OR Today [ORT]: I’ve never heard of Acreditas Global.

Jack Egnatinsky (JE): That doesn’t surprise me; we’ve been operating under that banner for less than a year. But it’s the new name for AAAHC International. AAAHC is a leading brand name in the U.S., but it didn’t mean as much in Central and South America, where we mainly operate, so we gave it a new name; one that would mean more in Spanish-speaking countries.

ORT: So you accredit ASCs in Central and South America?

JE: We accredit a wide range of international facilities, from small ambulatory, outpatient facilities and oncology centers to hospitals. We work with them in the same way we work with ambulatory facilities in the U.S., helping them raise the bar on patient care and patient safety.

ORT: Do the types of facilities that Acreditas Global serves differ from those in the U.S.?

JE: Ambulatory surgery centers, as we know them in the U.S., are not as widespread in Latin America, where we made our first significant impact. We target smaller hospitals ranging from roughly 50 to 100 beds, as well as smaller ambulatory surgery centers such as dental clinics and oncology centers.

As we enter different markets throughout Central and South America, we’re finding that smaller hospitals have a very strong interest in accreditation. Frankly, we didn’t foresee such strong interest from hospitals. But as a fairly new organization we can still be light on our feet, and quickly adapted our accreditation program to respond to their needs.

ORT: How does Acreditas Global differ from Joint Commission International?

JE: Well, in that respect we’re still very similar to the AAAHC everyone knows and loves in the U.S. Our approach remains very much educational and consultative with on-the-ground training – much less of the audit profile that many individuals associate with the Joint Commission, stateside and internationally.

Following the mission of our parent organization, we believe that education and onsite, collaborative interaction between surveyor and staff allow greater growth for both the customer and the surveyors.

As we grow, of course, our aim is to nurture more and more host nation personnel in training roles and in conducting the surveys, rather than using American teams. We’ve already introduced this concept in Peru.

ORT: AAAHC, the parent organization, is still a key organization in the U.S. market, correct?

JE: Absolutely. But as far back as 2004, AAAHC began exploratory initiatives by forming an international task force, and quickly realized there were already hospital accreditors like Joint Commission International out there.

With our 30-some years of experience in ambulatory outpatient settings, we developed our international program based on the U.S. marketplace. But as I said earlier, what we had predicted as a market and what has become our market are different. Now it’s centered more on small hospitals and dental clinics – we have many of those types of medical and dental settings already accredited in Costa Rica and Peru, with a lot more showing great interest in pursuing Acreditas accreditation.

Based on knowledge of the market, we revised and added to our standards to better reflect what a small hospital accreditation program would seek in accreditation. The timing for this was perfect, as it fell during the routine updating and refinement of our core International Standards Handbook. For example, our new Standards increasingly focus on emergency room, maternity and occupational health services – all primary components that make up smaller hospitals.

ORT: Is accreditation as much of a benefit to international markets?

JE: Whatever country you’re in, accreditation raises the bar on quality and safety, and from a market perspective, when one facility demonstrates that it’s raised the bar, others inevitably follow. Universally, if individuals don’t know much about a certain facility or center, accreditation provides them with reassurance and peace of mind.

One of the first things we did in exploring the international market was to use our regular U.S. Standards to review an organization in Peru. We found that they were remarkably applicable despite differences in language and culture. Since then, we‘ve refined and tailored our Standards to be even more relevant to Latin American health care environments.

ORT: Do you look at outcomes, infection rates and patient satisfaction?

JE: Yes, those are all individual standards, and in fact, we dedicate an entire chapter to safety and infection prevention in our accreditation handbook.

Of course, given that our mission of accreditation is based on quality and safety, we dedicated a single chapter to quality and quality studies, many of which are internal to the institution we visit. The sophistication of quality studies has increased dramatically over the last decade in the U.S. We anticipate that this same curve will occur internationally as institutions begin to reframe the importance of developing a culture of quality and safety as a routine environment for health care delivery.

The way we teach internal quality studies and, if possible, external benchmark studies is with a focus on measurable outcomes – highly quantitative outcomes more so than highly qualitative outcomes. Our international teams realize that quality programs are in various stages of development throughout the region and within the facilities, and we view this as one of the greatest opportunities for our program. Training on quality is often a major component of a pre-assessment survey or the actual survey itself.

Similar to any standards set by an accreditor, we also consider how satisfaction is gauged, measured, and what changes are put in place to improve patient satisfaction if such opportunities exist.

ORT: If hospitals do not meet the expectations necessary to become accredited, are they given a chance to remediate and re-apply?

JE: Yes, of course. Focused follow-ups do sometimes occur, and our teams will go back and review the specific aspects that need more attention. But we’ve been fortunate to date; all facility revisits have resulted in full accreditation due to their remedial efforts on the focused concerns.

ORT: What percentage of the hospitals or institutions surveyed by Acreditas Global earn the full three- year accreditation on the first go around?

JE: So far, they all have; but a small number of cases were required to provide us with follow-up information. There hasn’t been any facility that completely failed a survey – which is testament to the quality of care being provided in Central and South America.

With many of these international facilities, we actually go in and do pre-assessment surveys. This may consist of a facility visit six months before an actual survey where we engage in granular discussions that result in better performance. This is such a great environment, one in which the surveyors learn of the local challenges hospitals face, while hospital staff receive focused education and training opportunities on what will be looked at during the accreditation survey.

A pre-assessment really helps both organizations – the facility and the accreditor. It gives us a really local flavor of what to expect and helps the facility to become familiar with our standards.

ORT: How many hospitals outside the U.S. have you surveyed?

JE: We have around 10 organizations already accredited, with six more in the process of attaining accreditation, all located in Central and South America.

ORT: Are you going to market this program beyond Central and South America?

JE: Well, we’ve had inquiries from Hungary and Saudi Arabia among others; but we’re still relatively new to the international arena. While we set ambitious goals, we plan to expand markets in an orderly, measured way.

Dr. Jack Egnatinsky is an anesthesiologist with extensive experience in the ambulatory surgery arena, both HOPD and ASC. He is a Past-President of the Board of FASA, a predecessor to the ASC Association, and Past President of AAAHC. He Is the Medical Director of Acreditas Global and remains extremely active as a Medical Director for AAAHC, in addition to being a well-travelled AAAHC accreditation surveyor in the USA and internationally.