The Covid-19 virus has a major impact on the way everyone works. This also applies to the work for the Accreditation and Designation programme of the OECI.

This spring, the audit for the Cancer Centre in Reggio Emilia was cancelled in a hurry after it became clear that the number of Covid-19 patients in the northern provinces of Italy was rapidly increasing at the end of February. The number of Covid-19 cases also increased rapidly in the rest of Europe. It became clear that visiting cancer centres on-site would no longer be possible for the entire international audit team in the near future, since the auditors who work in cancer centres come from all over Europe. So the A&D Board asked the coordinators to set up a virtual peer review system.   The key enabler for this process is that the A&D Programme is entirely electronic in its documentation: all self-assessment, uploading of evidence, documentation, and auditors’ review, is through the e-tool in a secure area of the OECI website.

Hybrid audit

The A&D Board’s goal in making adjustments to the peer review was to protect the health and well-being of the health professionals and the OECI auditors and coordinators, and to minimise any spread of the virus. The goal was also to guarantee the quality of peer reviews and to continue the accreditation process for those institutes that had already prepared the self-assessment or had started this preparation.

In the hybrid audit, the audit team consists of 2 local auditors (from the country itself, in this case Italy), 2-3 remote auditors and the remote co-ordinator. The interviews are conducted by videoconferencing. The 2 local auditors visit the different departments and in this way they can observe the environment and atmosphere in the centre and share this with the remote auditors.

The first hybrid audit was carried out in September for a cancer centre in Aviano. A hybrid or virtual audit requires a very good preparation of the audit team, and detailed planning of the agenda and of the technical aspects.  Our evaluation, however, was the the hybrid peer review was successful, and indeed the centre reported in the post-audit evaluation from that they were very satisfied with the process.  This was despite the fact that it is quite difficult for the auditors to get a good feeling of what is going on at the other side of the screen, especially if the interviewees are wearing a mouth mask.

100% Virtual

With this first good experience, we looked forward to the next one with confidence. This was due to take place at the end of October. Only 2 days before the audit it became clear that the Covid-19 virus had caught up with us again. Due to the tightened measures in Italy it was again not possible for the local auditors to be physically present in Azienda Unità Sanitaria Locale di Reggio Emilia-IRCCS. Thanks to the commitment and flexibility of the centre and the auditors, we were able to convert this audit into a 100% virtual audit within one day. The centre did as much as possible to give us the best possible picture of their centre by giving us a virtual tour and the opportunity to join multidisciplinary team meetings.

This virtual form will allow us to continue auditing centres in the near future, as long as the virus does not preclude any non-critical clinical activity. This year, 3 more audits are planned in Padova, Naples and Rome; these will be completely virtual. But, ofcourse, we hope that the situation will improve soon and that we will be able to be physically present with other audits, because a virtual audit can never completely replace an on-site visit! For this reason also, the virtual format will not be feasible for a brand new accreditation of a centre.

If you want to know more about the OECI Accreditation and Designation programme or this approach to auditing, please contact one of the co-ordinators at accreditation@oeci.eu.

Willien Westerhuis, Annemiek Kwast, Jolanda van Hoeve and Harriët Blaauwgeers