The Importance of Standards in Healthcare

Global standards could significantly improve patient safety, efficiency and effectiveness of healthcare systems, says Josie Winter, Clinical Director at Advanced Clinical Solutions

It’s not unreasonable to assume that standards exist in healthcare. Most sectors have guidelines so that everyone can be reassured that best practice is taken as read. But as technology and digital health evolve ever faster, it’s becoming clear that healthcare needs to have a global set of standards so that there is equality and reassurance in treatment in every country.

Standards are systematically developed

‘sets of instructions’ to assist clinicians and patients around decisions of appropriate health care for specific circumstances. These days quality and safety are more important than ever, with avoidable harm occurring globally in as many as 4 in 10 patients.

Clearly there will always be discrepancies in the ability of certain countries to have the most up to date equipment, but if there are standards in place, clinical outcomes can be evaluated.

Global standards could significantly improve patient safety, e iciency and e ectiveness of healthcare systems. Their potential to improve both the quality or process of care and patient outcomes is also self-evident, and will encourage healthcare providers to seek out such certification as competition in healthcare becomes more driven.

The importance of high quality care and services

I’ve worked for the NHS - originally as a theatre nurse - and for private healthcare organisations including a large corporate med-tech organisation. I’ve developed and delivered hundreds of clinical audits and quality improvement plans and trained thousands of healthcare sta in various clinical skills.

Realising the lack of training and support around patient safety, I co-founded and head up Advanced Clinical Solutions, a professional services provider of patient safety, regulatory compliance, and quality improvement support to private healthcare organisations.

Our experts help other healthcare professionals deliver high quality clinical care and services, through a unique holistic partnership approach involving evaluation, audit, research, inspection, training and education. But beyond this we’re keen to fly the flag for patient safety. Surprisingly it’s not always top of the agenda in an obvious way, and it needs to be more prominent.

Challenges

Healthcare is o en regional, fragmented and heavily regulated, so most regulators are now defining standards to meet national rather than global goals. The WHO has made incredible strides to provide guidance and standards for a global audience, but more could be done.

Some areas of healthcare are fast moving which increases the risk of standards having out-of-date recommendations. There are somewhere in the region of two million papers and articles published every year, so how do we keep up with what is relevant and truly innovative and how does this shape practice?

Clinical audit is a way to find out if healthcare is being provided in line with standards. But how do we know if this is happening if there are no agreed standards and how can quality and outcomes be continuously improved? Most clinicians (particularly my nursing colleagues) have had no formal training in audit and this is worrying . We would not expect a nurse to put in a catheter or take our blood without training. Why is this the case with a critical skill that determines if we are meeting the standards?

Josie Winter Clinical Director Advanced Clinical Solutions

“Patients themselves will begin to understand they need a reliable measure to judge their care”

A potential solution

The benefit of our highly-communicated world is that we can keep up to date with new ideas, but it’s si ing through the relevant ones that is the hard part. For this reason it would be sensible to seek out systems already in place, such as The Living Standard (a coin termed in Australia by a group developing standards for COVID-19 care during the pandemic).

The aim is to provide specific, patientfocused standards and recommendations for the clinical care of particular patient

groups. These are ‘living’ guidelines, updated with new research in near realtime in order to give reliable, up-to-the minute advice to clinicians providing frontline care.

Another option could be adopting systematically reviewed literature and developed recommendations using GRADE. The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) working group began in the year 2000 as an informal collaboration of people with an interest in addressing the shortcomings of grading systems in healthcare.

The working group has developed a common, sensible and transparent approach to grading quality (or certainty) of evidence and strength of recommendations. Many international organisations have provided input into the development of the GRADE approach which is now considered the standard in guideline development.

Systematic reviews of the e ects of healthcare provide essential, but not su icient information for making wellinformed decisions. Reviewers and people who use reviews draw conclusions about the quality of the evidence, either implicitly or explicitly. Such judgments guide subsequent decisions.

A global standard

However, the concept of a global standard is still far from a reality, but as healthcare innovation develops apace, patients themselves will begin to understand they need a reliable measure to judge their care. It will provide reassurance if they fall ill abroad and perhaps don’t speak the language, or they can judge their clinician and treatment against familiar themes. And we can’t underestimate the importance of patient confidence at the end of the day.

Contact Information

josie@advancedclinicalsolution.co.uk www.advancedclinicalsolution.co.uk