the world.
The Trent Scheme was the first accreditation scheme to survey and accredit a hospital in Asia, in Hong Kong in 2000 http://www.union.org/new/english/about_us/mission.htm. Since then others such as JCI
JCI
JCI is a three-letter abbreviation with multiple meanings, as described below:* JCI, Jakarta Composite Index of Indonesia Stock Exchange* JCI Limited or Johannesburg Consolidated Investment Company Limited - One of the oldest listed companies on the JSE Securities Exchange having been formed in 1889...
have entered the market, with JCI first accrediting Bumrungrad International Hospital in Thailand in 2002.
Closure of Trent Accreditation Scheme
The UK-based Trent Accreditation Scheme (TAS UK) ceased surveying and accreditation activities in 2010. Subsequently, the British-based scheme QHA Trent AccreditationQHA Trent Accreditation
QHA Trent Accreditation is a United Kingdom-based independent holistic accreditation scheme for hospitals and clinics that functions worldwide. It represents an option for healthcare providers to international accreditation schemes such as Joint Commission International from the USA...
began operating.
See also
- HospitalHospitalA hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
- AccreditationAccreditationAccreditation is a process in which certification of competency, authority, or credibility is presented.Organizations that issue credentials or certify third parties against official standards are themselves formally accredited by accreditation bodies ; hence they are sometimes known as "accredited...
- Hospital AccreditationHospital accreditationHospital accreditation has been defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”...
- International healthcare accreditationInternational healthcare accreditationDue to the near-universal desire for quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process...
- Clinical governanceClinical governanceClinical governance is the term used to describe a systematic approach to maintaining and improving the quality of patient care within a health system. The term became widely used in health care following the Bristol heart scandal in 1995, during which anaesthetist Dr Stephen Bolsin exposed the...
- Clinical auditClinical auditClinical audit is a process that has been defined as "a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change"....
- Patient safetyPatient safetyPatient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
- List of International Healthcare Accreditation Organizations
- Medical EthicsMedical ethicsMedical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
- Nursing ethicsNursing ethicsNursing ethics is a branch of applied ethics that concerns itself with activities in the field of nursing. Nursing ethics shares many principles with medical ethics, such as beneficence, non-maleficence and respect for autonomy...
- Patient safety organizationPatient safety organizationA patient safety organization is a group, institution or association that improves medical care by reducing medical errors. In the 1990s, reports in several countries revealed a staggering number of patient injuries and deaths each year due to avoidable adverse health care events...
- Evidence-based medicineEvidence-based medicineEvidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
- List of hospitals in Hong Kong
- United Kingdom Accreditation ForumUnited Kingdom Accreditation ForumFounded in June 1998 by a group of leading healthcare accreditation organisations, the United Kingdom Accreditation Forum is a London-based network of healthcare accreditation organisations formed with the intention of sharing experience regarding good practice in accreditation, as well as sharing...
Hospitals co-operating with the former TAS (UK) outside of the United Kingdom
- Hong kong adventist hospitalHong Kong Adventist HospitalHong Kong Adventist Hospital is one of two Adventist Hospitals in Hong Kong, the other being Tsuen Wan Adventist Hospital. It is a private sector hospital, and is located on Hong Kong Island...
- Tsuen Wan Adventist HospitalTsuen Wan Adventist HospitalTsuen Wan Adventist Hospital is one of two Adventist Hospitals in Hong Kong, the other being Hong Kong Adventist Hospital.It is a private sector hospital, and is located in the New Territories...
- Hong Kong Sanatorium and HospitalHong Kong Sanatorium and HospitalHong Kong Sanatorium and Hospital , or HKSH, is a private hospital established in 1922 in Happy Valley, Hong Kong.It is one of the most famous of the Hong Kong hospitals, renowned for its high quality hospital services and comfortable accommodation for patients. All clients can also choose their...
- Union HospitalUnion HospitalUnion Hospital may refer to:* Union Hospital , Tai Wai, Shatin, Hong Kong* Union Hospital , Terre Haute, Indiana, United States* Union Hospital , Elkton, Maryland, United States...
- Hong Kong Baptist HospitalHong Kong Baptist HospitalHong Kong Baptist Hospital is an 800-bed private hospital located in the Kowloon area of Hong Kong. Founded in 1963, it was the first private hospital in Hong Kong. It does not provide Accident & Emergency services....
- Matilda International HospitalMatilda International HospitalMatilda International Hospital is a hospital in Hong Kong located at 41 Mount Kellett Road, The Peak. The hospital was built as a result of the last will and testament of Granville Sharp, the husband of Matilda Lincolne Sharp...
- Evangel Hospital Hong KongEvangel Hospital Hong KongEvangel Hospital in Hong Kong is a private hospital established in 1965. It was founded jointly by the Evangelical Free Church of America and the Evangelical Free Church of China.Evangel Hospital is particularly strong in the primary care field of medicine....
- Hong Kong Central HospitalHong Kong Central HospitalHong Kong Central Hospital is a non-profit, general private hospital located in the Central area of Hong Kong Island, Hong Kong.The hospital's services include a large number of specialties which cover a broad area of medicine....
- Precious blood hospitalPrecious Blood HospitalPrecious Blood Hospital is a private hospital in Hong Kong, located at No. 113 Castle Peak Road in the Sham Shui Po area of West Kowloon. It is a Roman Catholic Christian hospital, run by the Caritas group, as is Canossa Hospital. Patients of all faith and backgrounds are cared for.-History:The...
- St. Paul%27s Hospital%2C Hong Kong
- St Teresa%27s Hospital%2C Hong Kong
- Canossa Hospital%2C Hong Kong