How the independent sector can benefit from engaging with Anaesthesia Clinical Services Accreditation (ACSA)

I had mixed emotions about being the hospital lead for ACSA including fear, anxiety and elation. I was keen to see buy-in from the Benenden organisation. The anaesthetists working in the hospital do so within a consortium; they work in partnership with the organisation, not for it. Breaking that down, they come, do the job and go. I needed agreement that we were all going to be invested in the process and this required a shared internal decision. I worked with the Clinical Quality team at the College to help me achieve this.

I formally registered the hospital with the scheme and requested an onsite presentation from the ACSA team. This was a very important part of the process and accomplished what I’d hoped by explaining the benefits of accreditation to non-clinical executives. The presentation prompted a real impetus to move forward and increased conversations about ACSA in the organisation. It was the most discussed topic in theatres for a while.

It was now time to start the self-assessment. This comprised a rather a large document which I went through with a fine-tooth comb. Together with two anaesthetists and our theatre manager we divided the gap analysis over several months. We discussed which standards were applicable to the independent sector, what we felt we were compliant with and what we needed to put in place or improve.

All staff in our hospital are given annual objectives to meet and in our team objectives were included in review of the ACSA standards to help make recommendations about what we could do to meet them. The information we collected from staff helped us prepare for the prospect of an onsite review. There were things that we could change in house with no outside help but policies and procedures especially new ones were harder. This was where our College guide came in useful, it provided us with example policies that we could amend and adopt locally.

After a time, we felt ready and confident about being reviewed and so we scheduled our review to take place on March 2018. It took a lot of organisation to prepare which was only possible by getting others involved. I found it helpful to be in constant contact with the ACSA coordinators to confirm expectations for the visit. The ACSA team were extremely helpful in this respect, keeping your team in line with expectations.

The review process highlighted our areas of good practice as well as areas that required further improvement. We found aligning ourselves with the standards both motivating and productive. We went on to gain accreditation in December 2018, about 18 months from starting work on the project. After all the hard work, time and effort the entire team put in - we were thrilled. We were the first and currently still the only, independent hospital to have been awarded ACSA.

The Robert Francis report (2013) of the Mid Staffordshire NHS Foundation Trust Public Inquiry recommended numerous types of new regulation, including intelligent inspection by experts. The ACSA process is the embodiment of that statement. The report about private hospital and patient safety called ‘Patient Safety in the Private hospital - the known and the unknown risks (2014)’ explains transparency in the independent hospitals as more lax than the NHS. The ACSA review takes the known and unknown risks making you examine them in depth, minimise their impact and promote enhanced patient experience. The independent sector can feel that we don’t need to look at things as closely as the NHS, as we are admitting fewer ‘high risk patients’, but all surgery is risky wherever it is done. I think that the independent sector can be outdated in its thinking and fail to take the patient experience into consideration. 

We now have two plaques in the hospital demonstrating our ACSA accreditation, one in the atrium which patients can see on arrival at hospital, and one in theatres for staff, to remind us of why we are there, not as a business making money but for the safety and wellbeing of all our patients.

Simon Brooks