Nurses’ Perceptions of Joint Commission International Accreditation on Patient Safety in Tertiary Care in South Korea: A Pilot Study

The influence of hospital accreditation on nurses' perceptions of patient safety culture

OBJECTIVES

Hospitals' accreditation process is carried out to enhance the quality of hospitals' care and patient safety practices as well. The current study aimed to investigate the influence of hospitals' accreditation on patient safety culture as perceived by Jordanian hospitals among nurses.

METHODS

A descriptive cross-sectional correlational survey was used for the current study, where the data were obtained from 395 nurses by convenient sampling technique who were working in 3 accredited hospitals with 254 nurses, and 3 non-accredited hospitals with 141 nurses, with a response rate of 89%.

RESULTS

The overall patient safety culture was (71.9%). Moreover, the results of the current study revealed that there were no statistically significant differences between the perceptions of nurses in accredited and non-accredited hospitals in terms of perceptions of patient safety culture.

CONCLUSION

The current study will add new knowledge about nurses' perceptions of patient safety culture in both accredited and non-accredited hospitals in Jordan which in turn will provide valid evidence to healthcare stakeholders if the accreditation status positively affects the nurses' perceptions of patient safety culture or not. Continuous evaluation of the accreditation application needs to be carried out to improve healthcare services as well as quality and patient safety.

Perceptions of Chinese hospital leaders on joint commission international accreditation: a qualitative study

Background

Joint Commission International (JCI) accreditation plays a significant role in improving the quality of care and patient safety worldwide. Hospital leadership is critical in making international accreditation happen with successful implementation. Little is known about how Chinese hospital leaders experienced and perceived the impact of JCI accreditation. This paper is the first study to explore the perceptions of hospital leaders toward JCI accreditation in China.

Methods

Qualitative semi-structured interviews were used to explore the perceptions of the chief operating officers, the chief medical officers, and the chief quality officers in five JCI-accredited hospitals in China. Thematic analysis was used to analyze the interview transcripts and identify the main themes.

Results

Fifteen hospital leaders participated in the interviews. Three themes emerged from the analysis, namely the motivations, challenges, and benefits related to pursuing and implementing JCI accreditation. The qualitative study found that eight factors influenced hospital leadership to pursue JCI accreditation, five challenges were identified with implementing JCI standards, and eight benefits emerged from the leadership perspective.

Conclusion

Pursuing JCI accreditation is a discretionary decision by the hospital leadership. Participants were motivated by prevalent perceptions that JCI requirements would be used as a management tool to improve the quality of care and patient safety in their hospitals. These same organizational leaders identified challenges associated with implementing and sustaining JCI accreditation. The significant challenges were a clear understanding of the foreign accreditation standards, making staff actively participate in JCI processes, and changing staff behaviors accordingly. The top 5 perceived benefits to JCI accreditation from the leaders' perspective were improved leadership and hospital safety, improvements in the care processes, and the quality of care and the learning culture improved. Other perceived benefits include enhanced reputation, better cost containment, and a sense of pride in the staff in JCI-accredited hospitals.

Enabling Factors for the Successful Implementation of the CBAHI Accreditation Program

Background

Healthcare organizations worldwide tend to implement hospital accreditation programs to improve the quality of care they provide. However, the literature shows inconsistent findings on the impact of such programs on the quality of care due to improper implementation of accreditation programs.

Purpose

This study explored the enabling factors for the effective implementation of the Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) program in the Ministry of Health (MOH) hospitals in Madinah, Saudi Arabia.

Methods

This qualitative study involved 22 professionals from five CBAHI-accredited MOH hospitals in Madinah, Saudi Arabia. A purposive sampling technique was applied, and data were collected through in-depth, semi-structured interviews. A thematic analysis approach was applied to the interview transcripts.

Results

Four themes and 11 subthemes emerged. The emerging themes included the development of human capital, resolving quality management issues, ensuring the availability of resources, and strategizing CBAHI-specific solutions.

Conclusion

The current study fills this knowledge gap by identifying the factors leading to the effective implementation of the CBAHI accreditation program in the MOH hospitals. Only the effective execution of the CBAHI will increase healthcare quality and, as a result, justify the significant resources and efforts invested in these programs. Future research should replicate similar study in other governments or private hospitals.

Clinical nurses' patient safety competency, systems thinking and missed nursing care: A cross-sectional survey

AIM

The aim of this study was to examine the relationships among patient safety competency, systems thinking and missed nursing care.

BACKGROUND

Patient safety competency and systems thinking are important nurse attributes that promote patient safety. Missed nursing care is known to negatively impact patient safety. However, how nurses' patient safety competency and systems thinking relate to missed nursing care is unknown.

METHODS

A cross-sectional survey design was used to collect data from nurses practicing in two general hospitals in South Korea. Data were collected between 3 March and 17 April 2020. Questionnaires were distributed to nurses providing direct care in general and specialty units. Patient safety competency, systems thinking and missed nursing care were measured using reliable and valid instruments. A total of 432 complete sets of data were used in final analysis.

RESULTS

Higher patient safety competency of nurses was associated with lower missed nursing care. Systems thinking partially mediated the relationship between knowledge of patient safety competency and missed nursing care, and attitudes of patient safety competency and missed nursing care.

CONCLUSIONS

The knowledge, skills and attitudes sub-scales of patient safety competency showed somewhat different effects in the relationship between missed nursing care and systems thinking, suggesting that each attribute may tap into a separate aspect of patient safety.

Impact of the Accreditation Program of the Saudi Central Board for Accreditation of Healthcare Institutions on the Safety Dimension of the Institute of Medicine Quality

Background

Although hospital accreditation is recognized as a tool for improving healthcare, there are inconsistent results regarding its impact on healthcare quality. In Saudi Arabia, it is mandatory for all Ministry of Health (MOH) hospitals to be accredited by the Central Board for Accreditation of Healthcare Institutions (CBAHI).

Purpose

This study measured the impact of the CBAHI accreditation program on the Institute of Medicine's (IOM) safety dimension in Madinah.

Methods

A cross-sectional study was conducted using retrospective data gathered from a review of hospital records over 60 months (ie, 12 months before, 36 during, and 12 post-accreditation). The data were analyzed using piecewise (segmented) regression analysis.

Results

The three indicators (ie: incident reports, medication errors, and nosocomial infection) were continuously improved compared to the data before accreditation, as a results of implementing the CBAHI accreditation program. Therefore, the CBAHI had a significantly positively impacts on MOH hospitals' safety dimension.

Conclusion

Complying with the CBAHI standards can help reduce the rates of incident reports, medication errors, nosocomial infections, and post-admission mortality. This study provides insight for MOH hospitals and opportunities to expand the accreditation program to improve the quality of healthcare services.

The nurse anesthetist’s perception of the role of case manager in four provinces of Indonesia

Introduction

Integrated and patient-focused healthcare is urgently needed, and there is an important role for case managers in implementing them. However, the understanding of healthcare providers, especially nurse anesthetists, about the role of case managers is still varied and is often considered only as a complement to hospital accreditation. This study aimed to determine the factors that influence the nurse anesthetist’s perception of the role of the case manager.

Methods

This cross-sectional study involved 369 nurse anesthetists who were selected using cluster sampling. Data collection was done using Google Forms. Furthermore, the data were analyzed using multiple logistic regression to identify the factors that influence the nurse anesthetists’ perception of the role of the case manager.

Results

From a total of 369 respondents, most (60%) have a positive perception of case managers. Marital status (AOR = 2.3; 95% CI: 1.27–4.15) and knowledge (AOR = 3.2; 95% CI: 2.03–5.07) were significant predictors of the nurse anesthetist’s perception of the role of the case manager.

Discussion

Even though the majority of nurse anesthetists have positive perceptions, socialization to increase knowledge about case managers is needed to reduce misperceptions about the role of case managers.

Does Accreditation Symbolise Quality in Public Healthcare Delivery? An Investigation of Hospitals in Kerala

Accreditation has become an important benchmark for healthcare organisations, and accordingly, many government hospitals in Kerala got accredited with national level (National Accreditation Board for Hospitals & Healthcare Providers [NABH]) and state level (Kerala Accreditation Standards for Hospitals [KASH]) accreditation programmes. This study examined the quality of public healthcare delivery in these accredited hospitals while having a comparison with the non-accredited hospitals. It also compared the impact of national and state-level accreditation programmes in Kerala public healthcare settings. This cross-sectional study conducted between July 2017 and July 2018, employing a positivist approach using stratified random sampling. In total, 621 samples were collected from inpatients of both accredited (NABH and KASH) (312) and non-accredited (309) public healthcare institutions in Kerala. Nine constructs overarching the quality of healthcare delivery and patient satisfaction construct are used in the study. The study found that patient satisfaction is identical in both accredited and non-accredited hospitals ( M = 4.28). Patient satisfaction in NABH accredited hospital ( M = 4.27 ± 0.67874) is lower than that of KASH accredited hospital ( M = 4.30 ± 1.25417). The mean score of six constructs of quality healthcare delivery of KASH accredited hospitals is higher than NABH accredited. The study revealed that accreditation brings improvement in certain dimensions of healthcare delivery but does not bring a holistic change. The study concluded that if accreditation has to symbolize quality healthcare delivery, infrastructural and interpersonnel components of healthcare delivery must be improved.

The impact of hospital accreditation in selected Middle East countries: a scoping review

PURPOSE

There is conflicting evidence concerning the impact of hospital accreditation programmes, including across the Middle East Region, where such programmes have been most recently implemented in Iran, Jordan and Saudi Arabia. This paper maps available evidence regarding the impact of hospital accreditation in these three countries and draws attention to knowledge gaps for consideration.

DESIGN/METHODOLOGY/APPROACH

This scoping review was conducted in 2020, using the Arksey and O'Malley framework. Five research databases were searched, along with five government and accreditation agency websites. Searches were complemented by citation chaining. English and Arabic publications evaluating hospital accreditation in the selected countries were included. Commentaries and articles not based on primary data collection and reviews of existing registry data were excluded. There were no exclusions based on study design or methods. A descriptive numerical summary and thematic analysis were used to synthesise the literature.

FINDINGS

studies were included. The majority (n = 35) were published since 2014 and conducted in Saudi Arabia (n = 16). Four themes emerged: organisational impacts, patient safety, quality of care, and patient satisfaction and experience. The literature generally highlights positive impacts of accreditation, but most studies were based solely on health professionals' subjective perceptions. "Organisational impacts" had the largest, and strongest body of supporting evidence, while "patient safety" had the least and most variable evidence.

ORIGINALITY/VALUE

Opportunities to strengthen the design and evaluation of hospital accreditation programmes in the selected countries are highlighted. Additional experimental, mixed-method research is recommended to strengthen the evidence base and inform practical enhancements to hospital accreditation programmes in the region.

The Effectiveness of the Joint Commission International Accreditation in Improving Quality at King Fahd University Hospital, Saudi Arabia: A Mixed Methods Approach

INTRODUCTION

Saudi Arabia has one of the highest numbers of health organizations accredited by the Joint Commission International. This study aimed to measure this process's effectiveness in improving quality at King Fahd Hospital of the University in Khobar, Saudi Arabia. Additionally, the study investigated health providers' perceptions of this process.

MATERIALS AND METHODS

This research utilized a convergent parallel mixed method. For the quantitative analysis, an interrupted time series was conducted to assess the changes in a total of 12 quality outcomes pre- and post-accreditation. Thematic analysis was utilized to collect and analyze qualitative data from hospital employees and health providers.

RESULTS

The quantitative results indicated that pursuing accreditation positively impacted nine out of 12 outcomes. The improved outcomes included: the average length of stay, the percentage of hand hygiene compliance, the rate of nosocomial infections, the percentage of radiology reporting outliers, the rate of pressure ulcers, the percentage of the correct identification of patients, the percentage of critical lab reporting, and the bed occupancy rate. The outcomes that did not improve were the rate of patients leaving the ER without being seen, the percentage of OR cancelations, and the rate of patient falls. The qualitative analysis suggested that the accreditation process was perceived positively by participants. Nevertheless, participants also highlighted some of the drawbacks of this process, including: the potential bias in observation-based key performance indicators, the focus on improving process without enhancing the hospital structure, and the increased workload.

CONCLUSION

International accreditation had a positive impact on quality and was received positively by providers. However, several issues need to be addressed by hospital administrators in future accreditation cycles. According to participants, the most notable issue during the first two accreditation cycles was the increased workload and paperwork, which can potentially distract from patient care.

Strategies for Success in Regulatory Readiness

This article describes the formation of a Regulatory Advisory Council to address regulatory preparedness. The council used quality improvement methods to address data and findings from previous mock surveys and created 2 categories of work, an environment of care and clinical standards group, with checklists and work streams to improve organizational success with regulatory readiness.