Sajid Ahmed.pdf - International Hospital Federation

Does accreditation addresses ethical 

issues in cases from Middle East 

hospitals 

Dr. Sajid Ahmed 

Accounts Manager, Accreditation Canada 

37 th IHF World Hospital Congress in Dubai, UAE 

November 8, 2011

Presentation outline 

Objective 

Evolution of ethics standards 

Methodology 

Results 

Health Ethics Framework 

Conclusion 

© Accreditation Canada International 

2

Objective 

To identify how accreditation has 

mobilized organizations to address 

ethical issues and concerns at four 

hospitals in Saudi Arabia and Kuwait 


3

Methodology 

Accreditation Canada implemented its 

accreditation process in four hospitals in the 

Middle East (three in Saudi Arabia and one in 

Kuwait) 

Three of the hospitals were private and one 

was a public teaching hospital 

Timeline approximately three years (2006 – 

2009) 


4

Evolution of ethics standards 

Ethics standards addressing 

1986 – informed consent, patient choice/refusal of treatment, 

accessibility, restraints 

1991 – death and dying, abortion, research, patient complaints, 

organ donation and retrieval 

1995 – withdrawal of life support, confidentiality, conflict of 

interest 

2006 – written code of ethics 

2010 – ethical issues management, resource allocation, ethical 

implications of research projects 


5

International 

Accreditation Program 

Three-year Cycle 

SELF-ASSESSMENT 

• Client organization 

completes 

questionnaires and 

submits instrument 

and indicator data 

• Organization 

updates on-line 

profile 

SIMULATED 

SURVEY 

ON-SITE SURVEY 

Surveyors assess services 

and report findings 

EDUCATION 

Core and 

comprehensive 

sessions available 

Client 

Organization 

ACCREDITATION 

DECISION and 

REPORT 

READINESS ASSESSMENT and REPORT 

• Organization completes 

on-line profile 

• Assessment of fundamental elements of 

quality and safety using questionnaires 

and initial visit 

PROGRESS REVIEW 

Accreditation Canada reviews 

evidence of action taken and 

amends 

accreditation decision if 

applicable. Annual update of 

indicators required 

www.accreditation.ca 


6

Readiness Assessment (RA) 

Accreditation Canada surveyors evaluated 

current structures, processes, and 

outcomes 

Interviews conducted with staff 

Thorough tour of the physical structure of 

the hospitals 

Ethics was one of the elements assessed 


7

Results related to Ethics during the RA 

Hospitals had 

 

 

 

limited structures in place to deal with ethical issues 

or concerns including a lack of policy and 

procedure, ethical committee, ethical framework 

inconsistent practice related to obtaining informed 

and written consent prior to any surgical procedure 

or treatment, code of ethics, or support or education 

for staff 

absence of any kind of ethical framework lead to 

inconsistency in how staff dealt with ethical issues 


8

Self Assessment Progress 

Following the readiness assessment, each 

hospital formed a minimum of five 

multidisciplinary teams — Leadership, 

Environment, Human Resources, Information 

Management, and Service Delivery (which 

included clinical program teams such as 

Medicine, Surgery, Maternal / Child, Emergency) 

Teams were tasked with assessing the care and 

services provided in their respective unit, against 

Accreditation Canada’s standards of excellence 


9

Self Assessment Process 

Through this process, teams were able to 

develop action plans and implement 

improvement initiatives to address the focus 

areas identified in the readiness assessment 

Complete the self assessment through 

identification of strengths and areas of 

improvement 

Rating against criteria 


10

Readiness Assessment to Survey 

Average period between readiness 

assessment and on-site survey is 28 months 


11

Results of onsite survey related to 

Ethics 

Formation of an ethics committee 

Availability of an ethics coordinator 

Development of ethics-related policies and 

procedures 

Development of an ethical framework 

Increased education and training to staff 

around ethics 


12

Results of onsite survey related to 

Ethics (cont’d) 

Increased resources to help deal with ethical 

issues 

Development of a code of ethics 

Discussed code of ethics at orientation 

Availability of code of ethics in Arabic 


13

Health Ethics Framework for 

Supporting Ethical Practice 

Ref: Dr Robert Bucher, Ph. D 

Leading Ethicist in Canada 


14

Common ethical concerns in healthcare 

Patient care 

Professional practice 

Institutional practice 

Organizational ethics 


15

The Process for Ethical Decision-Making 

Problem 

Issues 

Stakeholders 

Options and assessment 

Decision 

Implementation 

© Accreditation Canada International

Problem 

What precisely, is the problem 

Who is responsible for taking the action 

required to implement the solution? 

Objectives at this stage 

 

 

Clarify the question 

Narrow question down to manageable proportions 


Issues 

What are the ethical issues at play in this problem? 

What hospital/professional policies or goals are relevant 

to the problem? 


 

Formulate ethical context 


Stakeholders 

Who are the relevant stakeholder groups? 

What are their interests? 

Are there conflicting interests between stakeholder 

groups 


 

 

Identify stakeholders 

Identify conflicts 

Sometimes ethical conflicts are between the legitimate 

interests of different groups 


Options and Assessments 

What are the possible courses of action? 


 

 

 

 

Identify alternatives 

Evaluate 

Form judgement 

Make decision 


Decision 

State the favoured outcome 

Explain reasons for preferring chosen outcome over the 

alternatives. 


 

 

Clearly identify decision 

Clearly articulate reasons for choice 


Decision Check 

Apply the TV test. 

Would you be comfortable going on the 6 o’clock news and 

publicly stating and explaining your decision? (You should 

not expect to be able to satisfy everyone’s demands, but 

you should feel that an impartial and fair observer would 

accept the decision and the reasons upon which it was 

made.) 


Implementation and Follow-Up 

Identify the steps required to put the choice into action 

Identify evaluation mechanism for follow up, if required 

Identify educational, information strategies as required 


 

 

 

Turn decision into action 

Provide evaluation mechanism 

Inform and educate 


Conclusion 

Results clearly show that accreditation is an important 

tool in improving the management of ethical issues. 

Further work still needs to be done to increase ethical 

awareness, develop a consistent hospital-wide ethical 

framework for decision-making, establish clear definitions 

around the ethics committee mandate, identify ethical 

dilemmas related to clinical practice, and provide training 

to all staff on the hospital’s ethical framework. 


24

Accreditation Canada International 

For further information 

Dr Sajid Ahmed 

Accounts Manager 

Sajid.Ahmed@accreditation.ca 

1-800-814-7769 

www.internationalaccreditation.ca 


The leader in raising the bar for health quality 

Le leader qui hausse la barre en matière 

de qualité de santé

Sajid Ahmed.pdf - International Hospital Federation

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