The Yuma Regional Medical Center in Arizona, USA, which underwent the programme accreditation process in 2021, also reported having a really beneficial experience. The WONCA assessment team for Yuma Center included Dr Garth Manning, Prof Val Wass and Dr Victor Ng. Due to travel restrictions during the pandemic, the assessment visits were carried out over three days, virtually. Despite the lack of face-to-face meetings, the process was undertaken in exactly the same way as for face-to-face assessments. The programme staff collated and submitted prescribed documentation, the documentation was reviewed by the assessment team and follow-up questions for the programme were issued. Following the desk review, a structured virtual visit took place, covering the full range of inputs, structures and personnel associated with the programme including, separately, residents themselves. As with Jiahui, the Yuma Regional Medical Center received provisional accreditation, until a successful in-person site visit can take place. When asked about the process of undertaking programme accreditation, Dr Natalaia Galarza, Clinical Lead for Family Medicine, said
The Japan Primary Care Association (JPCA) undertook programme accreditation in late 2019 and they are proud to be the first to receive accreditation at national level for their post graduate programme. Atsushi Igaki, on behalf of President Dr Tesshu Kusaba, told us that JPCA was concerned that family medicine training programmes in Japan were not specifically tailored to the specialty of family medicine and there was concern about quality. As a result, JPCA, as the only academic organisation in the field of family medicine in Japan, developed their own post graduate programme.
Adapting the standards of the World Federation of Medical Education (WFME) to fit with the needs specific to family medicine training, the WWP on Education set out standards across nine areas and 38 sub areas. The areas are defined as broad components in the structure, process and outcome of postgraduate medical education and training. They include:
In developing and adapting the standards, the WWP on Education indicated that a variety of applications were possible, including self-assessment and programme quality improvement; new programme development; peer review; or recognition and accreditation. It was not assumed that everyone who accessed the standards, which are freely available on the WONCA website, would proceed to the full accreditation process.
Practice accreditation standards were developed in response to demand from Member Organisations, under the aegis of the WWP on Quality and Safety and WWP on Education. The standards were developed with technical inputs and support of a large number of individuals and Colleges, with ongoing peer review. Practice accreditation was originally intended for areas where formal standards have not yet been established or where practices are unregulated by any formal mechanism. For those practices which undergo WONCA Practice Accreditation, it is intended that the standards inherent in the accreditation process provide support to individual practices until such times as nationals standards and regulations are developed and implemented. Indeed, WONCA Practice Accreditation standards are reported as being used to help define national standards for family medicine practices. Achieving WONCA Practice Accreditation shows patients that the family medicine practice is serious about providing high quality, safe and effective care, in the context of the local environment, as measured against the standards determined by the family medicine profession.
The process of practice accreditation – from the expression of interest by a practice, through compilation and submission of documentation, assessment by WONCA professional colleagues, and awarding of accreditation - is intended to be a supportive tool to help individual family medicine practices to assert their achievements, and to provide clear indications for improvement to reach and maintain international standards.
It is acknowledged that health systems in each country can be markedly different; methods of delivery of care at all levels of the system and the financing of health care can vary enormously from one country to another and even within countries. The delivery of family medicine in individual countries is entirely context specific and the accreditation process is sympathetic to those individual contexts.
Any practice may express an interest in being accredited. Practices are entitled to apply for accreditation irrespective of the financing process for delivery and providing care. They can apply if they are publicly funded, have co-payment systems in place, are privately run, are funded under a health insurance scheme or by a not-for-profit organisation, by an NGO, or by a mixture of any of these mechanisms. The role of WONCA accreditation is not to judge or overtly promote preferred systems: rather accreditation is a way to reflect the standards of care being delivered in context.
As with the standards for WONCA Programme Accreditation, the standards for WONCA practice Accreditation are available, freely,
on the WONCA website.
Practices are assessed against a range of criteria, under the general headings of:
• Practitioners (which refers to the professions providing care and their qualifications)
• Patients (services provided meet the needs, values and beliefs of their patients)
• Provider activity (scheduling of care, patient records, tests and follow up, referrals) and
• Premises (accessibility, privacy, accommodation, toilet facilities, equipment)
On completion of the assessment visit, the applicant is advised about the outcome and, where necessary, the improvements needed to achieve accreditation. A formal report is produced by the accreditation assessment team and sent to the applicant within two weeks of the accreditation visit, detailing the current situation and how it matches against WONCA criteria, and also suggests steps for further improvements, where needed, with a roadmap to re-accreditation.
Dr Ling Qiu said of the WONCA practice accreditation process in Jiahui, that it
‘recognised our care quality and helped us promote patient-centred care. It encouraged us to continually seek improvement. The accreditation will promote premium primary care coverage by national and commercial insurance organisations for patient care’.
Certification of digital health solutions is a growing need in family medicine, as the use of technology and digital health applications become increasingly available. It is important that WONCA is involved early in their development so that applications specifically produced for family medicine are appropriate, that we help to define the standards, rather than letting standards be defined for us. For those applications and platforms which are already available, their evaluation is increasingly important to improve their quality, to ensure patient safety and to strengthen public and professional trust. WONCA is positioning itself to play a key role in developing standards for a certification programme and applying those standards to platforms which become available.
Development of standards has been undertaken by a group of experts and the WONCA Working Party on eHealth, and these standards and the assessment process have been piloted for robustness with one of the largest digital health platforms, Ping An Healthcare and Technology Company, based in China. Their ‘Pin An Good Doctor’ consultation system (PAGD), is a digital service with an artificial intelligence (AI) based consultation facility for the assistance of online doctors.
The assessment process consists of 11 domains which incorporate 112 free text questions. These 11 domains are:
• General
• Intended use
• Users
• Services
• Organisation and governance
• Ethical aspects
• Evidence
• Privacy and data protection
• Technology
• Financial aspects and
• Implementation
During the pilot, the ratings under each domain were then reported on in terms of (a) whether or not the PAGD systems was scalable to other settings, countries and healthcare systems; (b) the comprehensiveness of the services provided, and (c) the validity and available evidence of issues such as cost effectiveness.
Based on the learning from this successful pilot and testing of the assessment methods, WONCA continues to develop the digital health assessment framework with individual WONCA members with relevant expertise and with inputs from a range of WONCA Working Parties and Special Interest Groups. WONCA is playing a pivotal role in developing a certification programme to ensure that systems which are being contemplated for use in family medicine – or which are already being used - meet the service requirements and clinical needs of our family medicine colleagues.
For each of our accreditation and certification schemes there is a built-in system of peer review, ensuring that both the standards being applied and the implementation of the programmes are robust, realistic and reflect the profession of family medicine.
The President of WONCA, Dr Donald Li, established the Accreditation Committee, which he chairs. The Accreditation Committee oversees all processes, approves assessment teams and considers all reports for sign-off and approval.
The WONCA accreditation and certification schemes are available to any post graduate programme, practice or clinic, and to any organisation developing systems and technology for application in primary care and family medicine. The schemes contribute to quality improvement, to expansion and improvement of services and, ultimately, to push towards the target of achieving universal health coverage.
If you are interested in either programme or practice accreditation or if you are interested in certification of a digital health solution or digital health platform for primary care or family medicine, please contact the WONCA Secretariat
[email protected].