The IMHA Quality Assurance and

Accreditation Programme for Maritime

Clinics

Dr Sally Bell

Clinical Quality Consultant

IMHA Quality Executive Secretary

• Why have a Quality Assurance

Programme?

• Development

• Implementation

• Benefits

• The Future

Why have a Quality

Assurance Programme?

Generally - Increasing relevance of Quality

Assurance to modern practice worldwide.

Specifically - Requirements of MLC and newly

drafted fitness standards for seafarers.

The best clinics and doctors provide a high

standard of service to seafarers and the

maritime sector but some clinics and doctors

do not.

What are the problems

• Lack of training or experience

• Poorly maintained or inappropriate

equipment

• Inaccurate test results

• Poor clinical decision taking

• Premises unhygienic, infection control

risk

• Cost cutting or corruption

Consequences of poor

service

• Seafarers who need treatment do not get the right

treatment.

• Seafarers may return to sea when they are not fit to

do so.

• Seafarers may be unreasonably denied employment

that they are capable of undertaking.

• Preventative medicine may not be used to the full.

• Time, money and seafaring skills are wasted.

• Lack of trust in providers

Who sees the problems

(if they look…)?

Maritime authorities

• Inconsistent fitness decisions may be taken

• Unethical standards of practice

Ship operators

• Loss of skilled crew

• Avoidable illness and safety risks at sea.

Seafarers’ organisations

• Denial of employment that is within a person’s capabilities

• Poor care for their members

Insurers

• Who end up paying the bills – but only if they are above

the relevant deductible

What are the solutions?

• Adoption of good practice criteria e.g. ILO/IMO

guidelines on medical examinations including QA

recommendations

• Audit and accreditation of doctors and clinics as

mark of quality for all users of the service.

• Already done to varying extents by some authorities,

ship operators, insurers or seafarers’ organisations

but programmes are not all to the same level, and

criteria may be ill defined.

• More effective to have a single definitive system

acceptable to all stakeholders – such as IMHA

Quality

IMHA Quality or ISO?

• ISO system

– good standards for management

– not adapted for the delivery of medical

care

• IMHA Quality Standards

– designed to ensure high quality provision

of maritime medical advice

– able to interact with stakeholders

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The process of development of

Quality Assurance standards

Standards needed in a

number of areas:

• Medical fitness examinations – first priority

• Occupational Health Advice

• Port Health Clinics

• Repatriation and rehabilitation

• Telemedical advice.

Medical Fitness

Examinations

• Standards have been developed to

define best practice and provide

straightforward goals.

• Assessment against these standards

will provide the basis for accreditation

and help to drive continuous quality

improvement.

How did we develop

them?

• The standards had to be easily understood,

comprehensive, and endorsed by an

approved accreditation body.

• We chose to work with CHKS, a London

organisation specialising in healthcare

accreditation worldwide.

What is covered by the

standards?

• Each standard addresses an area of work

or activity and is made up of a number of

criterion statements.

• Criteria are designed to be measurable

and set out what needs to be achieved.

Areas included in the

standards

• Clinic Management,

• Staff, Clinic Facilities, Clinical Practice

• Diagnostic Services

• Health Records and IT

• Infection Control, Health and Safety

• Quality Improvement Activities

296 criteria in all

Examples of standards:

• STAFF: The service is managed and staffed

effectively and efficiently in order to achieve

its objectives.

• CLINIC FACILITIES: The environment,

facilities and equipment ensure safe, efficient

and effective care for seafarers and staff.

Examples of specific

criteria for staff:

• The doctors performing seafarer

examinations have occupational health

qualifications, knowledge or experience.

• Staff using specialised equipment are

trained and competent in its use.

• The standards were reviewed and

approved by the CHKS accreditation

committee.

• They will continue to be improved and

refined at intervals in order to ensure

that they continue to reflect current best

practice.

The implementation of

the programme

Quality improvement and

accreditation

• Application and Self-assessment

– Listed as IMHA QA member

• Working towards compliance with standards

– Advisor from IMHA QA

• Assessment visit when ready (time limit)

– Peer review

• Accreditation decision

– Listed as IMHA QA Accredited Clinic

• Continuing quality improvement

www.imhaquality.net

• Public and member information

– Allows all to register an interest in the

programme

– All information about the programme

– Information regarding those accredited, and also

those working towards accreditation

21

www.imhaquality.net

• The virtual office of IMHA QUALITY

– Allows registration details to be entered on line

– Messaging facility for communications between

IMHA Quality staff and clinics

– Securely store accreditation information

Accreditation committee

• Endorses recommendations on

accreditation

• Composition

– Members from Stakeholder Advisory Group

– IMHA representatives

• Appointment by IMHA Board

Stakeholder

Correspondence Group

• All interested parties will be kept informed

– Governments

– Shipowners

– Seafarers

– P&I clubs

– Classification societies

– NGOs

– Crewing agencies

– Shipping agents

– Maritime Clinics

Stakeholder Advisory

Group

This group will be composed of selected

members of the Stakeholder

correspondence group, and will be

consulted throughout the programme on

matters of policy and procedure.

Quality Assurance of the

programme

• External training for assessors

• External advice from a recognised

accreditation body (CHKS are UKAS

accredited)

• External review of assessments by

outside auditors

• Regular review of standards by

independent advisors.

Benefits of the

programme

• Clinics

• Maritime Authorities

• Seafarers and Maritime Trade Unions

• Employers, Agents, Insurers

Clinics

• IMHA Quality provides a quality assured and

internationally recognised system of QA

• Will help to achieve quality goals

• Potential clients will be aware of commitment to

quality

• Can demonstrate by accreditation that they can

provide valid and fair seafarer assessment

• Accreditation will assist in achieving approval from

other bodies, whether maritime authorities,

shipowners or P & I Clubs.

Maritime Authorities

• ensure procedures comply with STCW and MLC

• meet the recommendations of the ILO/IMO

International Guidelines to provide a QA system for

seafarer medical examinations

• does not interfere with discretion to set national

standards but will confirm that these are being

correctly applied.

• assist with mutual recognition of medical certificates

• help authorities to decide which providers to approve

(particularly internationally)

Seafarers, Trade Unions

• Reduce concerns about justification or fairness of

seafarer fitness decisions.

• Ensure fair conduct of medicals (as per the ILO/IMO

Guidelines on Seafarer Medical Examinations )

• Ensure commitment to sound ethical standards

• Ensure seafarers provided with full information about

reasons for fitness decisions,

• Ensure referral if a new illness is found

• Maintain confidentiality of medical information.

• Ensure that only seafarers who cannot work safely or

effectively or who may have their health endangered

by doing so are prevented from working.

Employers, Agents,

Insurers

• Ensure seafarers can work safely and effectively

• Reduce risk of requiring evacuation, treatment or

repatriation.

• Ensure providers are committed to following the

detail of decision-taking requirements whether

national or in house.

• Reduce costs of in house clinic assessment or audit

• Minimise the inefficiency of multiple assessments of

the same provider by different users.

• Ensure providers are fit for purpose and acceptable

to seafarers, maritime authorities and other groups

The Future

• Later phases of the programme will

develop standards for other services:

– Occupational Health Advice

– Port Health Clinics

– Repatriation and rehabilitation

– Telemedical advice.

• This should involve only a small

increment in development work and

costs.

Contact

• General inquiries

– contact@imhaquality.net

• Manager

– alf.magne.horneland@imhaquality.net

• Executive committee members

– tim.carter@imhaquality.net

– sally.bell@imhaquality.net

• Supervisor

– suresh.idnani@imhaquality.net

www.imhaquality.net