What does the term 'Centre of Excellence' mean when it comes to hospitals?

One of the questions patients and their families can ask to verify a COE is about their complication rates, which includes the number of patients who have to return to the operating theatre, be readmitted and/or die from complications. — AFP

There has been a global move by healthcare facilities in meeting targets to achieve excellence in their service delivery.

Many healthcare facilities that are globally recognised for their expertise, skills and research have established Centre(s) of Excellence (COE).

Many Malaysian private healthcare facilities, and an increasing number of public healthcare facilities, have followed this trend and are using the term COE in their information that is disseminated to the public.

There is no universal definition of C0E.

However, it is generally accepted that the term COE, in healthcare institutions, is understood as a team, shared facility or entity that provides high standards of research, leadership, services or education, and brings innovative mechanisms to promote knowledge and scientific advancements in healthcare delivery.

COE healthcare institutions in developed economies have been combining existing highly-skilled expertise and resources to produce superior performance and productivity in focused specialities.

Becoming a COE has been utilised as a specific mechanism to establish and drive world-class excellence.

Today’s column explores the framework for healthcare professionals and consumers’ considerations when seeking care in healthcare facilities that state they are a COE.

Defining the term

A review of 78 articles from 33 countries by Dr Tsegahun Manyazewal and colleagues stated: “COE is a team of specialised expertise or organisational environment that is established to provide outstanding healthcare, research, education and training, regulatory, policy, information technology or industrial services and support in high levels of efficient and effective performance.

“COEs are geographically concentrated and focused on high potential in science and industry, as a world leader or a catalyst between neighbouring countries, anywhere from the local research and development (R&D) group up to a network of cooperative partners.

“They are characterised by the scope of their operations, mandates, funding, executive sponsorship, commitment, responsibilities and powers.

“Historically, COE is leveraged by IT leaders seeking to facilitate the creation of hubs for knowledge sharing and building, and enhancing capabilities.

“The idea had evolved and been used in favour of different targets in the last decade.

“Its driver, ‘Excellence’, was not considered an act that has to do with the end product, but a habit to do with the process.”

Of the articles in the review, published in the journal BMJ Open in February 2022, 35 were from the United States; three each from Nigeria, South Africa, Spain and India; two each from Ethiopia, Canada, Russia, Colombia, Sweden, Greece and Peru; and the remaining 17 from various other countries.

The essential foundations of a COE were summarised in the diagram below.

It is usually assumed that in the highly-regulated healthcare sector, the use of the COE designation would be restricted to healthcare facilities that meet prescribed standards with associated certifications.

However, this is generally not the case.

Except for a few exceptions globally, the term COE can be applied at will by healthcare facilities.

Although this freedom must be used responsibly, with healthcare facilities having a responsibility to take great care to apply the designation only in instances where warranted, there are some that use it as a marketing slogan.

Asking the right questions

There are differences and similarities in the questions that should be asked by healthcare providers, patients and their families of a COE.

A basic question is whether the healthcare facility is accredited or not, and if so, by whom and the type of accreditation (full or partial).

Any Malaysian hospital worth its salt is fully accredited by the Malaysian Society for Quality in Health (MSQH).

The duration of full accreditation is four years if there is substantial compliance with MSQH healthcare standards.

Some hospitals are also accredited by international accreditation organisations.

One such organisation is the Joint Commission International (JCI) based in the US.

JCI is recognised globally as a quality management system in accord with global healthcare standards.

According to JCI, its accreditation means that the services and standards provided at the hospital meet global standards.

Following the initial accreditation: “JCI continues to work with these high-achieving organisations to help them sustain their accreditation, keep up to date with new standards, and offer guidance on the continuous expectation of performance improvement that JCI accreditation promotes.”

A smaller number of hospitals are also accredited by the Australian Council of Healthcare Standards (ACHS).

The list of fully-accredited hospitals can be found at the websites of MSQH, JCI and ACHS.

The next question is whether the healthcare facility has the foundations as in the diagram above.

It is very probable that the response of every healthcare facility will be in the affirmative, and in general terms.

So, what can be checked in practical terms?

It would be prudent to seek information about:

• The volume of cases for specific conditions treated or procedures done
• The complication rates, including return to operating theatre, readmissions and mortality (death) rates
• Medium to long-term outcomes
• Qualifications and expertise of providers
• Medical devices available for use
• Patient safety and quality indicators, and
• What happens when there is an adverse event.

For example, if a hospital states that it is a COE for cancer, it should also state the specific organs involved, together with the information in the preceding paragraph for the various stages of the cancer.

The referring doctor can also seek feedback from professional colleagues about the healthcare facility’s claims, while the patient and family can seek advice from their regular doctor, and second, or even, third opinion(s).

The above will enable the questioner to make comparisons for informed decision-making.

Oversight needed

Although the Private Health Care Facilities and Services Act requires a hospital to provide adequate information to patients and their families, there is no functional regulatory oversight of what qualifies as a COE.

Different hospitals apply their own definitions, with patients and their families usually uninformed about the broad set of criteria used by each hospital.

The lack of standardisation for designating a COE prevents genuine centres from fully achieving the intended effects of identifying “excellent” hospitals that provide safe and quality care.

It also causes confusion for patients, employers and payers, which dilutes the meaning of the COE label.

Hospitals who claim to be a COE have a moral, ethical and legal duty to provide adequate information for patients and their families for informed decision-making.

It is time that the Health Ministry hold hospitals responsible for any claim that they are a COE.

Unfortunately, until the regulators get in on the act, it is caveat emptor, i.e. “let the buyer beware”.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.