» The Benefits of Imaging Accreditation

04 April, 2017

The Blackpool Teaching Hospitals NHS Foundation Trust was the first radiology/diagnostic imaging service to achieve accreditation within the NHS.  Here, Dr Graham Hoadley, Consultant Radiologist and National Clinical Advisor, NHS Improvement, looks at the benefits of successfully completing the accreditation process. 

Accreditation is a robust assessment of a radiology service, requiring great effort by a large number of staff to achieve success. There is also a small but not insignificant financial cost to achieving this standard.  At the time of writing there are just five NHS and two private services that have achieved accreditation.  It is reasonable therefore to ask “what are the rewards for the effort?”

The benefits can be considered under the headings of advantage to the department itself, to its staff, to patients, to the whole organisation, to commissioners, and to the wider NHS and the Department of Health.

My own organisation had a quality assurance programme for many years.  Since 2002 (as an early pilot site for what is now NHS Improvement) we have had an on-going programme of service improvement.  We wanted to have tangible evidence of high standards of service and patient care that we felt we delivered, and relished the opportunity to learn from others.

It was no mean feat to get all our governance processes and documentation up to date and organised, but we now have clear knowledge of where all relevant documents are held, who is responsible, and when they need updating.  This also applies to trust documents which impact our department.  We can therefore be sure that our governance is complete and current.

However documentation without action is pointless.  The accreditation process requires us to demonstrate, by audits or other evidence backed up by scrutiny on the site visit, that the procedures we have in place are being adhered to and are effective.  Our patient information is up to date, accurate and understandable, and provided in a patient friendly format.

Accreditation has given us contact with other departments going through the process, and we have helped and supported each other.  When there are enough accredited departments it may be possible to formalise this better with an accreditation ‘users’ forum, to promote exchange of ideas.  The process of inspection itself helps to share best practise between organisations, and this should become a national driver of quality.

The teamwork needed by hard pressed staff has led to a sense of unity and pride, not only in the achievement itself, but in knowing that our service is of a high quality, that it has been improved by the process, and also in identifying areas for further improvement.

The clinical domains indicate a major patient focus with 45% of the standards and 44% of the criteria relating to patient safety or experience.  With accreditation we can therefore confidently assure our patients that we will meet their needs, and that their privacy and dignity will be preserved.  Patients will not only have a better and safer experience of our service - benefiting from the  improvements required in all areas to achieve the standard – but will also have assurance that this will be so.

Accreditation also gives us evidence for our commissioners that we deliver high quality, patient focused services, as we persuade them to continue to commission our services.  This will be more important as the Department of Health extend the concept of ‘any qualified provider’ able to compete for diagnostic service provision in the coming years.  The trust also benefits from knowledge that we have been carefully scrutinised and not found wanting, and the award is a source of pride for all.  Ultimately it will be a risk not to have achieved accreditation, as it will imply that certain important standards have not been met in that organisation. 

If the visiting team identify areas where investment is required to achieve a satisfactory standard, that may of itself be useful evidence in generating the necessary business case. There is a possibility in the future that accreditation will attract a best practice tariff, though this is yet to be confirmed.

The benefits of a successful accreditation scheme to the wider NHS and the Department of Health are manifold.  As take up spreads, quality improvements will be driven across the NHS.  As accreditation becomes the normal state, trusts failing to reach a good standard will be more easily identified. 

The process provides a form of benchmarking of the quality of imaging services across a wide range of patient focused parameters, something that has been hard to achieve nationally by simple number counting.  With the advent of the new imaging dataset this year, and the future ability to cross reference with other clinical data, it may ultimately be possible to use the process to drive whole system changes to promote quality; for example by limiting accreditation to organisations that meet specified national targets such as the imaging components of the stroke strategy.

In summary, accreditation provides evidence for commissioners, providers and patients that an imaging service is safe and of a high quality.  The process itself will promote service improvement in individual organisations, and should become a national quality driver.