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Gutiérrez JP, Rodriguez MA, Torres-Pereda P, Reyes-Morales H. Hospital accreditation in Mexico fails to improve the quality of healthcare: lessons from an impact evaluation. Front Public Health 2024; 12:1386667. [PMID: 38957207 PMCID: PMC11217480 DOI: 10.3389/fpubh.2024.1386667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/24/2024] [Indexed: 07/04/2024] Open
Abstract
Healthcare quality in low- and middle-income countries poses a significant challenge, contributing to heightened mortality rates from treatable conditions. The accreditation of health facilities was part of the former health reform in Mexico, proposed as a mechanism to enhance healthcare quality. This study assesses the performance of hospital accreditation in Mexico, utilizing indicators of effectiveness, efficiency, and safety. Employing a longitudinal approach with controlled interrupted time series analysis (C-ITSA) and fixed effects panel analysis, administrative data from general hospitals in Mexico is scrutinized. Results reveal that hospital accreditation in Mexico fails to enhance healthcare quality and, disconcertingly, indicates deteriorating performance associated with increased hospital mortality. Amidst underfunded health services, the implemented accreditation model proves inadequately designed to uplift care quality. A fundamental redesign of the public hospital accreditation model is imperative, emphasizing incentives for structural enhancement and standardized processes. Addressing the critical challenge of improving care quality is urgent for Mexico's healthcare system, necessitating swift action to achieve effective access as a benchmark for universal healthcare coverage.
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Affiliation(s)
- Juan Pablo Gutiérrez
- Center for Policy, Population and Health Research, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Pilar Torres-Pereda
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
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Brouwers J, Seys D, Claessens F, Van Wilder A, Bruyneel L, De Ridder D, Eeckloo K, Vanhaecht K. Effect on hospital incentive payments and quality performance of a hospital pay for performance (P4P) programme in Belgium. J Healthc Qual Res 2024; 39:147-154. [PMID: 38594161 DOI: 10.1016/j.jhqr.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Belgium initiated a hospital pay for performance (P4P) programme after a decade of fixed bonus budgets for "quality and safety contracts". This study examined the effect of P4P on hospital incentive payments, performance on quality measures, and the association between changes in quality performance and incentive payments over time. METHODS The Belgian government provided information on fixed bonus budgets in 2013-2017 and hospital incentive payments as well as hospital performance on quality measures for the P4P programmes in 2018-2020. Descriptive analyses were conducted to map the financial repercussion between the two systems. A difference-in-difference analysis evaluated the association between quality indicator performance and received incentive payments over time. RESULTS Data from 87 acute-care hospitals were analyzed. In the transition to a P4P programme, 29% of hospitals received lower incentive payments per bed. During the P4P years, quality performance scores increased yearly for 55% of hospitals and decreased yearly for 5% of hospitals. There was a significant larger drop in incentive payments for hospitals that scored above median with the start of the P4P programme. CONCLUSIONS The transition from fixed bonus budgets for quality efforts to a new incentive payment in a P4P programme has led to more hospitals being financially impacted, although the effect is marginal given the small P4P budget. Quality indicators seem to improve over the years, but this does not correlate with an increase in reward per bed for all hospitals due to the closed nature of the budget.
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Affiliation(s)
- J Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Belgium.
| | - D Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - F Claessens
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - A Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - D De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
| | - K Eeckloo
- Department of Public Health and Primary Care, UGent & Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
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Brouwers J, Seys D, Claessens F, Van Wilder A, Bruyneel L, De Ridder D, Eeckloo K, Vanhaecht K, Kesteloot K. The Cost of a First and Second Hospital-Wide Accreditation in Flanders, Belgium. Int J Qual Health Care 2022; 34:6650077. [PMID: 35880736 DOI: 10.1093/intqhc/mzac062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/07/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospital accreditation is a popular and widely used quality control and improvement instrument. Despite potential benefits, questions are raised whether it constitutes appropriate use of hospitals' limited financial resources. This study aims to calculate the cost of preparing for and undergoing a first and second accreditation by the Joint Commission International or Qualicor Europe in acute-care hospitals. METHODS All (n=53) acute-care hospitals in Flanders (Belgium) were invited to participate and report on the costs in preparing for and undergoing a first and/or second accreditation cycle. To measure costs, a questionnaire with six domains and 90 questions was developed based on literature review, policy documents and a multidisciplinary expert group. All costs were recalculated to 2020 EUR to correct for inflation and reported as medians with interquartile range (IQR). RESULTS Twenty-five hospitals (47%) participated in the study. Additional investments and direct operational costs for a first accreditation cycle amounted to 879.45 EUR (IQR:794.81) per bed and 3.8 FTE per hospital additional new staff members were recruited for coordination and implementation of the trajectory. A second accreditation survey costed remarkably less with a total cost of extra investments and direct operational cost of 222.88 EUR (IQR: 244.04) per bed and less investment in additional staff (1.50 FTE). Most of the costs were situated in consulting costs and investments in infrastructure. The median total extra cost (direct operational cost and additional investments) amounted to 0.2% of the hospital's operating income for a first accreditation cycle and 0.05% for a second cycle. CONCLUSION A first accreditation cycle requires a strong financial commitment of hospitals, as many costs result from the preparation in the years prior to an accreditation survey. A second survey is less expensive for hospitals, but still requires a considerable effort in terms of budget and staff. Policy makers should be aware of these significant costs as hospitals are operating with public resources and budget is scarce. The identification of these costs is a necessary building block to evaluate cost-effectiveness of accreditation versus other quality improvement systems and the continuation of these accreditation systems and their costs needs further study and a thorough debate.
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Affiliation(s)
- Jonas Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium & Department of Orthopaedics, University Hospitals Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium & Department of Quality, University Hospitals Leuven, Belgium
| | - Kristof Eeckloo
- Department of Primary Care and Public Health, UGent & Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium & Department of Quality, University Hospitals Leuven, Belgium
| | - Katrien Kesteloot
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium & Financial department, University Hospitals Leuven, Leuven Belgium
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Ibrahim SA, Reynolds KA, Poon E, Alam M. The evidence base for US joint commission hospital accreditation standards: cross sectional study. BMJ 2022; 377:e063064. [PMID: 35738660 PMCID: PMC9215261 DOI: 10.1136/bmj-2020-063064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the evidence upon which standards for hospital accreditation by The Joint Commission on Accreditation of Healthcare Organizations (the Joint Commission) are based. DESIGN Cross sectional study. SETTING United States. PARTICIPANTS Four Joint Commission R3 (requirement, rationale, and reference) reports released by July 2018 and intended to become effective between 1 July 2018 and 1 July 2019. INTERVENTIONS From each R3 report the associated standard and its specific elements of performance (or actionable standards) were extracted. If an actionable standard enumerated multiple requirements, these were separated into distinct components. Two investigators reviewed full text references, and each actionable standard was classified as either completely supported, partly supported, or not supported; Oxford evidence quality ratings were assigned; and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the strength of recommendations. MAIN OUTCOME MEASURE Strengths of recommendation for actionable standards. RESULTS 20 actionable standards with 76 distinct components were accompanied by 48 references. Of the 20 actionable standards, six (30%) were completely supported by cited references, six were partly supported (30%), and eight (40%) were not supported. Of the six directly supported actionable standards, one (17%) cited at least one reference of level 1 or 2 evidence, none cited at least one reference of level 3 evidence, and five (83%) cited references of level 4 or 5 evidence. Of the completely supported actionable standards, strength of recommendation in five was deemed GRADE D and in one was GRADE B. CONCLUSIONS In general, recent actionable standards issued by The Joint Commission are seldom supported by high quality data referenced within the issuing documents. The Joint Commission might consider being more transparent about the quality of evidence and underlying rationale supporting each of its recommendations, including clarifying when and why in certain instances it determines that lower level evidence is sufficient.
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Affiliation(s)
- Sarah A Ibrahim
- Rush Medical College, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kelly A Reynolds
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Murad Alam
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Bergholt MD, von Plessen C, Johnsen SP, Hibbert P, Braithwaite J, Brink Valentin J, Falstie-Jensen AM. Accreditation and Clinical Outcomes: Shorter Length of Stay After First-Time Hospital Accreditation in the Faroe Islands. Int J Qual Health Care 2022; 34:6552202. [PMID: 35323967 DOI: 10.1093/intqhc/mzac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/14/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of accreditation is to improve quality of care and patient safety. However, studies on the effectiveness of accreditation on clinical outcomes are limited and inconsistent. Comparative studies have contrasted accredited with non-accredited hospitals or hospitals without a benchmark, but assessments of clinical outcomes of patients treated at hospitals undergoing accreditation are sparse. The Faroe Islands hospitals were accredited for the first time in 2017, making them an ideal place to study the impact of accreditation. The objective was to investigate the association between first-time hospital accreditation and length of stay (LOS), acute readmission (AR) and 30-day mortality in the unique setting of the Faroe Islands. METHODS A before and after study based on medical record audits in relation to first-time accreditation. All three Faroese hospitals were voluntarily accredited using a modified second version of the Danish Healthcare Quality Program (DDKM) encompassing 76 standards. We included in-patients 18 years or older treated at a Faroese hospital with one of six clinical conditions (stroke/TIA, bleeding gastric ulcer, COPD, childbirth, heart failure and hip fracture) in 2012-2013 designated 'before accreditation' or 2017-2018 'after accreditation'. Main outcome measures were LOS, all-cause AR and all-cause 30-day mortality. We computed adjusted cause specific hazard rate ratios (HR) using Cox Proportional Hazard regression with before accreditation as reference. The analyses were controlled for age, sex, cohabitant status, in-hospital rehabilitation, type of admission, diagnosis and cluster effect at patient and hospital level. RESULTS The mean LOS was 13.4 days (95%CI: 10.8, 15.9) before accreditation and 7.5 days (95%CI: 6.10, 8.89) after accreditation. LOS of patients hospitalized after accreditation was significantly shorter (overall, adjusted HR=1.23 (95% confidence interval (CI): 1.04, 1.46)). By medical condition, only women in childbirth had a significantly shorter LOS (adjusted HR=1.30 (95%CI: 1.04, 1.62)). In total, 12.3% of in-patients before and 9.5% after accreditation were readmitted acutely within 30 days of discharge, and 30-day mortality was 3.3% among in-patients before and 2.8% after accreditation, respectively. No associations were found overall or by medical condition for AR (overall, adjusted HR=1.34 (95%CI: 0.82, 2.18)) or 30-day mortality (overall, adjusted HR=1.33 (95%CI: 0.55, 3.21)) after adjustment for potential confounding factors. CONCLUSION First-time hospital accreditation in the Faroe Islands was associated with significant reduction in LOS, especially of women in childbirth. Notably,shorter LOS was not followed by increased AR. There was no evidence that first-time accreditation lowered the risk of AR or 30-day mortality.
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Affiliation(s)
- Maria Daniella Bergholt
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Allé 43-45, DK-8200 Aarhus N, Denmark.,Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900 Hellerup, Denmark
| | - Christian von Plessen
- Policlinique Médicale, Unisanté, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland.,Institute for Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, DK-9220 Aalborg, Denmark
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, New South Wales, 2109, Australia.,IIMPACT in Health, Allied Health and Human Performance, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide SA 5001, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, New South Wales, 2109, Australia
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, DK-9220 Aalborg, Denmark
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Al Mansour A, Merry AF, Jowsey T, Weller JM. Hospital accreditation processes in Saudi Arabia: a thematic analysis of hospital staff experiences. BMJ Open Qual 2022; 11:bmjoq-2021-001652. [PMID: 34980590 PMCID: PMC8724809 DOI: 10.1136/bmjoq-2021-001652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background Hospital accreditation by an international organisation can play an important role in health quality and safety. However, little is known about how managers and front-line employees experience and perceive the effects of accreditation. Their views could inform quality improvement processes and procedures. Objective To explore perceptions of employees at the managerial level on the Joint Commission International (JCI) accreditation process and its impact on quality of patient care in Saudi Arabian JCI-accredited hospitals. Methods We undertook a qualitative study using semi-structured interviews to explore the perspectives of senior staff from three accredited public hospitals in Saudi Arabia. Interviews were transcribed prior to thematic analysis. Results Twenty managers participated in the interviews. The following inter-related themes emerged concerning the JCI accreditation process and its impact on quality of patient care: drivers for the change; the plan for the change; the process of the change; maintaining changes post-accreditation and patients’ issues. Participants were positive in their accounts of: drivers for the change; planning for the change needed to achieve accreditation and managing patients’ issues. However, participants reported less favourably on: the process of the change; and maintaining changes post-accreditation. Conclusion The planning stage was perceived as the easiest component of JCI accreditation. Implementing and maintaining changes post-accreditation that demonstrably promote patient safety and quality of care was perceived as more difficult. When planning for accreditation, institutions need to incorporate strategies to ensure that improvements to care continue beyond the accreditation period.
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Affiliation(s)
- Ali Al Mansour
- Quality Management, Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
| | - Alan F Merry
- Department of Anaesthesiology, The University of Auckland School of Medicine, Auckland, Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, The University of Auckland School of Medicine, Auckland, New Zealand
| | - Jennifer M Weller
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.,Centre for Medical and Health Sciences Education, The University of Auckland School of Medicine, Auckland, New Zealand
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Bergholt MD, Falstie-Jensen AM, Brink Valentin J, Hibbert P, Braithwaite J, Johnsen SP, Von Plessen C. Patients experience more support, information and involvement after first-time hospital accreditation: a before and after study in the Faroe Islands. Int J Qual Health Care 2021; 33:6410636. [PMID: 34698825 DOI: 10.1093/intqhc/mzab149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/30/2021] [Accepted: 10/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The impact of hospital accreditation on the experiences of patients remains a weak point in quality improvement research. This is surprising given the time and cost of accreditation and the fact that patient experiences influence outcomes. We investigated the impact of first-time hospital accreditation on patients' experience of support from health-care professionals, information and involvement in decisions. OBJECTIVE We aimed to examine the association between first-time hospital accreditation and patient experiences. METHODS We conducted a longitudinal study in the three Faroese hospitals that, unlike hospitals on the Danish mainland and elsewhere internationally, had no prior exposure to systematic quality improvement. The hospitals were accredited in 2017 according to a modified second version of the Danish Healthcare Quality program. Study participants were 18 years or older and hospitalized for at least 24 h in 2016 before or 2018 after accreditation. We administered the National Danish Survey of Patient Experiences for acute and scheduled hospitalization. Patients rated their experiences of support, information and involvement in decision-making on a 5-point Likert scale. We calculated individual and grouped mean item scores, the percentages of scores ≥4, the mean score difference, the relative risk (RR) for high/very high scores (≥4) using Poisson regression and the risk difference. Patient experience ratings were compared using mixed effects linear regression. RESULTS In total, 400 patients before and 400 after accreditation completed the survey. After accreditation patients reported increased support from health professionals; adjusted mean score difference (adj. mean diff.) = 1.99 (95% confidence interval (CI): 1.89, 2.10), feeling better informed before and during the hospitalization; adj. mean diff. = 1.14 (95% CI: 1.07; 1.20) and more involved in decision-making; adj. mean diff. = 1.79 (95% CI: 1.76; 1.82). Additionally, the RR for a high/very high score (≥4) was significantly greater on 15 of the 16 questionnaire items. The greatest RR for a high/very high score (≥4) after accreditation, was found for the item 'Have you had a dialogue with the staff about the advantages and disadvantages of the examination/treatment options available?'; RR= 5.73 (95% CI: 4.51, 7.27). CONCLUSION Hospitalized patients experienced significantly more support from health professionals, information and involvement in decision-making after accreditation. Future research on accreditation should include the patients' perspective.
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Affiliation(s)
- Maria Daniella Bergholt
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Allé 43-45, Aarhus N DK-8200, Denmark.,Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Gentofte Hospital, Gentofte Hospitalsvej 1, Hellerup DK-2900, Denmark
| | | | - Jan Brink Valentin
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, Aalborg DK-9220, Denmark
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW 2109, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW 2109, Australia
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, Aalborg DK-9220, Denmark
| | - Christian Von Plessen
- Policlinique Médicale, Unisanté, Rue du Bugnon 44, Lausanne CH-1011, Switzerland.,Institute for Clinical Research, University of Southern Denmark, Campusvej 55, Odense M, Syddanmark DK-5230, Denmark
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Brouwers J, Cox B, Van Wilder A, Claessens F, Bruyneel L, De Ridder D, Eeckloo K, Vanhaecht K. The future of hospital quality of care policy: A multi-stakeholder discrete choice experiment in Flanders, Belgium. Health Policy 2021; 125:1565-1573. [PMID: 34689980 DOI: 10.1016/j.healthpol.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/04/2021] [Accepted: 10/10/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Collaboration between policymakers, patients and healthcare workers in hospital quality of care policy setting can improve the integration of new initiatives. The aim of this study was to quantify preferences for various characteristics of a future quality policy in a broad group of stakeholders. MATERIALS AND METHODS 450 policymakers, clinicians, nurses, patient representatives and hospital board members in Flanders (Belgium) participated in five discrete choice experiments (DCE) on quality control, quality improvement, inspection, patient incidents and transparency. For each DCE, various attributes and levels were defined from a literature review and interviews with 12 international quality and patient safety experts. RESULTS For the attributes with the highest relative importance, participants exhibited a strong preference for quality control by an independent national organization and coordination of quality improvement initiatives at the level of hospital networks. The individual hospital was chosen over the government for setting up an action plan following patient complaints. Respondents also strongly preferred mandatory reporting of severe patient incidents and transparency by publicly reporting quality indicators at the hospital level. CONCLUSIONS A future quality model should focus on a multicomponent approach with external quality control, improvement actions on hospital network level and public transparency. DCEs provide an opportunity to incorporate the attitudes and views for individual components of a new policy recommendation.
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Affiliation(s)
- Jonas Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Belgium.
| | - Bianca Cox
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Belgium
| | - Kristof Eeckloo
- Department of Primary Care and Public Health, Ghent University, Belgium; Strategic Policy Unit, Ghent University Hospital, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Belgium
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Hussein M, Pavlova M, Ghalwash M, Groot W. The impact of hospital accreditation on the quality of healthcare: a systematic literature review. BMC Health Serv Res 2021; 21:1057. [PMID: 34610823 PMCID: PMC8493726 DOI: 10.1186/s12913-021-07097-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Accreditation is viewed as a reputable tool to evaluate and enhance the quality of health care. However, its effect on performance and outcomes remains unclear. This review aimed to identify and analyze the evidence on the impact of hospital accreditation. METHODS We systematically searched electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, MEDLINE (OvidSP), CDSR, CENTRAL, ScienceDirect, SSCI, RSCI, SciELO, and KCI) and other sources using relevant subject headings. We included peer-reviewed quantitative studies published over the last two decades, irrespective of its design or language. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers independently screened initially identified articles, reviewed the full-text of potentially relevant studies, extracted necessary data, and assessed the methodological quality of the included studies using a validated tool. The accreditation effects were synthesized and categorized thematically into six impact themes. RESULTS We screened a total of 17,830 studies, of which 76 empirical studies that examined the impact of accreditation met our inclusion criteria. These studies were methodologically heterogeneous. Apart from the effect of accreditation on healthcare workers and particularly on job stress, our results indicate a consistent positive effect of hospital accreditation on safety culture, process-related performance measures, efficiency, and the patient length of stay, whereas employee satisfaction, patient satisfaction and experience, and 30-day hospital readmission rate were found to be unrelated to accreditation. Paradoxical results regarding the impact of accreditation on mortality rate and healthcare-associated infections hampered drawing firm conclusions on these outcome measures. CONCLUSION There is reasonable evidence to support the notion that compliance with accreditation standards has multiple plausible benefits in improving the performance in the hospital setting. Despite inconclusive evidence on causality, introducing hospital accreditation schemes stimulates performance improvement and patient safety. Efforts to incentivize and modernize accreditation are recommended to move towards institutionalization and sustaining the performance gains. PROSPERO registration number CRD42020167863.
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Affiliation(s)
- Mohammed Hussein
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Department of Hospitals Accreditation, Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI), Riyadh, Saudi Arabia.
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mostafa Ghalwash
- Department of Hospitals Accreditation, Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI), Riyadh, Saudi Arabia
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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10
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A decade of commitment to hospital quality of care: overview of and perceptions on multicomponent quality improvement policies involving accreditation, public reporting, inspection and pay-for-performance. BMC Health Serv Res 2021; 21:990. [PMID: 34544408 PMCID: PMC8450175 DOI: 10.1186/s12913-021-07007-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/07/2021] [Indexed: 01/02/2023] Open
Abstract
Background Quality improvement (QI) initiatives such as accreditation, public reporting, inspection and pay-for-performance are increasingly being implemented globally. In Flanders, Belgium, a government policy for acute-care hospitals incorporates aforementioned initiatives. Currently, questions are raised on the sustainability of the present policy. Objective First, to summarise the various initiatives hospitals have adopted under government encouragement between 2008 and 2019. Second, to study the perspectives of healthcare stakeholders on current government policy. Methods In this multi-method study, we collected data on QI initiative implementation from governmental and institutional sources and through an online survey among hospital quality managers. We compiled an overview of QI initiative implementation for all Flemish acute-care hospitals between 2008 (n = 62) and 2019 (n = 53 after hospital mergers). Stakeholder perspectives were assessed via a second survey available to all healthcare employees and a focus group with healthcare policy experts was consulted. Variation between professions was assessed. Results QI initiatives have been increasingly implemented, especially from 2016 onwards, with the majority (87%) of hospitals having obtained a first accreditation label and all hospitals publicly reporting performance indicators, receiving regular inspections and having entered the pay-for-performance initiative. On the topic of external international accreditation, overall attitudes within the survey were predominantly neutral (36.2%), while 34.5% expressed positive and 29.3% negative views towards accreditation. In examining specific professional groups in-depth, we learned 58% of doctors regarded accreditation negatively, while doctors were judged to be the largest contributors to quality according to the majority of respondents. Conclusions Hospitals have demonstrated increased efforts into QI, especially since 2016, while perceptions on currently implemented QI initiatives among healthcare stakeholders are heterogeneous. To assure quality of care remains a top-priority for acute-care hospitals, we recommend a revision of the current multicomponent quality policy where the adoption of all initiatives is streamlined and co-created bottom-up. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07007-w.
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Bergholt MD, Falstie-Jensen AM, Hibbert P, Eysturoy BJ, Guttesen G, Róin T, Valentin JB, Braithwaite J, von Plessen C, Johnsen SP. The association between first-time accreditation and the delivery of recommended care: a before and after study in the Faroe Islands. BMC Health Serv Res 2021; 21:917. [PMID: 34482842 PMCID: PMC8418753 DOI: 10.1186/s12913-021-06952-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022] Open
Abstract
Background Significant resources are spent on hospital accreditation worldwide. However, documentation of the effects of accreditation on processes, quality of care and outcomes in healthcare remain scarce. This study aimed to examine changes in the delivery of patient care in accordance with clinical guidelines (recommended care) after first-time accreditation in a care setting not previously exposed to systematic quality improvement initiatives. Methods We conducted a before and after study based on medical record reviews in connection with introducing first-time accreditation. We included patients with stroke/transient ischemic attack, bleeding gastric ulcer, diabetes, chronic obstructive pulmonary disease (COPD), childbirth, heart failure and hip fracture treated at public, non-psychiatric Faroese hospitals during 2012–2013 (before accreditation) or 2017–2018 (after accreditation). The intervention was the implementation of a modified second version of The Danish Healthcare Quality Program (DDKM) from 2014 to 2016 including an on-site accreditation survey in the Faroese hospitals. Recommended care was assessed using 63 disease specific patient level process performance measures in seven clinical conditions. We calculated the fulfillment and changes in the opportunity-based composite score and the all-or-none score. Results We included 867 patient pathways (536 before and 331 after). After accreditation, the total opportunity-based composite score was marginally higher though the change did not reach statistical significance (adjusted percentage point difference (%): 4.4%; 95% CI: − 0.7 to 9.6). At disease level, patients with stroke/transient ischemic attack, bleeding gastric ulcer, COPD and childbirth received a higher proportion of recommended care after accreditation. No difference was found for heart failure and diabetes. Hip fracture received less recommended care after accreditation. The total all-or-none score, which is the probability of a patient receiving all recommended care, was significantly higher after accreditation (adjusted relative risk (RR): 2.32; 95% CI: 2.03 to 2.67). The improvement was particularly strong for patients with COPD (RR: 16.22; 95% CI: 14.54 to 18.10). Conclusion Hospitals were in general more likely to provide recommended care after first-time accreditation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06952-w.
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Affiliation(s)
- Maria Daniella Bergholt
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Allé 43-45, DK-8200, Aarhus N, Denmark. .,Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark.
| | | | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, New South Wales, 2109, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Barbara Joensen Eysturoy
- Surgical Centre, National Hospital of the Faroe Islands, J.C Svabosgøta 41-49, 100, Tórshavn, Faroe Islands
| | - Gunnvá Guttesen
- Medical Centre, National Hospital of the Faroe Islands, J.C Svabosgøta 41-49, 100, Tórshavn, Faroe Islands
| | - Tóra Róin
- Department of Quality Improvement and Patient Safety, National Hospital of the Faroe Islands, J.C Svabosgøta 41-49, 100, Tórshavn, Faroe Islands
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, DK-9220, Aalborg, Denmark
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, New South Wales, 2109, Australia
| | - Christian von Plessen
- Unisanté, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.,Institute for Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, DK-9220, Aalborg, Denmark
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Khan S, Yousefinezhadi T, Hinchcliff R. The impact of hospital accreditation in selected Middle East countries: a scoping review. J Health Organ Manag 2021; ahead-of-print. [PMID: 34390550 DOI: 10.1108/jhom-04-2021-0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Salma Khan
- School of Business, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Reece Hinchcliff
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Araujo CAS, Siqueira MM, Malik AM. Hospital accreditation impact on healthcare quality dimensions: a systematic review. Int J Qual Health Care 2021; 32:531-544. [PMID: 32780858 DOI: 10.1093/intqhc/mzaa090] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/06/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To systematically review the impact of hospital accreditation on healthcare quality indicators, as classified into seven healthcare quality dimensions. DATA SOURCE We searched eight databases in June 2020: EBSCO, PubMed, Web of Science, Emerald, ProQuest, Science Direct, Scopus and Virtual Health Library. Search terms were conceptualized into three groups: hospitals, accreditation and terms relating to healthcare quality. The eligibility criteria included academic articles that applied quantitative methods to examine the impact of hospital accreditation on healthcare quality indicators. STUDY SELECTION We applied the PICO framework to select the articles according to the following criteria: Population-all types of hospitals; Intervention-hospital accreditation; Comparison-quantitative method applied to compare accredited vs. nonaccredited hospitals, or hospitals before vs. after accreditation; Outcomes-regarding the seven healthcare quality dimensions. After a critical appraisal of the 943 citations initially retrieved, 36 studies were included in this review. RESULTS OF DATA SYNTHESIS Overall results suggest that accreditation may have a positive impact on efficiency, safety, effectiveness, timeliness and patient-centeredness. In turn, only one study analyzes the impact on access, and no study has investigated the impact on equity dimension yet. CONCLUSION Mainly due to the methodological shortcomings, the positive impact of accreditation on healthcare dimensions should be interpreted with caution. This study provides an up-to-date overview of the main themes examined in the literature, highlighting critical knowledge-gaps and methodological flaws. The findings may provide value to healthcare stakeholders in terms of improving their ability to assess the relevance of accreditation processes.
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Affiliation(s)
- Claudia A S Araujo
- COPPEAD Graduate School of Business, Federal University of Rio de Janeiro-RJ, Rio de Janeir, Brazil.,Fundação Getulio Vargas's Sao Paulo School of Business Administration-FGV/EAESP, São Paulo-SP, Rio de Janeir, Brazil
| | - Marina Martins Siqueira
- COPPEAD Graduate School of Business, Federal University of Rio de Janeiro-RJ, Rio de Janeir, Brazil
| | - Ana Maria Malik
- Fundação Getulio Vargas's Sao Paulo School of Business Administration-FGV/EAESP, São Paulo-SP, Rio de Janeir, Brazil
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Brooks M, Beauvais BM, Kruse CS, Fulton L, Mileski M, Ramamonjiarivelo Z, Shanmugam R, Lieneck C. Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance? Healthcare (Basel) 2021; 9:healthcare9070887. [PMID: 34356265 PMCID: PMC8305524 DOI: 10.3390/healthcare9070887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/24/2022] Open
Abstract
The relationship between healthcare organizational accreditation and their leaders’ professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.
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Van Wilder A, Bruyneel L, De Ridder D, Seys D, Brouwers J, Claessens F, Cox B, Vanhaecht K. Is a hospital quality policy based on a triad of accreditation, public reporting and inspection evidence-based? A narrative review. Int J Qual Health Care 2021; 33:6278849. [PMID: 34013956 DOI: 10.1093/intqhc/mzab085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Since 2009, hospital quality policy in Flanders, Belgium, is built around a quality-of-care triad, which encompasses accreditation, public reporting (PR) and inspection. Policy makers are currently reflecting on the added value of this triad. METHODS We performed a narrative review of the literature published between 2009 and 2020 to examine the evidence base of the impact accreditation, PR and inspection, both individually and combined, has on patient processes and outcomes. The following patient outcomes were examined: mortality, length of stay, readmissions, patient satisfaction, adverse outcomes, failure to rescue, adherence to process measures and risk aversion. The impact of accreditation, PR and inspection on these outcomes was evaluated as either positive, neutral (i.e. no impact observed or mixed results reported) or negative. OBJECTIVES To assess the current evidence base on the impact of accreditation, PR and inspection on patient processes and outcomes. RESULTS We identified 69 studies, of which 40 were on accreditation, 24 on PR, three on inspection and two on accreditation and PR concomitantly. Identified studies reported primarily low-level evidence (level IV, n = 53) and were heterogeneous in terms of implemented programmes and patient populations (often narrow in PR research). Overall, a neutral categorization was determined in 30 articles for accreditation, 23 for PR and four for inspection. Ten of these recounted mixed results. For accreditation, a high number (n = 12) of positive research on adherence to process measures was discovered. CONCLUSION The individual impact of accreditation, PR and inspection, the core of Flemish hospital quality, was found to be limited on patient outcomes. Future studies should investigate the combined effect of multiple quality improvement strategies.
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Affiliation(s)
- Astrid Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Quality Improvement, University Hospitals Leuven, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Urology, University Hospitals Leuven, Belgium, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Quality Improvement, University Hospitals Leuven, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Bianca Cox
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Quality Improvement, University Hospitals Leuven, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
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Ghazanfari F, Mosadeghrad AM, Jaafari Pooyan E, Mobaraki H. Iran hospital accreditation standards: challenges and solutions. Int J Health Plann Manage 2021; 36:958-975. [PMID: 33713501 DOI: 10.1002/hpm.3144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 12/17/2020] [Accepted: 02/19/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify the challenges of Iranian hospital accreditation standards and provide solutions. DESIGN A qualitative research design was used in this study. Open and semi-structured interviews were conducted in 2018. Thematic analysis was used to analyse qualitative data. SETTING Public, private, semi-public, charity and military hospitals in Tehran, Iran. PARTICIPANTS A pluralistic evaluation approach was employed and 151 participants including policy makers, hospital management and staff, accreditation surveyors and university professors participated in this study. RESULTS Challenges of hospital accreditation standards were grouped into two groups: standards development process and standards content. Lack of an independent standards development committee, insufficient expertise of committee members, inconsistencies among the standards' constructs, inappropriate standard classification, ambiguity of standards, unmeasurable standards, vague and inflexible scoring system, and inability to use some standards were the main challenges of Iran hospital accreditation standards. Establishing a scientific committee consisting of representative from hospitals, health insurance companies, professional and scientific associations and universities for standard development, training the committee members, and utilizing hospital's feedback will help address these problems. CONCLUSION Iran's hospital accreditation standards face challenges that prevent them from achieving their goals, that is, improving the quality, safety, effectiveness and efficiency of hospital services. Necessary measures should be taken to solve these problems.
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Affiliation(s)
- Fatemeh Ghazanfari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad Mosadeghrad
- Department of Health Management and Economics. School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jaafari Pooyan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Mobaraki
- Rehabilitation Management Department, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
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Sperling D, Pikkel RB. Promoting patients' rights through hospital accreditation. Isr J Health Policy Res 2020; 9:47. [PMID: 32958047 PMCID: PMC7504649 DOI: 10.1186/s13584-020-00405-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Over the past decade, hospitals in many countries, including Israel, have undergone an accreditation process aimed at improving the quality of services provided. This process also refers to the protection and promotion of patients' rights. However, reviewing the criteria and content included in this category in the Israeli context reveals definitions and implications that differ from those presented by the law - specifically the Patient's Rights Act 1995. Moreover, the rights included in it are not necessarily equally represented in other legislation. METHODS This study seeks to examine the question of whether and to what extent the scope, contents, and definitions of patients' rights in the JCI Standards are similar to or different from patients' rights as they are addressed and protected in national legislation. The article provides a comparison and examination of the different regulatory frameworks of patients' rights, especially those in the accreditation of healthcare institution and legislation, analyzes the gaps between such frameworks, and suggests possible implications on our understanding of the concept of patients' rights. RESULTS The patients' right chapter in the accreditation process introduces and promotes the concepts of patient and family rights, increases the awareness and compliance of such concepts, and may create greater consistency in their introduction and application. CONCLUSIONS Discussion of the Israeli case not only demonstrates how regulatory frameworks are instrumental - for broader policy purposes, especially in the area of patients' rights and the rights of patients' families - but also calls for a more general examination of the concept of patients' rights in health policies and its contribution to the quality of health services. Reference to patients' rights in accreditation of healthcare institutions may promote and enhance this concept and contribute to the delivery of care, thereby complementing a lacuna in the law.
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Affiliation(s)
| | - Rina B. Pikkel
- International Center for Health, Law and Ethics, Faculty of Law, University of Haifa, Haifa, Israel
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Karamali M, Bahadori M, Ravangard R, Yaghoubi M. Knowledge mapping of hospital accreditation research: a coword analysis. Int J Health Care Qual Assur 2020; ahead-of-print. [PMID: 32886458 DOI: 10.1108/ijhcqa-03-2020-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Hospital accreditation has been adopted internationally as a way and solution for healthcare quality improvement in hospitals. The purpose of this study was to review and knowledge mapping of bibliographic data about "Hospital Accreditation" and assess the current quantitative trends. DESIGN/METHODOLOGY/APPROACH Scientometric methods and knowledge visualization using the coword analysis techniques conducted in three steps based on the data related to the field of hospital accreditation from 1975 to 2018 obtained from the MEDLINE database. Bibliographic data for titles, abstracts and keywords articles were saved in CSV format and MEDLINE templates by applying filters. Data extracted were exported into an Excel spreadsheet and were preprocessed. The authors applied the text mining and visualization using VOSviewer software. FINDINGS Hospital accreditation studies have been increased rapidly over the past 30 years. 6,661 documents in the field of hospital accreditation had been published from 1975 to 2018. Hospitals or organizations active in the field of hospital accreditation were in the United States, Italy and Canada. The 10 most productive authors identified in the area of hospital accreditation with a higher influence were identified. "The United States", "accreditation", "Joint commission on accreditation" and "quality assurance, healthcare" had, respectively, the highest frequency. The cluster analysis identified and categorized them into four major clusters. Hospital accreditation field had a close relationship with the quality improvement, patient safety, risk and standards. ORIGINALITY/VALUE Hospital accreditation had focused on the scopes of implementation of accreditation programs, adherence to JCI standards, and focus on safety and quality improvement. Future studies are recommended to be conducted on design interventions and paying attention to all dimensions of hospital accreditation.
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Affiliation(s)
- Mazyar Karamali
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Yaghoubi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Hospital accreditation: Driving best outcomes through continuity of midwifery care? A scoping review. Women Birth 2020; 34:113-121. [PMID: 32111556 DOI: 10.1016/j.wombi.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 01/26/2023]
Abstract
PROBLEM Continuity of midwifery care models are the gold standard of maternity care. Despite being recommended by the Australian Health Ministers' Advisory Council, few women in Australia have access to such models. BACKGROUND Extensive research shows that if all women had access to continuity of midwifery care, maternal and neonatal outcomes would improve. Hospital accreditation, the main national safety and quality system in Australia, aims to encourage and enable the translation of healthcare quality and safety standards into practice. AIM This paper explored the realities and possibilities of a health care accreditation system driving health service re-organisation towards the provision of continuity of midwifery care for childbearing women. METHODS A scoping review sought literature at the macro (policy) level. From 3036 records identified, the final number of sources included was 100:73 research articles and eight expert opinion pieces/editorials from journals, 15 government/accreditation documents, three government/accreditation websites, and one thesis. FINDINGS Two narrative themes emerged: (1) Hospital accreditation: 'Here to stay' but no clear evidence and calls for change. (2) Measuring and implementing quality and safety in maternity care. DISCUSSION Regulatory frameworks drive hospitals' priorities, potentially creating conditions for change. The case for reform in the hospital accreditation system is persuasive and, in maternity services, clear. Mechanisms to actualise the required changes in maternity care are less apparent, but clearly possible. CONCLUSIONS Structural changes to Australia's health accreditation system are needed to prioritise, and mandate, continuity of midwifery care.
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Al Kuwaiti A, Al Muhanna FA. Challenges facing healthcare leadership in attaining accreditation of teaching hospitals. Leadersh Health Serv (Bradf Engl) 2019; 32:170-181. [PMID: 30945601 DOI: 10.1108/lhs-01-2018-0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper aims to examine the challenges faced by health-care leadership in teaching hospitals in attaining accreditation for their institutions. DESIGN/METHODOLOGY/APPROACH This paper is based on a study of current literature on health-care leadership, hospital accreditation and quality of patient care and identifies the challenges facing health-care leadership in attaining accreditation for teaching hospitals. FINDINGS Based on a review and analysis of literature, infrastructure, finance, legal support, workforce recruitment and training, documentation and technology are identified as challenges faced by health-care leadership in teaching hospitals. The key challenges facing health-care leadership with respect to medical education and clinical research are found to be integration of education into hospital operations, compliance with all regulatory and professional requirements and adequacy of resources in executing research programs. ORIGINALITY/VALUE This study draws the attention of health-care leadership in teaching hospitals on the challenges they face in obtaining accreditation for their institutions so that they may develop appropriate strategies to overcome them.
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Affiliation(s)
- Ahmed Al Kuwaiti
- College of Dentistry and Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University , Al Khobar, Saudi Arabia
| | - Fahd A Al Muhanna
- Department of Internal Medicine, Imam Abdulrahman Bin Faisal University , Dammam, Saudi Arabia
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Greenfield D, Lawrence SA, Kellner A, Townsend K, Wilkinson A. Health service accreditation stimulating change in clinical care and human resource management processes: A study of 311 Australian hospitals. Health Policy 2019; 123:661-665. [PMID: 31076201 DOI: 10.1016/j.healthpol.2019.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/07/2019] [Accepted: 04/24/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to establish whether longitudinal participation in an accreditation program is translated into improvement in continuity of quality patient care and human resource management (HRM) processes outcomes. MATERIALS AND METHODS This was a secondary data analysis of accreditation panel data from acute hospitals participating in the Australian Council on Healthcare Standards' Evaluation and Quality Improvement Program (EQuIP). EQuIP criteria data from 311 hospitals were collected by external surveyors across 2003-2006 (Time 1) and 2007-2010 (Time 2). Mandatory accreditation criteria ratings at Time 1 were used to determine hospital performance group membership (1 = below moderate, 2 = moderate, 3 = above moderate). Analysis was undertaken of ratings across continuity of quality patient care and HRM process criteria, at Time 1 and 2. RESULTS Continuity of quality patient care and HRM processes improved across time in the three performance groups. Lower performing hospitals improved at a greater rate than moderate and higher performing hospitals. The groupings and performance order did not change over time. CONCLUSIONS An accreditation program is an external driver that facilitates continual and systemic quality improvement changes to sub-systems with an organisation.
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Affiliation(s)
- David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, NSW, Australia.
| | - S A Lawrence
- Centre for Work, Organisation and Wellbeing, Griffith University, QLD, Australia
| | - A Kellner
- Centre for Work, Organisation and Wellbeing, Griffith University, QLD, Australia
| | - K Townsend
- Centre for Work, Organisation and Wellbeing, Griffith University, QLD, Australia
| | - A Wilkinson
- Centre for Work, Organisation and Wellbeing, Griffith University, QLD, Australia
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Furnival J, Boaden R, Walshe K. Assessing improvement capability in healthcare organisations: a qualitative study of healthcare regulatory agencies in the UK. Int J Qual Health Care 2019; 30:715-723. [PMID: 29697843 PMCID: PMC6307330 DOI: 10.1093/intqhc/mzy085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/05/2018] [Indexed: 12/30/2022] Open
Abstract
Objectives Healthcare regulatory agencies are increasingly concerned not just with assessing the current performance of the organisations they regulate, but with assessing their improvement capability to predict their future performance trajectory. This study examines how improvement capability is conceptualised and assessed by healthcare UK regulatory agencies. Design Qualitative analysis of data from six UK healthcare regulatory agencies was conducted. Three data sources were analysed using an a priori framework of eight dimensions of improvement capability identified from an extensive literature review. Setting The focus of the research study was the regulation of hospital-based care, which accounts for the majority of UK healthcare expenditure. Six UK regulatory agencies that review hospital care participated. Participants Data sources included interviews with regulatory staff (n = 48), policy documents (n = 90) and assessment reports (n = 30). Intervention None-this was a qualitative, observational study. Results This research study finds that of eight dimensions of improvement capability, process improvement and learning, and strategy and governance, dominate regulatory assessment practices. The dimension of service-user focus receives the least frequency of use. It may be that dimensions which are relatively easy to 'measure', such as documents for strategy and governance, dominate assessment processes, or there may be gaps in regulatory agencies' assessment instruments, deficits of expertise in improvement capability, or practical difficulties in operationalising regulatory agency intentions to reliably assess improvement capability. Conclusions The UK regulatory agencies seek to assess improvement capability to predict performance trajectories, but out of eight dimensions of improvement capability, two dominate assessment. Furthermore, the definition and meaning of assessment instruments requires development. This would strengthen the validity and reliability of agencies' assessment, diagnosis and prediction of performance trajectories, and support development of more appropriate regulatory performance interventions.
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Affiliation(s)
- Joy Furnival
- Alliance Manchester Business School, Manchester, UK.,NHS Improvement, Wellington House, Waterloo Road, London, UK
| | - Ruth Boaden
- Alliance Manchester Business School, Manchester, UK
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Sheldon TA. Inspecting the inspectors - does external review of health services provide value for money? J Health Serv Res Policy 2019; 24:143-144. [PMID: 30977405 DOI: 10.1177/1355819619839425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Trevor A Sheldon
- Professor Health Services Research and Policy, Department of Health Sciences, University of York, UK
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Alhuwail D. Understanding health information management practices in public hospitals in Kuwait. Health Inf Manag 2019; 49:127-136. [PMID: 30894029 DOI: 10.1177/1833358319837247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Health information technology (IT) solutions can aid healthcare reform efforts, but without proper information management, these efforts are futile. In this study, we used Kuwait as an example of a high per-capita gross domestic product country that faces information management challenges to draw insights that can be generalised to other developed countries. OBJECTIVE (i) to uncover the status quo of information management practices in public hospitals and (ii) to offer recommendations to improve them. METHOD This study analysed qualitative and quantitative accreditation-related data pertaining to the compliance with the information management standard at all secondary care public hospitals over two accreditation cycles. RESULTS Overall, public hospitals had made positive progress in their compliance with the information management standard. However, issues still existed with (i) developing and implementing an information management plan, (ii) involving the appropriate stakeholders in selecting health IT solutions and (iii) access to the Internet by staff and patients. CONCLUSION Evidence underscored the importance of proper information management driven by clear centralised strategic plans. IMPLICATIONS With the rapid adoption of digital health systems, the role of health information management leaders should not be undervalued. Embracing health IT solutions with strong information management practices can aid healthcare reform efforts.
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Affiliation(s)
- Dari Alhuwail
- Kuwait University, Kuwait; Dasman Diabetes Institute, Kuwait
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25
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Zapata-Vanegas MA. [Comparative analysis of context factors for the accreditation of public and private hospitals in Colombia]. Rev Salud Publica (Bogota) 2019; 21:168-174. [PMID: 33027325 DOI: 10.15446/rsap.v21n2.75062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/04/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine and compare the contextual elements and factors that may favor the achievement of accreditation of public and private healthcare hospitals. MATERIALS AND METHODS Based on a source study of cases and controls conducted in medium and high complexity hospitals of Colombia, 16 accredited and 38 non-accredited, this auxiliary study investigated the 38 non-accredited hospitals according to their public or private nature. The MUSIQ instrument ("Model for Understanding Success in Quality") was used to collect data used as reference, while the dimensions "Environment-Macrosystem-Microsystems-Quality Equipment" of the elements and context factors underwent a comparative analysis by means of Chi square test and Student's t or Mann-Whitney's U test after distribution normality verification using the Shapiro-Wilk test. In all cases, a p-value equal to or less than 0.05 was considered significant. RESULTS The 23 elements and factors that make up the 4 context dimensions for the achievement of accreditation in health in public and private hospitals were evaluated. It was found that tree had significant differences associated with greater progress in private hospitals, namely, the information systems to support the Quality Improvement (QI) and job stability in the macrosystem, and the motivation factor in the microsystem. The remaining 20 elements and factors evaluated in this study did not have significant differences. CONCLUSION There are differences in elements and factors of the context between public and private hospitals that can favor privates in the achievement of accreditation in health.
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Affiliation(s)
- Mario A Zapata-Vanegas
- MZ: MD. Ph.D. Gestión de la Calidad en los Servicios de Salud. Universidad CES. Facultad de Medicina. Medellín, Colombia. ;
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Shakibaei E. Role of a hospital accreditation program in developing a process management system. Int J Health Care Qual Assur 2019; 32:120-136. [DOI: 10.1108/ijhcqa-01-2018-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to clarify the effects of the Iranian Hospital Accreditation Program (IHAP) on hospital processes from the viewpoint of the staff charged with establishing the program.Design/methodology/approachThis qualitative study is based on the data collected in semi-structured interviews conducted in 2016, which involved eight questions. Interviews were held with 70 staff members at 14 hospitals. Managerial staff were purposively interviewed based on their familiarity and involvement with the program. The hospitals were divided into five groups, comprising public, private, charity, military and social service hospitals. A thematic analysis was carried out using the collected data.FindingsThree themes emerged from the data, which together comprise a process management cycle: the establishment, implementation, and control phases of the program. For each phase, various positive trends, as well as hurdles for establishing the program, declared which were framed two sub-themes as positive effects and challenges.Originality/valueThe findings contribute to the body of evidence used by policy-makers and hospital managers to improve the change management processes related to the Iranian IHAP. Although positive changes in the process management cycles at Iranian hospitals were noted, successful implementation of the program demands a thorough assessment of the hospitals’ technical and financial needs (taking into account disparities between hospitals), and there is an urgent requirement for a plan to meet these needs.
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Lam MB, Figueroa JF, Feyman Y, Reimold KE, Orav EJ, Jha AK. Association between patient outcomes and accreditation in US hospitals: observational study. BMJ 2018; 363:k4011. [PMID: 30337294 PMCID: PMC6193202 DOI: 10.1136/bmj.k4011] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To determine whether patients admitted to US hospitals that are accredited have better outcomes than those admitted to hospitals reviewed through state surveys, and whether accreditation by The Joint Commission (the largest and most well known accrediting body with an international presence) confers any additional benefits for patients compared with other independent accrediting organizations. DESIGN Observational study. SETTING 4400 hospitals in the United States, of which 3337 were accredited (2847 by The Joint Commission) and 1063 underwent state based review between 2014 and 2017. PARTICIPANTS 4 242 684 patients aged 65 years and older admitted for 15 common medical and six common surgical conditions and survey respondents of the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS). MAIN OUTCOME MEASURES Risk adjusted mortality and readmission rates at 30 days and HCAHPS patient experience scores. Hospital admissions were identified from Medicare inpatient files for 2014, and accreditation information was obtained from the Centers for Medicare and Medicaid Services and The Joint Commission. RESULTS Patients treated at accredited hospitals had lower 30 day mortality rates (although not statistically significant lower rates, based on the prespecified P value threshold) than those at hospitals that were reviewed by a state survey agency (10.2% v 10.6%, difference 0.4% (95% confidence interval 0.1% to 0.8%), P=0.03), but nearly identical rates of mortality for the six surgical conditions (2.4% v 2.4%, 0.0% (-0.3% to 0.3%), P=0.99). Readmissions for the 15 medical conditions at 30 days were significantly lower at accredited hospitals than at state survey hospitals (22.4% v 23.2%, 0.8% (0.4% to 1.3%), P<0.001) but did not differ for the surgical conditions (15.9% v 15.6%, 0.3% (-1.2% to 1.6%), P=0.75). No statistically significant differences were seen in 30 day mortality or readmission rates (for both the medical or surgical conditions) between hospitals accredited by The Joint Commission and those accredited by other independent organizations. Patient experience scores were modestly better at state survey hospitals than at accredited hospitals (summary star rating 3.4 v 3.2, 0.2 (0.1 to 0.3), P<0.001). Among accredited hospitals, The Joint Commission did not have significantly different patient experience scores compared to other independent organizations (3.1 v 3.2, 0.1 (-0.003 to 0.2), P=0.06). CONCLUSIONS US hospital accreditation by independent organizations is not associated with lower mortality, and is only slightly associated with reduced readmission rates for the 15 common medical conditions selected in this study. There was no evidence in this study to indicate that patients choosing a hospital accredited by The Joint Commission confer any healthcare benefits over choosing a hospital accredited by another independent accrediting organization.
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Affiliation(s)
- Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA, USA
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA 02115, USA
| | - Jose F Figueroa
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Yevgeniy Feyman
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA 02115, USA
| | - Kimberly E Reimold
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA 02115, USA
| | - E John Orav
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Ashish K Jha
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Pross C, Strumann C, Geissler A, Herwartz H, Klein N. Quality and resource efficiency in hospital service provision: A geoadditive stochastic frontier analysis of stroke quality of care in Germany. PLoS One 2018; 13:e0203017. [PMID: 30188906 PMCID: PMC6126832 DOI: 10.1371/journal.pone.0203017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 08/14/2018] [Indexed: 02/07/2023] Open
Abstract
We specify a Bayesian, geoadditive Stochastic Frontier Analysis (SFA) model to assess hospital performance along the dimensions of resources and quality of stroke care in German hospitals. With 1,100 annual observations and data from 2006 to 2013 and risk-adjusted patient volume as output, we introduce a production function that captures quality, resource inputs, hospital inefficiency determinants and spatial patterns of inefficiencies. With high relevance for hospital management and health system regulators, we identify performance improvement mechanisms by considering marginal effects for the average hospital. Specialization and certification can substantially reduce mortality. Regional and hospital-level concentration can improve quality and resource efficiency. Finally, our results demonstrate a trade-off between quality improvement and resource reduction and substantial regional variation in efficiency.
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Affiliation(s)
- Christoph Pross
- Department of Healthcare Management, Berlin University of Technology, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Christoph Strumann
- Institute for Entrepreneurship and Business Development, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Alexander Geissler
- Department of Healthcare Management, Berlin University of Technology, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Helmut Herwartz
- Chair of Econometrics, Georg-August-University Göttingen, Humboldtallee 3, 37073 Göttingen, Germany
| | - Nadja Klein
- Melbourne Business School, University of Melbourne, 200 Leicester Street, Carlton VIC 3053, Australia
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Desveaux L, Mitchell JI, Shaw J, Ivers NM. Understanding the impact of accreditation on quality in healthcare: A grounded theory approach. Int J Qual Health Care 2018; 29:941-947. [PMID: 29045664 DOI: 10.1093/intqhc/mzx136] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To explore how organizations respond to and interact with the accreditation process and the actual and potential mechanisms through which accreditation may influence quality. Design Qualitative grounded theory study. Setting Organizations who had participated in Accreditation Canada's Qmentum program during January 2014-June 2016. Participants Individuals who had coordinated the accreditation process or were involved in managing or promoting quality. Results The accreditation process is largely viewed as a quality assurance process, which often feeds in to quality improvement activities if the feedback aligns with organizational priorities. Three key stages are required for accreditation to impact quality: coherence, organizational buy-in and organizational action. These stages map to constructs outlined in Normalization Process Theory. Coherence is established when an organization and its staff perceive that accreditation aligns with the organization's beliefs, context and model of service delivery. Organizational buy-in is established when there is both a conceptual champion and an operational champion, and is influenced by both internal and external contextual factors. Quality improvement action occurs when organizations take purposeful action in response to observations, feedback or self-reflection resulting from the accreditation process. Conclusions The accreditation process has the potential to influence quality through a series of three mechanisms: coherence, organizational buy-in and collective quality improvement action. Internal and external contextual factors, including individual characteristics, influence an organization's experience of accreditation.
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Affiliation(s)
- L Desveaux
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, Ontario, Canada
| | | | - J Shaw
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, Ontario, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada
| | - N M Ivers
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, Ontario, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada
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Pereira-Salgado A, Boyd L, Johnson M. Developing online accreditation education resources for health care services: An Australian Case Study. Int J Qual Health Care 2017; 29:124-129. [PMID: 27979963 DOI: 10.1093/intqhc/mzw146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/16/2016] [Indexed: 11/14/2022] Open
Abstract
Quality problem or issue In 2013, 'National Safety and Quality Health Service Standards' accreditation became mandatory for most health care services in Australia. Developing and maintaining accreditation education is challenging for health care services, particularly those in regional and rural settings. With accreditation imminent, there was a need to support health care services through the process. Initial assessment A needs analysis identified limited availability of open access online resources for national accreditation education. Choice of solution A standardized set of online accreditation education resources was the agreed solution to assist regional and rural health care services meet compulsory requirements. Implementation Education resources were developed over 3 months with project planning, implementation and assessment based on a program logic model. Evaluation Resource evaluation was undertaken after the first 3 months of resource availability to establish initial usage and stakeholder perceptions. From 1 January 2015 to 31 March 2015, resource usage was 20 272, comprising 12 989 downloads, 3594 course completions and 3689 page views. Focus groups were conducted at two rural and one metropolitan hospital (n = 16), with rural hospitals reporting more benefits. Main user-based recommendations for future resource development were automatic access to customizable versions, ensuring suitability to intended audience, consistency between resource content and assessment tasks and availability of short and long length versions to meet differing users' needs. Lessons learned Further accreditation education resource development should continue to be collaborative, consider longer development timeframes and user-based recommendations.
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Affiliation(s)
- Amanda Pereira-Salgado
- Centre for Nursing Research, Cabrini Health, Cabrini Education and Research Precinct, 154 Wattletree Road, Malvern, Victoria3144, Australia
| | - Leanne Boyd
- Cabrini Health, Cabrini Education and Research Precinct, 154 Wattletree Road, Malvern, Victoria 3144, Australia.,School of Nursing and Midwifery, Monash University, Clayton Campus, Wellington Road, Clayton, Victoria 3800, Australia.,Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Matthew Johnson
- Cabrini Health, Cabrini Education and Research Precinct, 154 Wattletree Road, Malvern, Victoria 3144, Australia.,HealthPEER, Faculty of Medicine, Nursing and Health Sciences, Clayton Campus, Wellington Road, Clayton, Victoria 3800, Australia
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Behera SK, Smith SN, Tacy TA. Impact of Accreditation on Quality in Echocardiograms: A Quantitative Approach. J Am Soc Echocardiogr 2017; 30:913-922. [DOI: 10.1016/j.echo.2017.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Indexed: 11/29/2022]
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Park IT, Jung YY, Park SH, Hwang JH, Suk SH. Impact of Healthcare Accreditation Using a Systematic Review: Balanced Score Card Perspective. ACTA ACUST UNITED AC 2017. [DOI: 10.14371/qih.2017.23.1.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hogden A, Greenfield D, Brandon M, Debono D, Mumford V, Westbrook J, Braithwaite J. How does accreditation influence staff perceptions of quality in residential aged care? QUALITY IN AGEING AND OLDER ADULTS 2017. [DOI: 10.1108/qaoa-07-2016-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme.
Design/methodology/approach
Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views.
Findings
Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life.
Research limitations/implications
For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question.
Originality/value
This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting.
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Could accreditation bodies facilitate the implementation of medical guidelines in laboratories? Clin Chem Lab Med 2017; 55:806-808. [DOI: 10.1515/cclm-2016-0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/28/2016] [Indexed: 11/15/2022]
Abstract
AbstractSeveral studies have shown that recommendations related to how laboratory testing should be performed and results interpreted are limited in medical guidelines and that the uptake and implementation of the recommendations that are available need improvement. The EFLM/UEMS Working Group on Guidelines conducted a survey amongst the national societies for clinical chemistry in Europe regarding development of laboratory-related guidelines. The results showed that most countries have guidelines that are specifically related to laboratory testing; however, not all countries have a formal procedure for accepting such guidelines and few countries have guideline committees. Based on this, the EFLM/UEMS Working Group on Guidelines conclude that there is still room for improvement regarding these processes in Europe and raise the question if the accreditation bodies could be a facilitator for an improvement.
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de Oliveira JLC, Gabriel CS, Fertonani HP, Matsuda LM. Management changes resulting from hospital accreditation. Rev Lat Am Enfermagem 2017; 25:e2851. [PMID: 28301031 PMCID: PMC5363327 DOI: 10.1590/1518-8345.1394.2851] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 11/15/2016] [Indexed: 12/30/2022] Open
Abstract
Objective to analyze managers and professionals' perceptions on the changes in hospital management deriving from accreditation. Method descriptive study with qualitative approach. The participants were five hospital quality managers and 91 other professionals from a wide range of professional categories, hierarchical levels and activity areas at four hospitals in the South of Brazil certified at different levels in the Brazilian accreditation system. They answered the question "Tell me about the management of this hospital before and after the Accreditation". The data were recorded, fully transcribed and transported to the software ATLAS.ti, version 7.1 for access and management. Then, thematic content analysis was applied within the reference framework of Avedis Donabedian's Evaluation in Health. Results one large family was apprehended, called "Management Changes Resulting from the Accreditation: perspectives of managers and professionals" and five codes, related to the management changes in the operational, structural, financial and cost; top hospital management and quality management domains. Conclusion the management changes in the hospital organizations resulting from the Accreditation were broad, multifaceted and in line with the improvements of the service quality.
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Affiliation(s)
- João Lucas Campos de Oliveira
- Doctoral student, Universidade Estadual de Maringá, Maringá, PR, Brazil.
Assistant Professor, Colegiado de Enfermagem, Universidade Estadual do Oeste do Paraná,
Cascavel, PR, Brazil
| | - Carmen Silvia Gabriel
- PhD, Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de
São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto,
SP, Brazil
| | - Hosanna Pattrig Fertonani
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade
Estadual de Maringá, Maringá, PR, Brazil
| | - Laura Misue Matsuda
- PhD, Associate Professor, Departamento de Enfermagem, Universidade
Estadual de Maringá, Maringá, PR, Brazil
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Griffin A, McKeown A, Viney R, Rich A, Welland T, Gafson I, Woolf K. Revalidation and quality assurance: the application of the MUSIQ framework in independent verification visits to healthcare organisations. BMJ Open 2017; 7:e014121. [PMID: 28196952 PMCID: PMC5318568 DOI: 10.1136/bmjopen-2016-014121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES We present a national evaluation of the impact of independent verification visits (IVVs) performed by National Health Service (NHS) England as part of quality assuring medical revalidation. Organisational visits are central to NHS quality assurance. They are costly, yet little empirical research evidence exists concerning their impact, and what does exist is conflicting. SETTING The focus was on healthcare providers in the NHS (in secondary care) and private sector across England, who were designated bodies (DBs). DBs are healthcare organisations that have a statutory responsibility, via the lead clinician, the responsible officer (RO), to implement medical revalidation. PARTICIPANTS All ROs who had undergone an IVV in England in 2014 and 2015 were invited to participate. 46 ROs were interviewed. Ethnographic data were gathered at 18 observations of the IVVs and 20 IVV post visit reports underwent documentary analysis. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were the findings pertaining to the effectiveness of the IVV system in supporting the revalidation processes at the DBs. Secondary outcomes were methodological, relating to the Model for Understanding Success in Quality (MUSIQ) and how its application to the IVV reveals the relevance of contextual factors described in the model. RESULTS The impact of the IVVs varied by DB according to three major themes: the personal context of the RO; the organisational context of the DB; and the visit and its impact. ROs were largely satisfied with visits which raised the status of appraisal within their organisations. Inadequate or untimely feedback was associated with dissatisfaction. CONCLUSIONS Influencing teams whose prime responsibility is establishing processes and evaluating progress was crucial for internal quality improvement. Visits acted as a nudge, generating internal quality review, which was reinforced by visit teams with relevant expertise. Diverse team membership, knowledge transfer and timely feedback made visits more impactful.
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Affiliation(s)
- Ann Griffin
- Research Department for Medical Education, UCL Medical School, London, UK
| | - Alex McKeown
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Antonia Rich
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Trevor Welland
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Irene Gafson
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Katherine Woolf
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
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Berssaneti FT, Saut AM, Barakat MF, Calarge FA. Is there any link between accreditation programs and the models of organizational excellence? Rev Esc Enferm USP 2016; 50:650-657. [DOI: 10.1590/s0080-623420160000500016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/02/2016] [Indexed: 11/21/2022] Open
Abstract
Abstract OBJECTIVE To evaluate whether accredited health organizations perform better management practices than non-accredited ones. METHOD The study was developed in two stages: a literature review, and a study of multiple cases in 12 healthcare organizations in the state of São Paulo, Brazil. It surveyed articles comparing hospital accreditation with the EFQM (European Foundation for Quality Management) model of excellence in management. According to the pertinent literature, the accreditation model and the EFQM model are convergent and supplementary in some aspects. RESULTS With 99% confidence, one can say that there is evidence that accredited organizations scored better in the evaluation based on the EFQM model in comparison to non-accredited organizations. This result was also confirmed in the comparison of results between the categories Facilitators and Results in the EFQM model. CONCLUSION There is convergence between the accreditation model and the EFQM excellence model, suggesting that accreditation helps the healthcare sector to implement the best management practices already used by other business sectors.
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Mumford V, Reeve R, Greenfield D, Forde K, Westbrook J, Braithwaite J. Is accreditation linked to hospital infection rates? A 4-year, data linkage study ofStaphylococcus aureusrates and accreditation scores in 77 Australian acute hospitals. Int J Qual Health Care 2015; 27:479-85. [DOI: 10.1093/intqhc/mzv078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2015] [Indexed: 11/14/2022] Open
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Mumford V, Greenfield D, Hogden A, Forde K, Westbrook J, Braithwaite J. Counting the costs of accreditation in acute care: an activity-based costing approach. BMJ Open 2015; 5:e008850. [PMID: 26351190 PMCID: PMC4563236 DOI: 10.1136/bmjopen-2015-008850] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess the costs of hospital accreditation in Australia. DESIGN Mixed methods design incorporating: stakeholder analysis; survey design and implementation; activity-based costs analysis; and expert panel review. SETTING Acute care hospitals accredited by the Australian Council for Health Care Standards. PARTICIPANTS Six acute public hospitals across four States. RESULTS Accreditation costs varied from 0.03% to 0.60% of total hospital operating costs per year, averaged across the 4-year accreditation cycle. Relatively higher costs were associated with the surveys years and with smaller facilities. At a national level these costs translate to $A36.83 million, equivalent to 0.1% of acute public hospital recurrent expenditure in the 2012 fiscal year. CONCLUSIONS This is the first time accreditation costs have been independently evaluated across a wide range of hospitals and highlights the additional cost burden for smaller facilities. A better understanding of the costs allows policymakers to assess alternative accreditation and other quality improvement strategies, and understand their impact across a range of facilities. This methodology can be adapted to assess international accreditation programmes.
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Affiliation(s)
- Virginia Mumford
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Maquarie University, Sydney, New South Wales, Australia
| | - David Greenfield
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Maquarie University, Sydney, New South Wales, Australia
| | - Anne Hogden
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Maquarie University, Sydney, New South Wales, Australia
| | - Kevin Forde
- School of Public Health and Community Medicine, UNSW Medicine, UNSW, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Maquarie University, Sydney, New South Wales, Australia
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Mumford V, Greenfield D, Hogden A, Debono D, Forde K, Westbrook J, Braithwaite J. Development and application of an indicator assessment tool for measuring health services accreditation programs. BMC Res Notes 2015; 8:363. [PMID: 26289324 PMCID: PMC4541736 DOI: 10.1186/s13104-015-1330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/12/2015] [Indexed: 11/27/2022] Open
Abstract
Background Hospital accreditation programs are internationally widespread and consume increasingly scarce health resources. However, we lack tools to consistently identify suitable indicators to assess and monitor accreditation outcomes. We describe the development and validation of such a tool. Results Using Australian accreditation standards as our reference point we: reviewed the research evidence for potential indicators; looked for links with existing external indicators; and assessed relevant state and federal policies. We allocated provisional scores, on a five point Likert scale, to the five accountability criteria in the tool: research; accuracy; proximity; no adverse effects; and specificity. An expert panel validated the use of the purpose designed indicator assessment tool. The panel identified hand hygiene compliance rates as a suitable process indicator, and hospital acquired Staphylococcus aureus infection (SAB) rates as an outcome indicator, with the hypothesis that improved hand hygiene compliance rates and lower SAB rates would correlate with accreditation performance. Conclusions This new tool can be used to identify, analyse, and compare accreditation indicators. Using infection control indicators such as hand hygiene compliance and SAB rates to measure accreditation effectiveness has merit, and their efficacy can be determined by comparing accreditation scores with indicator outcomes. To verify the tool as a robust instrument, testing is needed in other health service domains, both in Australia and internationally. This tool provides health policy makers with an important means for assessing the accreditation programs which form a critical part of the national patient safety and quality framework.
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Affiliation(s)
- Virginia Mumford
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| | - Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| | - Deborah Debono
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| | - Kevin Forde
- School of Public Health and Community Medicine, UNSW, Sydney, Australia.
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| | - Jeffrey Braithwaite
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
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Greenfield D, Hinchcliff R, Hogden A, Mumford V, Debono D, Pawsey M, Westbrook J, Braithwaite J. A hybrid health service accreditation program model incorporating mandated standards and continuous improvement: interview study of multiple stakeholders in Australian health care. Int J Health Plann Manage 2015; 31:e116-30. [PMID: 26044988 DOI: 10.1002/hpm.2301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011-12 there were 47 group and individual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies; shifting of program content focus and details; different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance; continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from "malicious compliance" to "performance audits" to "quality improvement journeys". Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- David Greenfield
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Reece Hinchcliff
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Anne Hogden
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Virginia Mumford
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Deborah Debono
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Marjorie Pawsey
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Johanna Westbrook
- University of New South Wales, Australian Institute of Health Innovation, Centre for Health Systems and Safety Research, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
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Evaluation Indexes of Military Hospitals From the Experts' Perspective: A Qualitative Study. Disaster Med Public Health Prep 2015; 9:409-14. [PMID: 25991414 DOI: 10.1017/dmp.2015.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Given the importance of evaluation in an organization and considering the objectives and missions of military hospitals, we aimed to extract some indexes (in addition to common evaluation indexes) for use in evaluating military hospitals. This was an applied-type qualitative study. The participants were 15 health experts who were first chosen by a purposeful sampling, which was then continued by theoretical sampling. The data obtained were analyzed by using MAXQDA11 software and the content analysis method. After 290 obtained codes were analyzed, 17 indexes in 6 domains were extracted, including capacity development for crisis periods, equipment and facilities, training and research, passive defense, treatment, and services, from which 8 indexes were related to capacity development for crisis periods and equipment and facilities (4 indexes each), 3 indexes were related to services, and 6 indexes were related to training and research, passive defense, and treatment (2 indexes each). The results of the present research, as a supplement to current evaluation methods such as accreditation, can be used for the comprehensive evaluation of military hospitals.
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Mumford V, Greenfield D, Hogden A, Debono D, Gospodarevskaya E, Forde K, Westbrook J, Braithwaite J. Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals. BMJ Open 2014; 4:e005284. [PMID: 25248496 PMCID: PMC4173108 DOI: 10.1136/bmjopen-2014-005284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates. DESIGN A retrospective, longitudinal, multisite comparative survey. SETTING Acute public hospitals in New South Wales, Australia. PARTICIPANTS 96 acute hospitals with accreditation survey results from two surveys during 2009-2012 and submitted data for more than four hand hygiene audits between 2010 and 2013. OUTCOMES Our primary outcome comprised observational hand hygiene compliance data from eight audits during 2010-2013. The explanatory variables in our multilevel regression model included: accreditation outcomes and scores for the infection control standard; timing of the surveys; and hospital size and activity. RESULTS Average hand hygiene compliance rates increased from 67.7% to 80.3% during the study period (2010-2013), with 46.7% of hospitals achieving target compliance rates of 70% in audit 1, versus 92.3% in audit 8. Average hand hygiene rates at small hospitals were 7.8 percentage points (pp) higher than those at the largest hospitals (p<0.05). The association between hand hygiene rates, accreditation outcomes and infection control scores is less clear. CONCLUSIONS Our results indicate that accreditation outcomes and hand hygiene audit data are measuring different parts of the quality and safety spectrum. Understanding what is being measured when selecting indicators to assess the impact of accreditation is critical as focusing on accreditation results would discount successful hand hygiene implementation by smaller hospitals. Conversely, relying on hand hygiene results would discount the infection control related research and leadership investment by larger hospitals. Our hypothesis appears to be confounded by an accreditation programme that makes it more difficult for smaller hospitals to achieve high infection control scores.
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Affiliation(s)
- Virginia Mumford
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - Deborah Debono
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - Elena Gospodarevskaya
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - Kevin Forde
- School of Public Health and Community Medicine, UNSW, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
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Bismark MM, Studdert DM. Governance of quality of care: a qualitative study of health service boards in Victoria, Australia. BMJ Qual Saf 2013; 23:474-82. [PMID: 24327735 PMCID: PMC4033274 DOI: 10.1136/bmjqs-2013-002193] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To describe the engagement of health service boards with quality-of-care issues and to identify factors that influence boards’ activities in this area. Methods We conducted semistructured interviews with 35 board members and executives from 13 public health services in Victoria, Australia. Interviews focused on the role currently played by boards in overseeing quality of care. We also elicited interviewees’ perceptions of factors that have influenced their current approach to governance in this area. Thematic analysis was used to identify key themes from interview transcripts. Results Virtually all interviewees believed boards had substantial opportunities to influence the quality of care delivered within the service, chiefly through setting priorities, monitoring progress, holding staff to account and shaping culture. Perceived barriers to leveraging this influence included insufficient resources, gaps in skills and experience among board members, inadequate information on performance and regulatory requirements that miss the mark. Interviewees converged on four enablers of more effective quality governance: stronger regional collaborations; more tailored board training on quality issues; smarter use of reporting and accreditation requirements; and better access to data that was reliable, longitudinal and allowed for benchmarking against peer organisations. Conclusions Although health service boards are eager to establish quality of care as a governance priority, several obstacles are blocking progress. The result is a gap between the rhetoric of quality governance and the reality of month-to-month activities at the board level. The imperative for effective board-level engagement in this area cannot be met until these barriers are addressed.
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Affiliation(s)
- Marie M Bismark
- Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - David M Studdert
- Melbourne School of Population and Global Health & Melbourne Law School, Melbourne, Victoria, Australia
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