1. The IMHA Quality Assurance and
Accreditation Programme for Maritime
Clinics
Dr Sally Bell
Clinical Quality Consultant
IMHA Quality Executive Secretary

2. • Why have a Quality Assurance
Programme?
• Development
• Implementation
• Benefits
• The Future

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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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9. The process of development of
Quality Assurance standards

10. Standards needed in a
number of areas:
• Medical fitness examinations – first priority
• Occupational Health Advice
• Port Health Clinics
• Repatriation and rehabilitation
• Telemedical advice.

11. 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.

12. 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.

14. 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.

15. 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

16. 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.

17. 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.

18. • 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.

19. The implementation of
the programme

20. 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

21. 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

22. 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

23. Accreditation committee
• Endorses recommendations on
accreditation
• Composition
– Members from Stakeholder Advisory Group
– IMHA representatives
• Appointment by IMHA Board

24. 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

25. 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.

26. 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.

27. Benefits of the
programme
• Clinics
• Maritime Authorities
• Seafarers and Maritime Trade Unions
• Employers, Agents, Insurers

28. 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.

29. 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)

30. 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.

31. 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

32. 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.

33. 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

34. www.imhaquality.net