Industrial Revolution 4.

0 in Global
Healthcare and Hospital Accreditation
5-7 August, 2019
Jakarta Convention Center, Jakarta, Indonesia

Professor Cliff Hughes,

AO
Australian Institute of Health Innovation
Centre for Healthcare Resilience and
Implementation Science
Macquarie University, Sydney, Australia
Past President
International Society for Quality in Health
Care (ISQua)
International Accreditation
Programme (IAP)
Since 1999, the IAP has provided accreditation bodies with an
independent third-party assessment process to validate
existing systems and drive continuous quality improvement.

The IAP enables organisations to demonstrate their credibility

and benchmark their performance on an international level.
The International Society for Quality in
Health Care External Evaluation
Association (IEEA) was established, as
a separate legal entity, by the
International Society for Quality in
Health Care in 2018 to deliver its
external evaluation services.
Based in Geneva, Switzerland, the IEEA
commenced operations on 1st January
2019.
The IEEA provides third-party external
evaluation services to health and social
care external evaluation organisations
and standards developing bodies around
the globe.
The IEEA is governed by the same
Board as the Board of ISQua.
The IEEA’s
primary The International Accreditation
Programme (IAP) delivers a unique
programme is
global accreditation service to
the International health and social care external
Accreditation evaluation organisations and
Programme standards developing bodies.
(IAP)
 ISQua’s Vision
to transform health and the quality and safety of
healthcare, through global communities.

Mission
to inspire and empower people to advocate
for, and facilitate health and improvements, in the
quality and safety of healthcare worldwide.

Enabling a global community to transform health through External Evaluation,

Knowledge, Network and Voice.
IAP
Programmes
O P E R AT I N G I N O V E R 6 0
COUNTRIES, THE IAP OFFERS
T H R E E S E PA R AT E P E E R
REVIEW ASSESSMENT OPTIONS
Our
continuous
accreditation
process
encourages
growth and
development
The
Industrial
Revolutions
The Industrial Revolutions

[Source: StudyMalasia,
May 2 2018:
https://www.studymalays
ia.com/education/top-
stories/the-fourth-
industrial-revolution-ir-
4.0-and-what-it-means-
for-students-like-you]
The Industrial Revolutions

1.0 Mass Transport = Steam

2.0 Mass Production = Electricity

3.0 Mass Data = Computers

4.0 Mass Efficiency = Connectivity (AI)

1.0 Steam/machines Revolution

The steam/machines
revolution, during the 18th
century, witnessed the
transition to machine
manufacturing:

• Steam engine
• Automobiles
• Telephone and telegraph

[Source: Encyclopaedia Britannica, Jun

21 2019, Industrial Revolution]
1.0 Steam/machines Revolution

These new machines

revolutionised society
(particularly the
middle class),
transport and the
economy.

It also led to:

Pollution (smog) ….
[Source: Encyclopaedia
Britannica, Jun 21 2019,
Industrial Revolution]
1.0 Steam/machines Revolution

It also led to….

Dangerous and poor working

conditions
[Source: Encyclopaedia Britannica, Jun 21
2019, Industrial Revolution]
2.0 Electricity Revolution

Who can imagine a world without

electricity now?

Th electricity revolution, during the

late 1800s, powered homes, rural
areas and cities. Electricity made
everyday work tasks easier.

[Source: Vanhattan AB and Centre for Business

History, 2019, The revolution of electricity]
 2.0 Electricity Revolution

Paving the way to new machines (electric railways, electric

stove and electric iron) meant a new way of living, both in
cities and the countryside.

This led to a change in jobs – many domestic appliances

changed other professions (e.g. maids) and led to more
women in the workforce.

Now: dependence on electricity, increased expense and has

contributed to climate change.
[Source: Vanhattan AB and Centre for Business History, 2019, The revolution of
electricity]
3.0 Computer Revolution

Computers and access to the

World Wide Web started taking
off in the early 21st century.

Th digital and computer

revolution made everyday tasks
and business easier to do in real-
time.

[Source: Encyclopedia of Modern Europe:

Europe since 1914: Encyclopedia of the Age
of War and Reconstruction, 2019, Computer
Revolution.]
3.0 Computer Revolution

The intersection of many

technologies, like
telecommunications, has
revolutionised society the world
around us.

What do you think the downside

for the individual is in this
instance?

[Source: Encyclopedia of Modern Europe:

Europe since 1914: Encyclopedia of the Age
of War and Reconstruction, 2019, Computer
Revolution.]
4.0 Connectivity Revolution

Now we are more connected than ever

before – we are also producing more data
than ever before. With areas like
genomics growing, we have more
information than we can store.

Our health record for instance, is the

most valuable record we have.

[Source: Harper, E. (2013) The economic value of health

care data. Nursing Administration Quarterly 37(2):105-
108]
What
happened
next?
Stagnation

[Source: Washington, R.A.

(2011) The Great Stagnation.
Book Review; The economist ]
Innovation exhausted the low
hanging economic fruit

Everything slowed in face of

problems until the
community demanded more
change for its own good!
That is, we the people
matter!
BIG DATA –
who is it for?
The evidence
 Quality and safety structures and
procedures are more evident in
Accreditation hospitals which are accredited or ISO
certified
and ISO
Some differences exist between
accredited versus certified hospitals
(Interpretation of these results is limited by sample size and variation)

Sept 2010
Shaw et al .Accreditation and ISO Certification: Do they explain differences in
Quality Management in European Hospitals. Intl J Qual in Healthcare. 2010; 22
(6): 445-451.
 Paucity of high-quality controlled
evaluations of the effectiveness
Cochrane and the cost-effectiveness of
external inspection systems.
review
More studies required

The Cochrane Library

Gerd Flodgren Daniela C Gonçalves-Bradley, Marie-Pascale Pomey
External inspection of compliance with standards for improved healthcare outcomes
2 December 2016
The need for evidence
The challenge for accreditation agencies is to publish
their research protocols and then their findings, both
positive and negative, in the peer-reviewed literature.

When they do publish their results the agencies will

be explicitly displaying leadership, transparency and
evidence of improvement, the very qualities and
conduct they require of the health organisations they
accredit.
Developing the evidence base for accreditation of healthcare organisations: a call for transparency and innovation
David Greenfield, Jeffrey Braithwaite Qual Saf Health Care. 2009;18:162–163.
 Systematic reviews
Accreditation
 promotes change and professional development
 has an organisational financial impact
 improves measured quality performance
 With public disclosure of outcomes, increases the credibility of the
hospital with the community
 Improves the process of care provided by healthcare services.
 Improves clinical outcomes of a wide spectrum of clinical conditions.
 Should be supported as a tool to improve the quality of healthcare
services.
Greenfield and Braithwaite, Health Sector Accreditation Research: a systematic review.. Int. J for Qual. in Healthcare. 2008; 20 (3): 172-183
Alkhenizan and Shaw. Impact of Accreditation on the Quality of Healthcare Services: a Systematic Review of the Literature. Ann Saudi Med. 2011; 31(4): 407-416
 Clinical benefits an example
Gratwohl et al (2011) Patient outcome was
systematically better when the transplantation centre was
at a more advanced phase of JACIE accreditation
Lichtman et al (2011) CVA accreditation resulted in
reduced mortality rate but no change in readmission
rates
Menachemi et al (2008) Ambulatory care centres,
patients in JCI accredited facilities were significantly less
likely to be re-hospitalised after colonoscopy
Accreditation cannot simply be judged as a
stand-alone entity, especially regarding any
effect it may have on patient outcomes.

Healthcare accreditation effectiveness is to a

large extent determined by the effectiveness
and appropriateness of the standards,
guidelines and protocols it assures against.

Accreditation cannot guarantee complete

safety of a healthcare facility as is true of
any ‘point in time’ approach. However, it can
be a positive indication of an organisation’s
safety culture (ACHS, 2017).
Healthcare is in constant change in order to
meet consumer needs and defined priorities.

Changes in populations, technology and new

research also combine to ensure that the care
delivered will change, even if subtly, on a
regular basis.

Any tool for assuring and improving healthcare

must therefore also be flexible and responsive.

Accreditation should be adaptive enough to

ensure its contribution is positive (Braithwaite et
al, 2018).
What will
happen next
in
Healthcare?
Stagnation,
unless…..
[Source: Braithwaite, J. et al (2018) The future of health systems
to 2030: a roadmap for global progress and sustainability. Int J
Qual Health Care]
…unless we
learn the
lessons
from history!
[Source: Amalberti, R. et al (2018) Coping with more people with more
illness. Part 1: the nature of the challenge and the implications for safety and
quality. Int J Qual Health Care.]
Five trends

1.Sustainable health systems

2.Genomics revolution
3.Emerging technologies
4.Global demographic dynamics
5.New models of care
Nine themes
1. Integration of healthcare services
2. Financing, economics and insurance
3. Patient based care and empowering the patient
4. Universal health care
5. Technology and information technology
6. Ageing populations
7. Preventative care
8. Accreditation, standards and policy
9. Human development, education and training
 Back to the
future?
[Source: Braithwaite, J.
(2018) Coping with more
people with more illness.
Part 2: new generation
of standards for enabling
healthcare system
transformation and
sustainability. Int J Qual
Health Care.]
It is all about
the patient –
and always
has been!
Back to the future?

Cliff to put in text

Contact Details
Australian Institute of Health Innovation
Faculty of Medicine and Health Sciences, Macquarie University
Name Australia
Sydney,
Company
Title
International Society for Quality in Health Care External
Evaluation
Phone
Association (IEEA)
Multifiduciaire
Email
Genève,Carrefour de Rive 1,
Case postale 3369,
1211 Genève 3
Switzerland
Email: Cliff.hughes@mq.edu.au

AIHI website: http://aihi.mq.edu.au

Email: support@ieea.ch

IEEA website: https://ieea.ch/

Indonesian Kars
Award for Innovation
and Accreditation
2019
ISQua’s
Annual
Conferences
Questions,
comments,
discussion?
Thank You
Industrial Revolution 4.0 in Global
Healthcare and Hospital
Accreditation
Revolusi Industri 4.0
di Global Healthcare
dan Akreditasi
Rumah Sakit