Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study

Impact of short-notice accreditation assessments on hospitals' patient safety and quality culture-A scoping review

AIM

To explore the published evidence describing the impact of short-notice accreditation assessments on hospitals' patient safety and quality culture.

DESIGN

Arksey and O'Malley (2005)'s scoping study framework and Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping reviews (PRISMA-ScR).

METHODS

A scoping review was conducted to identify papers that provided an evaluation of short-notice accreditation processes. All reviewers independently reviewed included papers and thematic analysis methods were used to understand the data.

DATA SOURCES

PubMed/MEDLINE, CINAHL, and ProQuest databases were searched to identify papers published after 2000.

RESULTS

Totally, 3317 records were initially identified with 64 full-text studies screened by the reviewers. Five studies were deemed to meet this scoping review's inclusion criteria. All five studies reported variable evidence on the validity of health service or hospital accreditation processes and only three considered the concept of patient safety and quality culture in the context of accreditation. None of the five included studies report the impact of a short-notice accreditation process on a hospital's patient safety and quality culture.

CONCLUSIONS

Limited evidence exists to report on the effectiveness of hospital short-notice accreditation models. No study has been undertaken to understand the impact of short-notice accreditation on patient safety and quality cultures within hospital settings.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Understanding this topic will support improved hospital quality, safety, policy, and governance.

IMPACT

To provide an understanding of the current knowledge base of short-notice accreditation models and its impact on hospital patient safety and quality culture.

REPORTING METHODS

PRISMA reporting guidelines have been adhered to.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Nursing perception towards the impact of JCI accreditation on the quality of care in a university hospital in Palestine: a cross-sectional study

BACKGROUND

This study investigates nursing staff perceptions regarding the impact of Joint Commission International (JCI) accreditation on the quality of care within a university hospital in Palestine. The research specifically examines how the accreditation process influences nursing practices, patient results, and overall healthcare quality in a challenging environment marked by unique operational and external pressures.

METHODS

The study was conducted at An-Najah National University Hospital (NNUH), a university hospital in Palestine, using a cross-sectional survey design. The structured questionnaire employed in the study was based on the Donabedian model, which evaluates the process and outcome dimensions of healthcare quality influenced by JCI accreditation. The questionnaire consisted of 47 items, divided into ten main subsections. These subsections included participants' demographical information (6 items), quality measurement and analysis (4 items), leadership, commitment and support (4 items), use of data (4 items), strategic quality planning (4 items), human resources education and training (4 items), quality management (4 items), quality results (4 items), staff involvement (5 items), and benefits of accreditation (8 items). The questionnaire was rigorously designed to assess both the quality processes and quality results. The eight subscales evaluated various aspects, such as leadership commitment, strategic planning, and staff involvement. To ensure reliability, the internal consistency of the survey was confirmed with a high Cronbach's alpha score, demonstrating the tool's robustness and reliability in capturing the intended data.

RESULTS

The study of 180 nurses overwhelmingly supported the positive impact of JCI accreditation on hospital quality improvement processes. More than 90% of respondents acknowledged the role of accreditation in improving resource utilization, meeting population needs, and promoting professional standards and values ​​among staff. Statistical analyses, including Pearson correlation and stepwise regression, highlighted strong positive associations between quality process variables and quality results. In particular, leadership commitment, strategic planning, and staff engagement were found to be significant predictors of improved quality results.

CONCLUSIONS

This study's findings demonstrate that JCI accreditation significantly positively impacts nurses' perceptions of care quality at NNUH. The study underscores the importance of international accreditation in driving quality improvements in healthcare, particularly in settings with unique challenges such as those faced in Palestine. These insights are crucial for policymakers and healthcare administrators aiming to enhance care standards through accreditation in similar environments.

Hospital employees' perception of Joint Commission International Accreditation: effect of re-accreditation

Joint Commission International (JCI) accreditation is a recognized leader in healthcare accreditation worldwide. It aims to improve quality of care, patient safety, and organizational performance. Many hospitals do not apply for re-accreditation after JCI status expires. Understanding employees' perceptions of JCI accreditation would benefit hospital management. We aimed to examine whether re-accredited hospital employees perceived more significant benefits and were more likely to recommend JCI to other hospitals than ex-accredited employees. This is a prospective cross-sectional study with a comparison group design. Survey questionnaires, developed from a qualitative study, included perceptions of challenges, benefits, and overall rating of JCI accreditation. An electronic-based questionnaire was distributed to physicians, nurses, medical technicians, and administrative staff in five private Obstetrics and Gynecology hospitals in China, March-April 2023. Descriptive and linear regression analyses were performed. The statistically significant level is P-value <.05. Of 2326 employees, 1854 (79.7%) were included in the study after exclusions, 1195 were re-accredited, and 659 were ex-accredited. Perceptions of JCI accreditation were positive, as both groups reported a mean score >4.0 regarding the overall benefits. Adjusted for covariates, re-accredited employees were more willing to recommend JCI accreditation to other hospitals than ex-accredited employees. Re-accredited employees perceived greater benefits of JCI accreditation and were more willing to recommend it to other hospitals, suggesting that perceived benefits contribute to a desire to maintain and sustain JCI accreditation. Employee participation is vital for its effective implementation. Employees' perceived challenges and benefits may provide insights for healthcare leaders considering pursuing and reapplying for JCI accreditation.

The impact of self-assessment and surveyor assessment on site visit performance under the National General Practice Accreditation scheme

Objective There is a need to undertake more proactive and in-depth analyses of general practice accreditation processes. Two areas that have been highlighted as areas of potential inconsistency are the self-assessment and surveyor assessment of indicators. Methods The data encompass 757 accreditation visits made between December 2020 and July 2022. A mixed-effect multilevel logistic regression model determined the association between attempt of the self-assessment and indicator conformity from the surveyor assessment. Furthermore, we present a contrast of the rate of indicator conformity between surveyors as an approximation of the inter-assessor consistency from the site visit. Results Two hundred and seventy-seven (37%) practices did not attempt or accurately report conformity to any indicators at the self-assessment. Association between attempting the self-assessment and the rate of indicator non-conformity at the site visit failed to reach statistical significance (OR = 0.90 [95% CI = 1.14-0.72], P  = 0.28). A small number of surveyors (N  = 9/34) demonstrated statistically significant differences in the rate of indicator conformity compared to the mean of all surveyors. Conclusions Attempt of the self-assessment did not predict indicator conformity at the site visit overall. Appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified.

Highlighting efficiency and redundancy in the Royal Australian College of General Practice standards for accreditation

Objectives Accreditation to standards developed by the Royal Australian College of General Practice provides assurance to the community of the quality and safety of general practices in Australia. The objective of this study was to conduct an empirical evaluation of the 5th edition standards. Minimal empirically driven evaluation of the standards has been conducted since their publication in 2020. Methods Data encompass consecutive Australian general practice accreditation assessments between December 2020 and July 2022 recorded from a single accrediting agency. Met and not met compliance (binary) scores for 124 indicators evaluated at the site visit were recorded. A subset of indicators derived from a selection of existing and consistently non-conformant indicators within each criterion was generated. Concordance between the indicator subset and the criterion was assessed to determine the predictive ability of the indicator subset in distinguishing practices who are conformant to the entire criterion. Results A total of 757 general practices were included in the analysis. On average, 113.69 (s.d. = 8.16) of 124 indicators were evaluated as conformant at the site visit. In total, 52 (42%) indicators were required to obtain a true positive conformity rate above 95% for all criterions of the standards. For criterion 1 (General Practice 1) conformity to the entire criterion (nine indicators; >95% true positive rate) could be obtained by including 2/9 indicators (C1-1a and C1-2a). Conclusion Our results identified that indicator non-conformity was driven by a small proportion of indicators and identifying a subset of these consistently non-conformant indicators predicted a true positive rate above 95% at the criterion level.

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

Background

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

Methods

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

Results

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

Conclusion

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

Enabling Factors for the Successful Implementation of the CBAHI Accreditation Program

Background

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

Purpose

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

Methods

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

Results

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

Conclusion

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

Accreditation of primary health care centres in the KSA: Lessons from developed and developing countries

Background/Objectives

In 2013, the KSA made Central Board for Accreditation of Healthcare Institutions (CBAHI) accreditation mandatory for all healthcare facilities, including primary health care centres (PHCs) and set a target to have 502 PHCs accredited by 2020. However, there is a real gap in knowledge and research on the impact of CBAHI accreditation on PHCs. This absence of research has been linked to the lack of understanding of the accreditation programme. Therefore, it was recommended by scholars that the KSA could learn from the experience of other countries to improve policy implementation and avoid future complications.

Methods

This study aimed to explore lessons that KSA can draw from developed and developing countries that have implemented accreditation programmes for PHCs. We performed a literature review using a systematic approach to identify articles related to the accreditation of PHCs. The identified articles were examined by applying evaluation criteria in respect of prospective policy transfer.

Results

The research results yielded 22 publications from different countries. There were variations among the countries in the specific information acquired. However, Denmark had the highest number of articles providing detailed information. Regarding their aims, most studies shared the same goal of improving quality and patient safety. Generally, there was limited discussion of policy failure compared with policy success. In addition, most of the countries were in the process of implementing local accreditation. Almost all of the countries that had implemented external programmes were developing countries. In terms of application criteria, most cases made recommendations for the programme or for PHCs.

Conclusion

Analysis indicated that because of the differences in information between countries and settings, there is no ideal country-based experience from which the KSA can transfer lessons. Lessons from outside the KSA would need careful consideration when adopting them in the local context of the Kingdom.

An integrative model of patients' perceived value of healthcare service quality in North Cyprus

Background

Improving healthcare quality has become an essential objective for all health institutions worldwide to address the need to improve services, manage costs and satisfy patient expectations about the quality of care. As health is one of the leading service sectors of the North Cyprus economy, analysing patients’ perceived value of healthcare service quality is crucial. In this research, a comparative analysis of existing models revealed affordability, acceptability and accessibility as the leading modern service quality indicators affecting patients’ perceived value of healthcare service quality. The quality of services is a leading factor impacting business competition and retention dictated by the current market. This study aimed to investigate the factors that influence patient perceptions of healthcare service quality in North Cyprus.

Methods

A self-administered questionnaire was carried out among 388 patients of public and private hospitals in North Cyprus, and the data were analysed using partial least squares-structural equation modelling.

Results

Empirical results highlight that the acceptability of healthcare services is a prerequisite for perceiving a high value of service quality. The affordability and accessibility of services, respectively, were less effective. Results concerning mediating effects confirm that acceptability could fully mediate the relationship between affordability and perceived value and could partially mediate the impact of accessibility on the perceived quality of healthcare services.

Conclusion

This study contributes to healthcare theory and practice by developing a conceptual framework to provide policymakers and managers with a practical understanding of factors that affect healthcare service quality.

Accreditation of specialized surgical units in general and digestive surgery: A step forward by the AEC for quality improvement and subspecialized Fellowship training

At present, in daily practice, the Departments of Surgery in most hospitals in Spain are organized into "Specialized Surgical Units", including specific structure, human resources, organization, teaching and research in the different subspecialties included in General and Digestive Surgery (GDS). Furthermore, there are also several specialized "fellowship-like", training programs in the different subspecialties already working in some of these "Specialized Surgical Units", although not officially financed. However, until now there was no model for accreditation or recognition of these Units or fellowship programs. The AEC has designed a regulation for the accreditation of Specialized Surgical Units in GDS, that will also serve as a model to define subspecialty training in these areas. The accreditation process, and with it, the process of quality improvement, includes different quality indicators, including unit structure, process quality, and result indicators.

From assurance to coproduction: a century of improving the quality of health-care service

BACKGROUND

Over the last century, the invitation to improve health-care service quality has taken many different forms: questions, observations, methods, tools and actions have emerged and evolved to create relevant 'improvement work.' In this paper we present three phases of this work. The basic frameworks used in these phases have not supplanted each other, but they have been layered one upon the next over time. Each brought important new thinking, new change opportunities and a new set of limits. The important messages of each need to be carried together into the future, as must the sense of curiosity and possibility about the commonalities that has driven this evolution.

METHODS

Literature, personal experience and other artifacts were reviewed to develop this description of how the focus on quality work has evolved (and continues to evolve) over the last century.

RESULTS

We describe three phases. Quality 1.0 seeks to answer the question 'How might we establish thresholds for good healthcare services?' It described certain 'basic' standards that should be used to certify acceptable performance and capability. This led to the formation of formal processes for review, documentation and external audits and a system for public notice and recognition. Over time, the limits and risks of this approach also became more visible: a 'micro-accounting compliance' sometimes triumphed over what might be of even greater strategic importance in the development and operations of effective systems of disease prevention and management to improve outcomes for patients and families. Quality 2.0 asked 'How might we use enterprise-wide systems for disease management?' It added a focus on the processes and systems of production, reduction of unwanted variation, the intrinsic motivation to take pride in work, outcome measurement and collaborative work practices as ways to improve quality, modeled on experiences in other industries. Quality 3.0 asks 'How might we improve the value of the contribution that healthcare service makes to health?' It requires careful consideration of the meaning of 'service' and 'value', service-creating logic, and prompts us to consider both relationships and activities in the context of the coproduction of health-care services.

CONCLUSION

Efforts to improve the quality and value of health-care services have evolved over the last century. With each success have come new challenges and questions, requiring the addition of new frames and approaches.

Emilia-Romagna Regional Blood System accreditation as an example of improvement through application of specific requirements: a retrospective analysis

BACKGROUND

Institutional accreditation in Italy represents the license given by a region to a public or private facility to provide services in the name and on behalf of the National Health Service. This study aims to evaluate the improvement of the Emilia-Romagna Regional Blood System and to highlight its unresolved issues, analysing non-conformities observed during accreditation and maintenance inspections between 2013 and 2018.

METHODS

All the Emilia-Romagna Regional Blood facilities were invited to participate in this study voluntarily and anonymously. Participants had to access a web application that we developed specifically. For each of the three inspections evaluated in this study, they had to enter data about the state of their organisation branches and non-conformities observed by regional inspectors. All data entered were finally exported from the web application database and analysed with spreadsheets. Statistical analysis was performed using Wilcoxon signed-rank test with continuity correction.

RESULTS

17 structures took part in the study, with a total of 174 organisation branches. The number of branches changed over the years because of new openings and closures due to reorganisations or non-conformities that were too difficult to correct. Inspectors observed 2381 non-conformities (291 structural, 611 technological and 1479 organisational). As a result of accreditation inspections and consequent improvement actions, non-conformities were reduced by 88%. The most frequent non-conformities concerned the management software and the transportation of blood and blood components.

CONCLUSION

An improvement in the Emilia-Romagna Regional Blood System over time is evident: institutional accreditation certainly pushed it to change and overcome its problems to comply with specific requirements. The remaining non-conformities after the three inspections were mostly organisational and management software was the most critical issue. Despite these non-conformities, all currently active structures are accredited and guarantee high standards of quality and safety of products and services.

Hospital management by health services management graduates: the change paradigm in Iran

BACKGROUND

The hospital management and its functions can be very important in improving the quality of hospital care, and their managers need several competencies to perform these functions efficiently and effectively. Today, more attention should be paid to the use of professional hospital managers, especially those educated in the field of Health Services Management. The present study aimed to study the change paradigm of hospital management by graduates of Health Services Management in a hospital in Iran as a developing country.

MATERIALS AND METHODS

This study was a qualitative case study conducted in the Hazrate Ali Asghar Hospital in Shiraz, Iran in 2018 in order to determine the "why", "how" and "what" aspects of applying hospital managers educated in the field of Health Services Management instead of other traditional managers, as a change paradigm. The samples were selected purposefully and semi-structured in-depth interviews with 12 people were used to explain the experiences of management style by graduates of Health Services Management. Data were collected and analyzed simultaneously using the thematic analysis method and with the inductive approach.

RESULTS

Results of the interviews led to the identification of 6 main themes and 26 sub-themes. The main themes were structural reforms, process reforms, organizational culture reforms, performance reforms, resource reforms, and consequences and results.

CONCLUSION

According to the results, shifting from the use of traditional managers to the use of graduates of Health Services Management in the hospital proposed as a change paradigm in the hospital management is accompanied by some reforms in the hospital structures, processes, resources, culture, and performance. Such reforms may lead to some valuable final consequences and results such as increasing patient and staff satisfaction and effectiveness of actions and activities. This hypothesis is recommended to be tested in other similar settings.

Quality Measurement and Patient Outcomes in Inpatient Behavioral Health: Assessing the Current Framework

ABSTRACT

Quality measurement across healthcare is undertaken with a goal of improving care and outcomes for patients; however, the relationship between quality measurement and patient outcomes remains largely untested, particularly in inpatient behavioral health. Using a retrospective quantitative design, we assessed 142 behavioral health organizations' quality data submitted to the Hospital-Based Inpatient Psychiatric Services and Inpatient Psychiatric Facility Quality Reporting programs from 2017 to 2018 and tested relationships between compliance on 16 quality measures and symptom improvement on patient self-report outcomes (SROs) at the facility level. Performance on many quality measures was negatively skewed (at least four have almost no room for improvement on average), and there was high interrelatedness between most quality measures. Nine of the assessed measures correlated with patient SROs but not in clear groupings. Findings indicate that an underlying organizational construct may be driving compliance rates on quality measures, but the measures are not linked to treatment outcomes as expected. We encourage an expansion of the current framework of behavioral health quality measurement beyond process and organization and suggest the addition of patient outcomes such as SROs as quality measures to directly assess patient improvement.

An appraisal of healthcare accreditation agencies and programs: similarities, differences, challenges and opportunities

BACKGROUND

The study, following similar reviews in 2000 and 2010, presents an update of knowledge about external evaluation agencies and accreditation programs.

OBJECTIVE

The study aim was to investigate the current profile of external evaluation agencies identifying their program features, and significant changes and challenges.

The association between experience of hospital accreditation and nurses' perception of patient safety culture in South Korean general hospitals: a cross-sectional study

Background

Hospital accreditation programs can positively affect nurses’ perceptions of patient safety culture. However, no previous research has identified the association between experience of hospital accreditation and nurses’ perception of patient safety culture in general hospitals. This study aims to examine 1) the level of perception of each area of patient safety culture in nurses working in general hospitals and 2) the relationship between experience of hospital accreditation and nurses’ overall perceptions of safety in Korean general hospitals.

Methods

A cross-sectional survey design was used, with a convenience sample of 310 nurses from six general hospitals. Nurses were asked to complete the self-reported Korean version of the Hospital Survey on Patient Safety Culture and the experience of hospital accreditation. A hierarchical multiple regression analysis was used to examine the associations between hospital accreditation experience and perception of patient safety culture.

Results

The patient safety composites with the highest positive response were the frequency of events reported (90.6) and supervisor/manager expectations promoting patient safety (69.4%). The composites with the lowest scores were non-punitive responses to errors (22.9%) and organizational learning/continuous improvement (35.5%). Hierarchical multiple regression analysis showed that the experience of hospital accreditation had a very small increase on overall perceptions of safety (β = 0.097, p = 0.023).

Conclusions

This study found that general hospital nurses’ experience of hospital accreditation had very weak relationship with their overall perceptions of patient safety. Therefore, a longitudinal study is needed to confirm the influence of hospital accreditation on nurses’ patient safety culture in general hospitals.

The impact of hospital accreditation on the quality of healthcare: a systematic literature review

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.

Association Between Hospital Accreditation and Outcomes: The Analysis of Inhospital Mortality From the National Claims Data of the Universal Coverage Scheme in Thailand

BACKGROUND

In Thailand, hospital accreditation (HA) is widely recognized as one of the system tools to promote effective operation of universal health coverage. This nationwide study aims to examine the relationship between accredited statuses of the provincial hospitals and their mortality outcomes.

METHOD

A 5-year retrospective analysis of the Universal Coverage Scheme's claim dataset was conducted, using 1 297 869 inpatient discharges from 76 provincial hospital networks under the Ministry of Public Health. Mortality outcomes of 3 major acute care conditions, including acute myocardial infarction, acute stroke, and sepsis, were selected.

RESULTS

Using generalized estimating equations to adjust for area-based control variables, hospital networks with HA-accredited provincial hospitals showed significant associations with lower standardized mortality ratios of acute stroke and sepsis.

CONCLUSION

Our findings added supportive evidence that HA, as an organizational and health system management tool, could help promote hospital quality and safety in a developing country, leading to better outcomes.

Developing a hospital accreditation model: a Delphi study

BACKGROUND

Hospital accreditation (HA) is an external evaluation of a hospital's structures, processes and results by an independent professional accreditation body using pre-established optimum standards. The Iranian hospital accreditation system faces several challenges. The overall aim of this study was to develop a model for Iran national hospital accreditation program.

METHODS

This research uses the modified Delphi technique to develop and verify a model of hospital accreditation. The first draft of the HA model was introduced through a critical review of 20 pioneer accreditation models and semi-structured interviews with 151 key informants from Public, private, semi-public, charity and military hospitals in Iran. Three rounds of Delphi were conducted with 28 experts of hospital accreditation to verify the proposed model. Panel members were selected from authors of research articles and key speakers in the area of hospital accreditation, senior managers of the country's health system, university professors in the fields of health policy and management across the country.

RESULTS

A comprehensive model for hospital accreditation was introduced and verified in this study. The HA model has ten constructs of which seven are enablers ("Management and leadership", "Planning", "Education and Research", "employee management", "patient management", "resource management", and "process management") and three are the results ("employee results", "patient and society results" and "hospital results"). These constructs were further broken into 43 sub-constructs. The enablers and results scored 65 and 35% of the model's total scores respectively. Then, about 150 accreditation standards were written and verified.

CONCLUSIONS

A comprehensive hospital accreditation model was developed and verified. Proper attention to structures, processes and outcomes and systemic thinking during the development of the model is one of the advantages of the hospital accreditation model developed in this study. Hospital accreditation bodies can use this model to develop or revise their hospital accreditation models.

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

PURPOSE

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

DESIGN/METHODOLOGY/APPROACH

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

FINDINGS

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

ORIGINALITY/VALUE

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

Impact of Accreditation Certification on Improving Healthcare Quality and Patient Safety at Johns Hopkins Aramco Healthcare

Introduction

Accreditation gained worldwide attention as a means of increasing awareness of medical errors, improving healthcare quality, and ensuring a culture of safety. Johns Hopkins Aramco Healthcare has been accredited by Joint Commission International (JCI) since 2002. The aim of this study was to evaluate the effect of the accreditation process on healthcare quality performance by maintaining compliance with the requirements of JCI's international patient safety goals (IPSGs) over a 4-year period and how this was reflected by patient safety and satisfaction.

Methods

In Johns Hopkins Aramco Healthcare, the six JCI IPSGs are part of the as key performance indicators that reflect organizational performance in different services. For this study, data from January 2017 to the end of 2020 were analyzed apropos performance and correlation with patient experience.

Results

The IPSGs data analysis showed that general performance was maintained above the target values (> 90%-96%) in all IPSGs. This was significantly reflected in high patient satisfaction during this period, with Pearson correlation of 0.9 and p < 0.000.

Conclusions

Maintaining accreditation status over time enhances patients' confidence in an organization and its leadership as providers of safe, quality healthcare services. However, individual staff perception, commitment, accountability, and responsibility have an influence on performance, the organization's accreditation status, and patients' experiences.

Factors that influence the implementation of health and social care Standards: a systematic review and meta-summary protocol

Health and social care Standards are evidence-based statements that demonstrate a desired level of care. Setting Standards for health and social care is a mechanism by which quality improvements can be achieved. Limited evidence exists on appropriate implementation strategies to overcome challenges with implementing Standards. The aim of this protocol is to set out a comprehensive plan to undertake a systematic search, appraisal and mixed research synthesis of the international literature that examines factors that hinder and facilitate implementation of health and social care Standards in order to inform the design of implementation strategies.

A research question, “What are the enablers and barriers to implementing health and social care Standards in health and social care services?” was designed using the ‘SPICE’ (Setting, Perspectives, Interest phenomenon of, Comparison, Evaluation) framework. Electronic databases, grey literature and reference lists from included studies will be searched. Primary qualitative, quantitative descriptive and mixed methods studies reporting on enablers and barriers to implementing nationally endorsed Standards, will be included. The review will focus on experiences and perspectives from multi-level stakeholders including patient and public involvement. The quality of studies will be appraised using appropriate tools and findings used to weight interpretation of findings. Search outputs, data extraction and quality appraisal will be undertaken by two reviewers independently. Sandelowski meta-summary will be used to synthesise the data. Frequency and intensity effect sizes of enablers and barriers will be calculated to evaluate their prevalence across the studies. The Confidence in Evidence from Reviews of Qualitative research (CERQual) approach will be applied to assess confidence in the findings of the review.

Findings from this examination will inform influencing factors to implementation. Subsequently, this will contribute to pairing Standards with appropriate implementation strategies that will optimise the enabling factors and overcome challenges to implementation.

A multidimensional framework for rating health system performance and sustainability: A nine plus one ranking system

Background

Health Care provision in terms of prevention, detection and treatment is primarily dependent on the quality of the hosting Health System. In its health report 2000, the WHO's attempt to assess and rank health systems’ quality Worldwide was heavily criticized. We propose a novel framework for health system performance and ranking using three indicators for three domains; general health system performance, clinical outcome of treatment applied to the main causes of death and health system sustainability domains.

Methods

Each domain was rated as “A – high”, “B – intermediate” or “C – poor” according to the aggregate score values of its three indicators. Hence the highest rank a health system can achieve is “AAA” and the lowest is “CCC”. If there is a need to define a “numerical rank” to further differentiate health systems with similar rating from one another, the total health expenditure per capita per year was used as an additional “number 10” indicator to achieve that level of differentiation. The framework was applied to Health Systems serving most of the World population including China, India, Brazil, USA, Russia, Germany, Japan, UK, France, Singapore and Switzerland. Data pertinent to each indicator was captured from published reports in peer-reviewed journals and/or from official websites. A Delphi survey was conducted for data not available online.

Results

Among the 11 health systems tested, no one scored AAA, Switzerland, France, Germany and Japan scored AAB, Singapore scored ABB, UK scored BBB, USA, Russia and China scored BBC, Brazil scored BCC while India scored CCC. Total health expenditure per capita per year lead to ranking Switzerland first followed by France, Germany, and Japan.

Conclusion

This novel ranking system is a practical and an applicable tool that test health system performance and sustainability. It can be utilized to guide all organizations, people and actions whose primary intent is to promote, restore or maintain health to achieve their targets. An International Health System Ranking database that will be hosted by the Institute of Global, Health, Faculty of Medicine, University of Geneva, Switzerland.

National accreditation programmes for hospitals in the Eastern Mediterranean Region: Case studies from Egypt, Jordan, and Lebanon

BACKGROUND

Many countries use external evaluation programmes such as accreditation in order to improve quality and safety in their healthcare settings. Hospital accreditation has developed in many low-and-middle-income countries (LMICs); however, the implementation and sustainability of these programmes vary in each country. This study addresses design and implementation issues of national hospital accreditation programmes. It identifies factors which may explain why programmes can be implemented successfully in one country but not in another and derives lessons for the design and implementation of national accreditation programmes in poor-resource settings.

METHODS

A multiple case study design was used, comprising three countries in the Eastern Mediterranean Region: Egypt, Lebanon and Jordan. In-depth semi-structured interviews were conducted with 27 key stakeholders in the three countries and experts from international organisations concerned with accreditation activities in LMICs.

RESULTS

The hospital accreditation programme was successful and sustainable in Jordan but experienced some difficulties in Egypt and Lebanon. The premature end of external funding and devastating political instability after the Arab Spring were problematic for the programmes in Egypt and Lebanon, but continuous funding and strong political will supported the implementation and sustainability of the programme in Jordan.

CONCLUSIONS

LMICs striving to improve their hospitals' performance through accreditation programmes should consider their vulnerability to a scarcity of financial resources and political instability. An important factor underpinning sustainability is recognising that the accreditation programme is an ongoing and developing quality improvement process that needs continuing and careful attention from funders and political systems if it is to survive and thrive.

Accreditation of specialized surgical units in general and digestive surgery: A step forward by the AEC for quality improvement and subspecialized Fellowship training

At present, in daily practice, the Departments of Surgery in most hospitals in Spain are organized into "Specialized Surgical Units", including specific structure, human resources, organization, teaching and research in the different subspecialties included in General and Digestive Surgery (GDS). Furthermore, there are also several specialized "fellowship-like", training programs in the different subspecialties already working in some of these "Specialized Surgical Units", although not officially financed. However, until now there was no model for accreditation or recognition of these Units or fellowship programs. The AEC has designed a regulation for the accreditation of Specialized Surgical Units in GDS, that will also serve as a model to define subspecialty training in these areas. The accreditation process, and with it, the process of quality improvement, includes different quality indicators, including unit structure, process quality, and result indicators.

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

BACKGROUND

Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care.

METHODS

A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context-mechanism-outcome configurations (CMOcs).

RESULTS

From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration.

CONCLUSIONS

This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts.

PROSPERO REGISTRATION

CRD42016039882.

Iran hospital accreditation standards: challenges and solutions

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.

Implementation of healthcare accreditation in Danish general practice: a questionnaire study exploring general practitioners' perspectives on external support

OBJECTIVE

To describe the use and perceived usefulness of implementation support provided to general practice during an accreditation process and to explore potential variations across clinic characteristics.

DESIGN

Cross-sectional questionnaire study.

SETTING AND SUBJECTS

All Danish general practice clinics undergoing an accreditation survey from 27 September 2016 to 15 December 2017 (n = 608).

MAIN OUTCOME MEASURES

Use and perceived usefulness of seven types of implementation support as reported by general practitioners (GPs). Clinic characteristics included practice type, number of GP partners and staff and employment of GP trainees.

RESULTS

The total response rate was 74% (n = 447). Most clinics (99.5%) used some type of implementation support (average: 4.8 different types). The most used types of support were peer support (80-92%) and various accreditation documents (85-92%). Support tailored to the individual clinic was most often considered useful (91-97%). However, this type of support was used relatively infrequently (16-40%). In most cases, clinic characteristics were neither significantly associated with the use of support nor with the perceived usefulness of the available support.

CONCLUSION

During the accreditation processes, each clinic used a broad variety of implementation support. Support tailored to the individual clinic was highly appreciated and should be promoted in future quality interventions in general practice. Discussions with peers were widely used, and it should be investigated further how peer discussions are best facilitated. The study calls for a multifactorial approach to future quality interventions in general practice to target the needs and capacities of the individual clinics.

Factors that influence the implementation of health and social care Standards: a systematic review and meta-summary protocol

Health and social care Standards are evidence-based statements that demonstrate a desired level of care. Setting Standards for health and social care is a mechanism by which quality improvements can be achieved. Limited evidence exists on appropriate implementation strategies to overcome challenges with implementing Standards. In order to inform the design of implementation strategies, there is a need to examine factors that influence their implementation. The aim of this protocol is to set out a comprehensive plan to undertake a systematic search, appraisal and mixed research synthesis of the international literature that examines implementation of health and social care Standards. A research question, “What are the enablers and barriers to implementing health and social care Standards in health and social care services?” was designed using the ‘SPICE’ (Setting, Perspectives, Interest phenomenon of, Comparison, Evaluation) framework. Electronic databases, grey literature and reference lists from included studies will be searched. Primary qualitative, quantitative descriptive and mixed methods studies reporting on enablers and barriers to implementing nationally endorsed Standards, will be included. The review will focus on experiences and perspectives from multi-level stakeholders including patient and public involvement. The quality of studies will be appraised using appropriate tools and findings used to weight interpretation of findings. Search outputs, data extraction and quality appraisal will be undertaken by two reviewers independently. Sandelowski meta-summary will be used to synthesise the data. Frequency and intensity effect sizes of enablers and barriers will be calculated to evaluate their prevalence across the studies. The Confidence in Evidence from Reviews of Qualitative research (CERQual) approach will be applied to assess confidence in the findings of the review. Findings from this examination will inform influencing factors to implementation. Subsequently, this will contribute to pairing Standards with appropriate implementation strategies that will optimise the enabling factors and overcome challenges to implementation.

Determinants of Successful Nursing Home Accreditation

OBJECTIVES

This study examined the factors associated with better accreditation outcomes among nursing homes.

METHOD

A total of 538 nursing homes in Taiwan were included in this study. Measures included accreditation scores, external factors (household income, Herfindahl-Hirschman Index, old-age dependency ratio, population density, and number of older adult households), organizational factors (hospital-based status, chain-affiliated status, occupancy rate, the number of registered nurses or nurse aides per bed, and bed size), and internal factors (accountability, deficiencies, person-centered care, nursing skills, quality control, and integrated care).

RESULTS

Bed size, hospital-based status, accountability, deficiencies, person-centered care, nursing skills, quality control, and integrated care were found to predict accreditation.

CONCLUSION

Among all variables in this study, the quality indicators contributed to the most variation, followed by organizational factors. External environmental factors played a minor role in predicting accreditation. A focus on quality of care would benefit not only the residents of a nursing home but also facilitate its accreditation.

The Perspective of Key Stakeholders on the Impact of Reaccreditation in a Large National Mental Health Institute

BACKGROUND

Obtaining and maintaining accreditation is an important component of high-quality mental health care services. However, research is lacking, and explanations for quantitative observations surrounding the sustainability of improvements are unfounded in qualitative data. The aim of this study was to explore how accreditation, specifically that provided by Joint Commission International, affects service quality at the Institute of Mental Health in Singapore to advance our understanding of its effects and the durability of improvements.

METHODS

Researchers conducted 21 qualitative semistructured interviews with key informants to understand how obtaining reaccreditation was affecting the institute. The data were analyzed thematically to produce an understanding of the various ways in which accreditation improved care quality.

RESULTS

Accreditation contributed to the improvement of care via several mechanisms. Although participants universally endorsed the positive impact of accreditation on safety, it was harder to pinpoint specific outcomes that improved because of it. Accreditation, however, had unintended consequences: Unnecessary processes arising from overinterpretation of standards led to several staff behaviors that might ultimately compromise the sustainability of new processes.

CONCLUSION

Although accreditation drives improvement via clear mechanisms, policy makers must be aware of unintended consequences. Organizations struggling with accreditation must clearly communicate the rationale for the implementation of new processes linked to reaccreditation. With a clear purpose, changes may be more sustainable.

The role of accreditation in 21st century health professions education: report of an International Consensus Group

BACKGROUND

Accreditation is considered an essential ingredient for an effective system of health professions education (HPE) globally. While accreditation systems exist in various forms worldwide, there has been little written about the contemporary enterprise of accreditation and even less about its role in improving health care outcomes. We set out to 1) identify a global, contemporary definition of accreditation in the health professions, 2) describe the relationship of educational accreditation to health care outcomes, 3) identify important questions and recurring issues in twenty-first century HPE accreditation, and 4) propose a framework of essential ingredients in present-day HPE accreditation.

METHODS

We identified health professions accreditation leaders via a literature search and a Google search of HPE institutions, as well as by accessing the networks of other leaders. These leaders were invited to join an international consensus consortium to advance the scholarship and thinking about HPE accreditation. We describe the consensus findings from the International Health Professions Accreditation Outcomes Consortium (IHPAOC).

RESULTS

We define accreditation as the process of formal evaluation of an educational program, institution, or system against defined standards by an external body for the purposes of quality assurance and enhancement. In the context of HPE, accreditation is distinct from other forms of program evaluation or research. Accreditation can enhance health care outcomes because of its ability to influence and standardize the quality of training programs, continuously enhance curriculum to align with population needs, and improve learning environments. We describe ten fundamental and recurring elements of accreditation systems commonly found in HPE and provide an overview of five emerging developments in accreditation in the health professions based on the consensus findings.

CONCLUSIONS

Accreditation has taken on greater importance in contemporary HPE. These consensus findings provide frameworks of core elements of accreditation systems and both recurring and emerging design issues. HPE scholars, educators, and leaders can build on these frameworks to advance research, development, and operation of high-quality accreditation systems worldwide.

Evaluation of continuous quality improvement in accreditation for medical education

BACKGROUND

Accreditation systems are based on a number of principles and purposes that vary across jurisdictions. Decision making about accreditation governance suffers from a paucity of evidence. This paper evaluates the pros and cons of continuous quality improvement (CQI) within educational institutions that have traditionally been accredited based on episodic evaluation by external reviewers.

METHODS

A naturalistic utility-focused evaluation was performed. Seven criteria, each relevant to government oversight, were used to evaluate the pros and cons of the use of CQI in three medical school accreditation systems across the continuum of medical education. The authors, all involved in the governance of accreditation, iteratively discussed CQI in their medical education contexts in light of the seven criteria until consensus was reached about general patterns.

RESULTS

Because institutional CQI makes use of early warning systems, it may enhance the reflective function of accreditation. In the three medical accreditation systems examined, external accreditors lacked the ability to respond quickly to local events or societal developments. There is a potential role for CQI in safeguarding the public interest. Moreover, the central governance structure of accreditation may benefit from decentralized CQI. However, CQI has weaknesses with respect to impartiality, independence, and public accountability, as well as with the ability to balance expectations with capacity.

CONCLUSION

CQI, as evaluated with the seven criteria of oversight, has pros and cons. Its use still depends on the balance between the expected positive effects-especially increased reflection and faster response to important issues-versus the potential impediments. A toxic culture that affects impartiality and independence, as well as the need to invest in bureaucratic systems may make in impractical for some institutions to undertake CQI.

Promoting patients' rights through hospital accreditation

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.

Can publicly reported data be used to understand performance in an Australian rural hospital?

BACKGROUND

Despite agreement among policymakers, funders, consumers and researchers about the value of public reporting of health information, limited attention has been paid to how it can be used to understand the performance of rural hospitals.

OBJECTIVE

To determine whether publicly available information can be used to measure health service performance in a rural hospital.

METHOD

The study used performance data routinely reported for public consumption in Australia. Data across four domains, multiple measures and time periods were collected to examine access and equity; efficiency and sustainability; quality, safety and patient orientation; and employee engagement. Performance of the rural hospital was examined using a visualisation tool.

RESULTS

Visualisation of multiple measures of performance over time was achievable but required a high degree of health information management skills.

CONCLUSION AND IMPLICATIONS

Publicly reported data can be used to represent performance for a rural hospital. Timeliness, level of detail available and peer groupings of data limits optimal utility. Consumers, clinicians and health service managers wanting to understand the performance of rural hospitals will need to use significant health information management skills to gain a picture of performance. Further research in the applied use of publicly available performance data and relevant dashboards for rural hospitals is suggested.

Knowledge mapping of hospital accreditation research: a coword analysis

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.

Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis

OBJECTIVES

External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections.

METHODS

We performed a literature search (1980-January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change.

RESULTS

We included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation's current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance.

CONCLUSIONS

External inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.

Accreditation as a management tool: a national survey of hospital managers' perceptions and use of a mandatory accreditation program in Denmark

BACKGROUND

This study aimed to examine managers' attitudes towards and use of a mandatory accreditation program in Denmark, the Danish Healthcare Quality Program (Den Danske Kvalitetsmodel [DDKM]) after it was terminated in 2015.

METHODS

We designed a nationwide cross-sectional online survey of all senior and middle managers in the 31 somatic and psychiatric public hospitals in Denmark. We elicited managers' attitudes towards and use of DDKM as a management using 5-point Likert scales. Regression analysis examined differences in responses by age, years in current position, and management level.

RESULTS

The response rate was 49% with 533 of 1095 managers participating. Overall, managers' perceptions of accreditation were favorable, highlighting key findings about some of the strengths of accreditation. DDKM was found most useful for standardizing processes, improving patient safety, and clarifying responsibility in the organization. Managers were most negative about DDKM's ability to improve their hospitals' financial performance, reshape the work environment, and support the function of clinical teams. Results were generally consistent across age and management level; however, managers with greater years of experience in their position had more favorable attitudes, and there was some variation in attitudes towards and use of DDKM between regions.

CONCLUSION

Future attention should be paid to attitudes towards accreditation. Positive attitudes and the effective use of accreditation as a management tool can support the implementation of accreditation, the development of standards, overcoming disagreements and boundaries and improving future quality programs.

Exploring hospital certification processes from the certification body's perspective - a qualitative study

BACKGROUND

Hospital certification is an external assessment mechanism to assure quality and safety systems. Auditors representing the certification body play a key role in certification processes, as they perform the assessment activities and interact with the involved healthcare organizations. There is limited knowledge about the approaches and methods that auditors use, such as role repertoire, conduct, and assessment practice. The purpose of this study was to explore auditors' practice in hospital certification processes, guided by the following research questions: What styles do auditors apply in hospital certification processes, and how do auditors perceive their role in hospital certification processes?

METHODS

The study was performed in two stages. In the first stage, non-participant observations (59 h) were conducted, to explore the professional practice of three lead auditors in certification processes of Norwegian hospitals. In the second stage, semi-structured interviews were conducted with these three observed lead auditors. The role repertoires and conducts identified were analyzed by using a deductive approach according to a surveyor (equivalent with auditor) styles typology framework.

RESULTS

Two distinct auditor styles ("explorer" and "discusser") were identified among the three studied auditors. Both styles were characterized by their preference for an opportunistic and less structured type of interview practice during certification audits. All three auditors embedded a guiding approach (reflections about findings, stimulate improvements, experience transfer from other industries) to their perception and practice of certification audits, interacting with the auditees. The use of group interviews instead of individual interviews during certification audits, was the rule of their professional practice.

CONCLUSION

The auditors' perceptions and styles demonstrated a multifaceted certification reality, in contrast to what is often presumed as consistent, stringent and independent practices. These findings may have implications for reliability judgements when developing hospital certification programs, and for the refinement of the current framework used here to study the different auditing practices.

Implementation and data-related challenges in the Deepening our Understanding of Quality in Australia (DUQuA) study: implications for large-scale cross-sectional research

Healthcare organisations vary in the degree to which they implement quality and safety systems and strategies. Large-scale cross-sectional studies have been implemented to explore whether this variation is associated with outcomes relevant at the patient level. The Deepening our Understanding of Quality in Australia (DUQuA) study draws from earlier research of this type, to examine these issues in 32 Australian hospitals. This paper outlines the key implementation and analysis challenges faced by DUQuA. Many of the logistical difficulties of implementing DUQuA derived from compliance with the administratively complex and time-consuming Australian ethics and governance system designed principally to protect patients involved in clinical trials, rather than for low-risk health services research. The complexity of these processes is compounded by a lack of organizational capacity for multi-site health services research; research is expected to be undertaken in addition to usual work, not as part of it. These issues likely contributed to a relatively low recruitment rate for hospitals (41% of eligible hospitals). Both sets of issues need to be addressed by health services researchers, policymakers and healthcare administrators, if health services research is to flourish. Large-scale research also inevitably involves multiple measurements. The timing for applying these measures needs to be coherent, to maximise the likelihood of finding real relationships between quality and safety systems and strategies, and patient outcomes; this timing was less than ideal in DUQuA, in part due to administrative delays. Other issues that affected our study include low response rates for measures requiring recruitment of clinicians and patients, missing data and a design that necessarily included multiple statistical comparisons. We discuss how these were addressed. Successful completion of these projects relies on mutual and ongoing commitment, and two-way communication between the research team and hospital staff at all levels. This will help to ensure that enthusiasm and engagement are established and maintained.

S. Impact of accreditation on performance of healthcare organizations

Purpose

The purpose of this paper is to review the accreditation research in specific to its effect on the performance of healthcare organizations.

Design/methodology/approach

A comprehensive search and analysis of literature on the effect of healthcare accreditation were conducted between June 2017 and May 2018. The study identified 62 empirical research studies that examined the effect of healthcare accreditation programmes. Study particulars such as year of publication, objectives, focus of the study, research settings and key findings were recorded. A content analysis was performed to identify the frequency of the main themes in the literature. Knowledge gaps needing further examination were identified.

Findings

Majority of the accreditation impact studies were carried out in the developed nations (n = 49). The thematic categories, that is the impact on “patient safety and healthcare quality” (n = 26), “healthcare professionals’ views” (n = 28) and “clinical process and outcomes” (n = 17) were addressed more times. Whereas the other two thematic categories “organizational performance” and “consumers’ views or satisfaction,” each was examined less than 10 instances. This review reveals mixed views on effect of healthcare accreditation. The varied quality of studies and the availability of a few studies on consumers’ perception of accreditation effectiveness were the important limiting factors of this review.

Originality/value

The findings are valuable to healthcare managers and hospital administrators in accreditation decisions, whereas findings are of value to researchers and academicians in terms of gaps identified for future research studies pertaining to the impact of healthcare accreditation. Future studies need to consider holistic theoretical frameworks for assessing the effect of accreditation on performance of healthcare organizations to achieve precise results.

Evaluation results of national hospital accreditation program in Iran: The view of hospital managers

BACKGROUND

Accreditation programs have a crucial role in improving the safety and effectiveness of hospital services. Many factors contribute to achieve accreditation goals. This study evaluated the national Iranian hospital accreditation program from the view of hospital managers in Iran.

METHODS

The study was conducted in 2015 using a validated questionnaire designed to collect feedback concerning accreditation processes and impacts. In total, 547 managers were surveyed using a stratified random sampling method. A 5-degree scale Likert from totally disagree=1 to totally agree=5 has been used for the evaluation. Descriptive and inferential statistics were used to analyze the data.

RESULTS

Approximately half of hospital managers were satisfied with the accreditation standards and surveying methods. The reason for their dissatisfaction was the high number of measures (2.38). The main challenges to the accreditation method were reported inadequate surveyor training (2.94) their satisfaction with the infrastructure was low because of a lack of hospital resources. Nonetheless, the accreditation program was perceived as being successful in improving patient safety (3.80), patient compliance (3.72), and error reduction (3.53).

CONCLUSION

An effective accreditation program requires reducing the number of standards and making them clearer as well as the infrastructure for the implementation of accreditation such as sufficient and sustainable funds, enough human resources and equipment should be provided. Appropriate surveyors should be selected and trained professionally to ensure inter-rater reliability among them.

A Comparison of Three Models of Hospital Performance Assessment Using IPOCC Approach

Background

Hospital performance measurement is an essential component of providing feedback on the efficacy and effectiveness of service. The purpose of this study was to compare three models of performance assessment through the IPOCC approach.

Methods

This descriptive-analytical study was conducted in 2018 in Sari educational hospital. The data collection instrument was BSC, EFQM and accreditation questionnaire which was filled out through census. The validity of the BSC questionnaire and EFQM was based on expert opinion, and its reliability was found to be 0.97 and 0.92 using Cronbach's alpha coefficient. The accreditation questionnaire was developed using a checklist of the Ministry of Health. Using the expert panel, the components of the questionnaires were classified into dimensions of input, process, output, control, and context. Data analysis was done applying descriptive statistics and one way ANOVA.

Results

The highest distribution of components and acquired points through the IPOCC approach were found in the BSC in the process dimension (58.8%) and control dimension (3.62 ± 0.56), in the EFQM, in the result dimension (40.2%) and structure dimension (3.25 ± 0.44), and in the accreditation, in the process dimension (64.4%) and control dimension (3.45 ± 0.72), respectively. The results of one-way ANOVA showed that there was a significant difference between different quality models (P <0.001).

Conclusion

The results of the present study showed that in evaluating the hospital through the IPOCC approach, the distribution of components was more in the dimensions of the process. Therefore, having a robust systematic approach was considered to be effective for hospitals.

Managers' perceptions of the effects of a national mandatory accreditation program in Danish hospitals. A cross-sectional survey

OBJECTIVE

This study aimed to examine and compare middle and senior hospital managers' perceptions of the effects of a mandatory accreditation program in Denmark, the Danish Healthcare Quality Program (Den Danske Kvalitetsmodel [DDKM]) after it was terminated in 2015.

DESIGN

A cross-sectional online questionnaire survey.

SETTING

All 26 somatic and psychiatric public hospitals in Denmark.

PARTICIPANTS

All senior and middle managers.

METHODS

A questionnaire with open and closed response (five-point Likert scale) questions. Quantitative data were analyzed descriptively and through ordered logistic regression by management level. Qualitative data were subjected to a software-assisted content analysis.

RESULTS

The response rate was 49% (533/1059). In both the qualitative and quantitative data sets, participants perceived the DDKM as having: led to an increased focus on registration, documentation and additional and unnecessary procedures. While the DDKM was perceived as increasing a focus on quality, the time required for accreditation was at the expense of patient care. There were significant differences by management level, with middle managers having more negative perceptions of the DDKM related to time spent on documentation and registration.

CONCLUSION

While the DDKM had some perceived benefits for quality improvement, it was ultimately considered time-consuming and outdated or having served its purpose. Including managers, particularly middle managers, in refinements to the new quality improvement model could capitalize on the benefits while redressing the problems with the terminated accreditation program.

Short-notice (48 hours) ACCREDITATION trial in Australia: stakeholder perception of assessment thoroughness, resource requirements and workforce engagement

Background

External, independent accreditation assessments of healthcare organisations are necessary to ensure the nationally legislated minimum standards of quality and safety (QS) are met. The predetermined scheduling of the assessments continues to be criticised due to the high level of organisational emphasis on preparing for accreditation.

Objectives

To determine the stakeholder perception of assessment thoroughness, staff resource requirements and workforce engagement changes if only 48 hours’ notice is given to an organisation prior to an accreditation assessment, compared with the standard-notice accreditation process.

Methods

Logan and Beaudesert Hospitals in Brisbane, Australia, trialled the ‘Short-Notice Survey Accreditation Assessment Process’ (SNAAP) between August 2017 and December 2018. The organisation was given just 48 hours’ notice prior to an accreditation assessment. Staff perception of the standard-notice accreditation process and short-notice process was assessed using a 5-point Likert scale repeated measures questionnaire (pretrial, 6 and 12 months after SNAAP launch).

Results

There was a statistically significant stakeholder opinion that SNAAP more effectively identified the true strengths and achievements of the organisation’s QS compared with ‘standard-notice’ survey (p=0.033). There was a significantly lower overall perceived proportion of staff resources required for SNAAP preparation in contrast to ‘standard-notice’ process (Baseline Av=21.38% vs Follow-up 1 and 2 Av=9.75%–6.25%, p=0.021). The questionnaire results reflected that SNAAP increased staff engagement in QS activities (Av=3.75 and 3.69, 95% CI=3.45–4.05 and 3.45–3.94).

Conclusions

With sufficient cultural and operational preparation to move to SNAAP, hospitals can potentially use SNAAP as a truer validation of QS standards, require less staffing resources to prepare for accreditation assessments and improve staff engagement in QS assurance and improvement.

Implantação da acreditação pedagógica de cursos lato sensu em Saúde Pública no Brasil: desafios e perspectivas

RESUMO O objetivo do artigo foi analisar a implantação da acreditação pedagógica no Brasil, no período de 2014 a 2018. Realizou-se análise documental para produção dos dados, a partir dos relatórios elaborados no período, buscando identificar os principais problemas referentes a essa implantação na dimensão da gestão mais ampla e quanto aos processos de acreditação. Os resultados apontaram problemas de várias ordens e efeitos positivos para o processo, para os atores institucionais e para o Sistema Único de Saúde (SUS). Os resultados mostram que há problemas de ordem gerencial, pedagógica e de infraestrutura, entretanto as acreditações produziram efeitos positivos para as escolas, para os trabalhadores e para o SUS.