Trent Accreditation Scheme

The Trent Accreditation Scheme (TAS) is a United Kingdom-based non-profit organisation formed with a mission to maintain and continually standards of quality, especially in health care delivery, through the surveying and accreditation of health care organisations, especially hospitals, both in the UK and elsewhere in the world.

Trent's basic mission resembles that of the USA's Joint Commission International, or JCI, and other major international healthcare accreditation groups, although there are some significant differences. Apart from hospitals in the United Kingdom, Trent also surveys a large number of private sector hospitals in Hong Kong.

The approach Trent takes to Hospital Accreditation is based on the axiom that no single healthcare system, whether European, American, Asian or otherwise in origin, has the right to claim a monopoly viewpoint over what represents acceptable quality and best clinical practice, and no one country has the absolute right to tell another how their hospitals should be run. What is vital is that the quality of care which patients receive should be of the highest possible standard, and also that the hospitals providing that care should be independently capable when it comes to working out how best to maintain those standards and how best to respond to any new challenges which will inevitably come along. If the overall standards of a hospital can be shown to be of acceptable quality, then it is desirable, and even ideal, that local differences related to culture and legislation should be specifically discussed and incorporated into the assessment standards in an appropriate fashion.

To achieve this, Trent works in close partnership with participating hospitals to generate an appropriate and mutually acceptable set of standards to survey against. Because the world of healthcare is constantly changing, these standards are constantly reviewed and up-dated through a system of working jointly with representatives of partner hospitals.

Trent has developed various ways to ensure local participation, and even ownership, over the accreditation process in a locality. Trent utilises UK-sourced surveyors who are either working in the British National Health Service, or NHS, or have retired in recent times, and hence have valuable experience and insight “at the coal face”, and in Hong Kong Trent also appoints locally-domiciled surveyors (see later). Trent surveyors are drawn from a wide variety of professional backgrounds, but especially from the worlds of medicine, nursing, the professions complementary to medicine (e.g. physiotherapy, pharmacy etc.) and healthcare management/administration, so as to ensure an appropriately broad portfolio of knowledge and skills are always present within the surveying teams and the wider organisation. Surveyors are all volunteer professionals rather than salaried employees.

Trent surveys are not just a matter of working through a “tick-list” of standards, a process which Trent believes may elevate standards to a certain level but nevertheless do little to inculcate a culture of “thinking for oneself” – instead, Trent surveys involve direct face-to-face conversation with all levels of staff, including clinical medical staff and senior management (for this reason, qualified medical doctors are included in all surveying teams organised by Trent) and Trent surveyors expect full freedom to go anywhere in the hospital under survey and to talk to anyone they choose to. Discussion and analysis of the data thus generated, not only by the Trent team but also by the hospital under survey, represents a major component of Trent's approach to hospital accreditation, and reflects an underlying philosophy that the whole process is about improving services to patients and the ability of an organisation to work effectively towards that aim.

Trent surveyors evaluate a vast range of modalities of a hospital's activities and governance, including management, estates, equipment, audit, research, education and training, as well as clinical/medical activity. In Hong Kong hospitals, survey teams always consist of 2 or 3 surveyors from the UK working together with (usually) 2 based in Hong Kong and who are actively working in the local hospitals. One surveyor will be nominated as the lead. The Hong Kong-based surveyors are nominated by the participating hospitals, and after receiving training they always survey hospitals other than their own. This approach has led to unrivalled opportunity and potential for the sharing of ideas about best practice between hospitals working in the same locality, and the development of cameraderie. Patients are also spoken to, and their views and experiences are also sought.

At the end of a survey, the key findings are initially presented by the Lead Surveyor to the hospital undergoing the survey, this event taking place almost always on the last day. The findings are subsequently digested, analysed and put into a more detailed printed report, with positive virtues being highlighted as well as problems. However, because of the end-of-survey oral presentation, hospitals can start putting remedial action into place as soon as possible.

After a round of surveys, a joint meeting is held at which the printed reports of all the hospital surveys conducted in that particular round are discussed jointly and in depth by the Trent Board (which has both local and UK representation) together with senior representatives of the hospital being surveyed, and a decision is then taken as to whether or not accreditation will be granted unconditionally, or if it will be subject to conditions.

The Trent approach to accreditation ensures that the local hospitals enjoy some ownership over the whole process, which would not be the case if all of the standards, all of the surveyors and all of the decisions regarding who is successful or not in achieving accreditation were imposed unilaterally from outside. It helps to build up the confidence of participating hospitals in their ability to develop ways to maintain and improve quality in a way that schemes which operate a more didactic approach would not. It also means that there are Trent surveyors constantly present in all of its participating hospitals.

Trent is a member of the United Kingdom Accreditation Forum (UKAF)

International Healthcare Accreditation
With the advent of medical tourism, international healthcare accreditation has increasingly grown in importance. There are accreditation organisations from a number of countries which fulfill this internationally-orientated role, including:

· The Canadian Council on Health Services Accreditation, or CCHSA · The Trent Accreditation Scheme, or TAS, in the UK

· Joint Commission International (JCI), in the USA

· The Australian Council on Healthcare Standards, or ACHS

Also, The Society for International Healthcare Accreditation, or SOFIHA, is a free-to-join group providing a forum for discussion and for the sharing of ideas and good practice by providers of international healthcare accreditation and users of the same.