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Aoun N, Tajvar M. Healthcare delivery in Lebanon: a critical scoping review of strengths, weaknesses, opportunities, and threats. BMC Health Serv Res 2024; 24:1122. [PMID: 39334362 PMCID: PMC11429949 DOI: 10.1186/s12913-024-11593-w] [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: 06/26/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Lebanon, an Eastern Mediterranean country with a lower-middle income status, that once boasted a health care system that was functional despite its challenges and complexity. However, it has faced a series of crises-economic, an influx of refugees, political instability, and recent sanctions-that have significantly impacted its aim, principles and values that has impacted upon its ability to function. The objective of this study is to delve into the health service delivery within the Lebanese system and conduct a SWOT analysis (assessing strengths, weaknesses, opportunities, and threats). METHODS We conducted a scoping review, examining literature related to the Lebanese health system and its performance in delivering healthcare services. We followed the Arksey and O'Malley framework, which involves six key phases: identifying the research question, identifying relevant studies, study selection, charting the data, collating, summarizing, and reporting the results, consultation. RESULTS Despite Lebanon grappling with multiple crises in recent years-such as the COVID-19 pandemic and economic downturn-the health system has demonstrated resilience in service delivery. However, challenges persist. Healthcare providers, including physicians and nurses, must address these issues. Additionally, economic and political crises pose threats that have necessitated significant changes in healthcare service delivery. CONCLUSION In the system of healthcare in Lebanon, there have been remarkable achievements, but continuous attention by healthcare providers and the Ministry of Public Health (MoPH) is critical. Economic and political challenges exert constant pressure on service delivery and thus reveal a need for strategic changes, most importantly in health financing if Universal Health Coverage (UHC) is to be attained. Proper resources to strategic reform and system implementation in all parts of the country to ensure equitable access and quality care that is sustained are obligatory.
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Affiliation(s)
- Nour Aoun
- Department of Disaster and Emergency Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tajvar
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Mansoor T, Wan Puteh SE, Aizuddin AN, Malak MZ. Challenges and Strategies in Implementing Hospital Accreditation Standards Among Healthcare Professionals in Healthcare Systems in Yemen: A Phenomenological Study. Cureus 2024; 16:e59383. [PMID: 38817454 PMCID: PMC11139055 DOI: 10.7759/cureus.59383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION The implementation of hospital accreditation standards in healthcare systems in Yemen that ensure safe and high-quality healthcare services is hampered by specific challenges. Therefore, this study was purposed to explore the challenges and strategies for applying hospital accreditation standards among healthcare professionals in Yemen. METHODS A qualitative, phenomenological design was adopted to conduct this study. Semi-structured interviews were used to collect data during the period from January 1, 2022, to February 28, 2022. RESULTS Based on the content analysis, the study outcomes and lack of (i) funding, (ii) competent human resources, (iii) optimal infrastructure, and (iv) equipment and supplies deter the implementation of hospital accreditation standards. Also, this study highlighted the cultural and social barriers limiting the effectiveness of hospital accreditation standards, the need for increased investment in healthcare infrastructure and human resources, and cultural sensitivity training for healthcare professionals to enhance the implementation of and compliance with hospital accreditation standards. CONCLUSIONS Policymakers should engage global corporations and development partners for technical assistance and capacity building that support the local application of hospital accreditation standards.
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Affiliation(s)
- Talal Mansoor
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Sharifa Ezat Wan Puteh
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Azimatun Noor Aizuddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Malakeh Z Malak
- Faculty of Nursing, Al-Zaytoonahh University of Jordan, Amman, JOR
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Etemadi S, Dehnavieh R, Pour MH, Mehri M, Behzadi A. The Prerequisites of Executing the Accreditation Program for Primary Healthcare: A Systematic Review and Meta-Synthesis. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:59-69. [PMID: 38694855 PMCID: PMC11058379 DOI: 10.18502/ijph.v53i1.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/14/2023] [Indexed: 05/04/2024]
Abstract
Background In Iran, the primary healthcare system is the front-line for society's encounter with healthcare. Health planners aim to enhance quality and administer an accreditation program. This study examined program administration prerequisites through systematic review and meta-synthesis. Methods We conducted a systematic review and meta-synthesis of qualitative literature using Thomas and Hudson's framework. Peer-reviewed papers were searched in Scopus, PubMed, Web of Science, Google, and Google Scholar up to 2023. Results The search found 1308 articles, with 37 relevant ones selected for review. Data extraction included setting, participants, study design, data collection, analysis, and themes. Thirteen qualitative subthemes were identified and were categorized under three elements of the Donabedian model. Conclusion Before implementing a plan, it is crucial to consider its executive prerequisites. Revision and trial-and-error approaches can be costly and time-consuming, potentially hindering the plan's effectiveness and diverting organizations from their primary goal, leading to failure.
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Affiliation(s)
- Sina Etemadi
- Healthcare Management, Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Marjan Hedayati Pour
- Healthcare Management, Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Milad Mehri
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Behzadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Gharibi F, Moshiri E, Tavani ME, Dalal K. Challenges of Implementing an Effective Primary Health Care Accreditation Program: a qualitative study in Iran. BMC PRIMARY CARE 2023; 24:270. [PMID: 38093194 PMCID: PMC10717432 DOI: 10.1186/s12875-023-02232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/01/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Accreditation is a prerequisite for scientific management of the health system, owing to its numerous benefits on health centres' performance. The current study examined Iran's primary healthcare accreditation program to ascertain the challenges to its successful implementation. METHODS This qualitative study examined the perspectives of 32 managers and staff members in the pilot accreditation program (from the Ministry of Health and Medical Education, Semnan University of Medical Sciences, and Aradan District Health Network). Three in-depth group interviews were conducted using a semi-structured questionnaire, and the data obtained were assessed using thematic analysis. As a result of this investigation identified six themes, 29 sub-themes, and 218 codes as challenges to the successful accreditation of primary health care in Iran. RESULTS Six main themes, including "organisational culture", "motivational mechanisms", "staff workload", "training system", "information systems", and "macro-executive infrastructure", were identified as the main domain of challenges, with seven, five, two, four, three, and eight sub-themes respectively. CONCLUSION Accreditation of PHC in Iran faces significant challenges and obstacles that, if ignored, can jeopardise the program's success and effectiveness. By identifying challenges and obstacles and making practical suggestions for overcoming them, the findings of this study can aid in the program's successful implementation and achievement of desired outcomes.
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Affiliation(s)
- Farid Gharibi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Esmaeil Moshiri
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Masoumeh Ebrahimi Tavani
- Academic Research Staff, Quality Improvement, Monitoring and Evaluation Department, Center of Health Network Management, Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Koustuv Dalal
- Division of Public Health Science, Department of health Sciences, Mid Sweden University, Sweden and Institute for Health Sciences, University of Skovde, Skovde, Sweden.
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Tabrizi JS, As'habi A, Nazari M, Ebrahimi Tavani M, Haghi M, Gharibi F. Impacts of accreditation on the performance of primary health care centres: A systematic review. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:63. [PMID: 38026575 PMCID: PMC10664760 DOI: 10.51866/rv.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Introduction Evidence on the impacts of accreditation on primary health care (PHC) services is inconsistent. Thus, this study aimed to assess the impacts of accreditation on the performance of PHC centres. Method This study systematically reviewed articles published from 2000 to 2019 in the Web of Science, Scopus, ScienceDirect, Springer, PubMed and ProQuest. The following keywords were used: ((primary care OR primary health care) AND (accreditation) AND (impact OR effect OR output OR outcome OR influence OR result OR consequences)). The database search yielded a total of41256 articles, among which 30 articles were finally included in the review. Results Accreditation showed the most positive impacts on the quality, effectiveness, human resource management and strategic management of PHC services. Accreditation also positively affected safety, responsiveness, accessibility, customer satisfaction, documentation, leadership, efficiency and continuity of care. Few negative impacts were noted, including the possibility of accreditation being used as a bureaucratic tool, high cost of acquiring accreditation, difficulties in understanding the accreditation process, high staff turnover rate in accredited PHC centres and weak sustainability of some accreditation programmes. Conclusion Given its numerous positive impacts, accreditation could be used to effectively improve the performance of PHC centres.
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Affiliation(s)
- Jafar Sadegh Tabrizi
- MD, PhD, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh As'habi
- BSc, MSc, PhD, Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iram
| | - Maryam Nazari
- BSc, MSc, PhD, Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iram
| | - Masoumeh Ebrahimi Tavani
- BSc, MSc, MPH, PhD, Quality Improvement, Monitoring and Evaluation Department, Center of Health Network Management, Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehdi Haghi
- BSc, MSc, PhD, Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farid Gharibi
- BSc, MSc, PhD, Social Determinants of Health Research Centers, Semnan University of Medical Sciences, Semnan, Iran.
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Alsaedi A, Sukeri S, Yaccob NM. Enabling Factors for the Successful Implementation of the CBAHI Accreditation Program. J Multidiscip Healthc 2023; 16:2189-2199. [PMID: 37547805 PMCID: PMC10404050 DOI: 10.2147/jmdh.s422174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
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.
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Affiliation(s)
- Abdulaziz Alsaedi
- Department of Medical Services, Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affairs, Madinah, Saudi Arabia
| | - Surianti Sukeri
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Najib Majdi Yaccob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Nair TS, Memon P, Tripathi S, Srivastava A, Sunny Kujur M, Singh D, Bhamare P, Yadav V, Kumar Srivastava V, Prasad Pallipamula S, Usmanova G, Kumar S. Implementing a quality improvement initiative for private healthcare facilities to achieve accreditation: experience from India. BMC Health Serv Res 2023; 23:802. [PMID: 37501069 PMCID: PMC10375635 DOI: 10.1186/s12913-023-09619-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/30/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The Manyata program is a quality improvement initiative for private healthcare facilities in India which provided maternity care services. Under this initiative, technical assistance was provided to selected facilities in the states of Uttar Pradesh, Jharkhand and Maharashtra which were interested in obtaining 'entry level certification' under the National Accreditation Board for Hospitals and Healthcare Providers (NABH) for provision of quality services. This paper describes the change in quality at those Manyata-supported facilities when assessed by the NABH standards of care. METHODS Twenty-eight private-sector facilities underwent NABH assessments in the three states from August 2017 to February 2019. Baseline assessment (by program staff) and NABH assessment (by NABH assessors) findings were compared to assess the change in quality of care as per NABH standards of care. The reported performance gaps from NABH assessments were then also classified by thematic areas and suggested corrective actions based on program implementation experience. RESULTS The overall adherence to NABH standards of care improved from 9% in the baseline assessment to 80% in the NABH assessment. A total of 831 performance gaps were identified by the NABH assessments, of which documentation issues accounted for a majority (70%), followed by training (19%). Most performance gaps could be corrected either by revising existing documentation or creating new documentation (62%), or by orienting facility staff on various protocols (35%). CONCLUSION While the adherence of facilities to the NABH standards of care improved considerably, certain performance gaps remained, which were primarily related to documentation of facility policies and protocols and training of staff, and required corrective actions for the facilities to achieve NABH entry level certification.
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Affiliation(s)
- Tapas Sadasivan Nair
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Parvez Memon
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Sanjay Tripathi
- Jhpiego - an affiliate of Johns Hopkins University, Lucknow, Uttar Pradesh, India
| | - Ashish Srivastava
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Meshach Sunny Kujur
- Jhpiego - an affiliate of Johns Hopkins University, Ranchi, Jharkhand, India
| | - Deepti Singh
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Parag Bhamare
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Vikas Yadav
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Vineet Kumar Srivastava
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Suranjeen Prasad Pallipamula
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Gulnoza Usmanova
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India.
| | - Somesh Kumar
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
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Salloum RG, Romani M, Bteddini DS, El-Jardali F, Lee JH, Theis R, LeLaurin JH, Hamadeh R, Osman M, Abla R, Khaywa J, Ward KD, Shelley D, Nakkash R. An effectiveness-implementation hybrid trial of phone-based tobacco cessation interventions in the Lebanese primary healthcare system: protocol for project PHOENICS. Implement Sci Commun 2023; 4:72. [PMID: 37365656 PMCID: PMC10294351 DOI: 10.1186/s43058-023-00456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Tobacco use remains the leading cause of preventable disease, disability, and death in the world. Lebanon has an exceptionally high tobacco use burden. The World Health Organization endorses smoking cessation advice integrated into primary care settings as well as easily accessible and free phone-based counseling and low-cost pharmacotherapy as standard of practice for population-level tobacco dependence treatment. Although these interventions can increase access to tobacco treatment and are highly cost-effective compared with other interventions, their evidence base comes primarily from high-income countries, and they have rarely been evaluated in low- and middle-income countries. Recommended interventions are not integrated as a routine part of primary care in Lebanon, as in other low-resource settings. Addressing this evidence-to-practice gap requires research on multi-level interventions and contextual factors for implementing integrated, scalable, and sustainable cessation treatment within low-resource settings. METHODS The objective of this study is to evaluate the comparative effectiveness of promising multi-component interventions for implementing evidence-based tobacco treatment in primary healthcare centers within the Lebanese National Primary Healthcare Network. We will adapt and tailor an existing in-person smoking cessation program to deliver phone-based counseling to smokers in Lebanon. We will then conduct a three-arm group-randomized trial of 1500 patients across 24 clinics comparing (1) ask about tobacco use; advise to quit; assist with brief counseling (AAA) as standard care; (2) ask; advise; connect to phone-based counseling (AAC); and (3) AAC + nicotine replacement therapy (NRT). We will also evaluate the implementation process to measure factors that influence implementation. Our central hypothesis is that connecting patients to phone-based counseling with NRT is the most effective alternative. This study will be guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, supported by Proctor's framework for implementation outcomes. DISCUSSION The project addresses the evidence-to-practice gap in the provision of tobacco dependence treatment within low-resource settings by developing and testing contextually tailored multi-level interventions while optimizing implementation success and sustainability. This research is significant for its potential to guide the large-scale adoption of cost-effective strategies for implementing tobacco dependence treatment in low-resource settings, thereby reducing tobacco-related morbidity and mortality. TRIAL REGISTRATION ClinicalTrials.gov, NCT05628389, Registered 16 November 2022.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA.
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Maya Romani
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dima S Bteddini
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ji-Hyun Lee
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
- Division of Quantitative Sciences, University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - Ryan Theis
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | | | - Mona Osman
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jihan Khaywa
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA
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Coss-Mandiola J, Vanegas-López J, Rojas A, Dubó P, Campillay-Campillay M, Carrasco R. Accreditation of Quality in Primary Health Care in Chile: Perception of the Teams from Accredited Family Healthcare Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2477. [PMID: 36767844 PMCID: PMC9915018 DOI: 10.3390/ijerph20032477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to investigate the perception of the health teams belonging to the Family Healthcare Centers (CESFAMs) that are accredited, regarding the process of implementation and the achievement of accreditation. A qualitative approach was applied, with contributions from grounded theory, through the technique of individual in-depth interviews and focus groups. The interviews were carried out in nine accredited CESFAMs. For the presentation, organization and analysis of the data, Atlas.ti V9 software was used. From the results, derived from the open phase of the analysis, obtained from the opinions of the participants, a total of 26 categories emerged relating to the facilitating and hindering factors of the process. From the axial phase, it was possible to establish central categories that were related to quality management policies, the structure of Primary Health Care (PHC), participation and co-construction, and leadership and change management. In conclusion, the discourse of the teams reveals the need to have necessary conditions for the accreditation process, which are mainly related to training, characteristics of the types of leadership and teamwork in harmony with the process. Finally, the study reveals a gap in the community participation in this process, which suggests continuing this line of research.
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Affiliation(s)
- Juan Coss-Mandiola
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320096, Chile
| | - Jairo Vanegas-López
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320096, Chile
| | - Alejandra Rojas
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320096, Chile
| | - Pablo Dubó
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Maggie Campillay-Campillay
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Raúl Carrasco
- Facultad de Ingeniería y Negocios, Universidad de Las Américas, Santiago 3981000, Chile
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Ansbro É, Masri S, Prieto-Merino D, Willis R, Aoun Bahous S, Molfino L, Boulle P, Perel P. Fixed dose combination drugs for cardiovascular disease in a prolonged humanitarian crisis in Lebanon: an implementation study. BMJ Open 2023; 13:e063668. [PMID: 36697043 PMCID: PMC9884866 DOI: 10.1136/bmjopen-2022-063668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/12/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This pre-post implementation study evaluated the introduction of fixed dose combination (FDC) medications for atherosclerotic cardiovascular disease (ASCVD) secondary prevention into routine care in a humanitarian setting. SETTING Two Médecins sans Frontières (MSF) primary care clinics serving Syrian refugee and host populations in north Lebanon. PARTICIPANTS Consenting patients ≥18 years with existing ASCVD requiring secondary prevention medication were eligible for study enrolment. Those with FDC contraindication(s) or planning to move were excluded. Of 521 enrolled patients, 460 (88.3%) were retained at 6 months, and 418 (80.2%) switched to FDC. Of these, 84% remained on FDC (n=351), 8.1% (n=34) discontinued and 7.9% (n=33) were lost to follow-up by month 12. INTERVENTIONS Eligible patients, enrolled February-May 2019, were switched to Trinomia FDC (atorvastatin 20 mg, aspirin 100 mg, ramipril 2.5/5/10 mg) after 6 months' usual care. During the study, the COVID-19 pandemic, an economic crisis and clinic closures occurred. OUTCOME MEASURES Descriptive and regression analyses compared key outcomes at 6 and 12 months: medication adherence, non-high density lipoprotein cholesterol (non-HDL-C) and systolic blood pressure (SBP) control. We performed per-protocol, intention-to-treat and secondary analyses of non-switchers. RESULTS Among 385 switchers remaining at 12 months, total adherence improved 23%, from 63% (95% CI 58 to 68) at month 6, to 86% (95% CI 82 to 90) at month 12; mean non-HDL-C levels dropped 0.28 mmol/L (95% CI -0.38 to -0.18; p<0.0001), from 2.39 (95% CI 2.26 to 2.51) to 2.11 mmol/L (95% CI 2.00 to 2.22); mean SBP dropped 2.89 mm Hg (95% CI -4.49 to -1.28; p=0.0005) from 132.7 (95% CI 130.8 to 134.6) to 129.7 mm Hg (95% CI 127.9 to 131.5). Non-switchers had smaller improvements in adherence and clinical outcomes. CONCLUSION Implementing an ASCVD secondary prevention FDC improved adherence and CVD risk factors in MSF clinics in Lebanon, with potential for wider implementation by humanitarian actors and host health systems.
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Affiliation(s)
- Éimhín Ansbro
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology & Population Health, London, UK
| | | | - David Prieto-Merino
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology & Population Health, London, UK
| | - Ruth Willis
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Sola Aoun Bahous
- Department of Internal Medicine, School of Medicine, Lebanese American University, Beirut, Lebanon
| | | | | | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology & Population Health, London, UK
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11
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Alotaibi SY. Accreditation of primary health care centres in the KSA: Lessons from developed and developing countries. J Taibah Univ Med Sci 2023; 18:711-725. [PMID: 36852254 PMCID: PMC9957815 DOI: 10.1016/j.jtumed.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/09/2022] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Shaymaa Y. Alotaibi
- Health Service and Hospital Management Department, College of Business, King Abdul-Aziz University, Rabigh, Saudi Arabia,Health Services Management Centre, College of Social Sciences, University of Birmingham, Birmingham, UK
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Al Janabi T, Chung S. Current Impact and Long-Term Influence of the COVID-19 Pandemic on Iraqi Healthcare Systems: A Case Study. EPIDEMIOLOGIA 2022; 3:412-433. [PMID: 36547253 PMCID: PMC9778304 DOI: 10.3390/epidemiologia3040032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 12/25/2022] Open
Abstract
Decades of wars, sanctions, and internal conflicts have compromised Iraq's health system, which once was the best system in the region. National and international efforts to revitalize the system have been successful to some extent; however, significant challenges still exist. The COVID-19 pandemic has exposed new vulnerabilities and exacerbated the existing ones, affecting the quality and the quantity of the health services delivered. This case study explored the baseline function of Iraq's health system within the context of the World Health Organization (WHO) health system framework. The paper also examined the country's response to the COVID-19 pandemic and some of its impacts. Results show that the system was not functioning optimally nor was it prepared to address the immediate impact of the current pandemic and other emerging public health issues. While mitigating the pandemic's short-term and long-term impacts are essential, it should not divert the focus from restructuring and strengthening the health system. Iraq may need to prioritize the health information system and leadership/governance as they provide the basis for health policies and regulations for all other health system building blocks.
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Affiliation(s)
- Taysir Al Janabi
- New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Glen Head, NY 11545, USA
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13
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Attoh S, Tetteh FK, McAddy M, Ackah K, Kyei R, Moroti M, Boateng C, Adusu-Donkor L, Boafo J, Yakubu A, Kwao S, Sarkodie E, Koranteng NB, Addo MA, Hobenu F, Agyeman-Bediako K, Fatchu RD. Challenges with the pursuit of ISO 15189 accreditation in a public health laboratory in Ghana. Afr J Lab Med 2022; 11:1448. [PMID: 35937765 PMCID: PMC9350552 DOI: 10.4102/ajlm.v11i1.1448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/04/2022] [Indexed: 11/03/2022] Open
Abstract
Background: Accreditation is important for all medical laboratories, particularly public health laboratories in developing countries. Several laboratories in Ghana implemented the requirements of the International Organization for Standardization (ISO) 15189 but were unable to proceed to accreditation. This article describes the challenges faced by the Pathology Division Laboratory of the 37 Military Hospital, Accra, Ghana, during the acquisition of ISO 15189 accreditation and suggests solutions for a better approach.Intervention: Following ISO 15189 accreditation in 2017, an online survey was conducted between 01 and 30 March 2020 among the laboratory staff. Respondents were required to grade, on a scale of 0 (least) to 5 (most), the extent to which 16 key challenges influenced the process of obtaining accreditation. Key informant interviews were also held with laboratory personnel who were directly involved in the establishment of the quality management system in the laboratory and the accreditation acquisition process.Lessons learnt: Documentation, laboratory safety measures, laboratory management support, and reagent unavailability were estimated as the challenges that most affected the acquisition of laboratory accreditation. Challenges such as poor communication, staff apathy and workload had the least effect on the accreditation process. There was no difference in challenges identified between persons who worked in the laboratory before or after accreditation (p = 0.11).Recommendations: To surmount the anticipated challenges, there is the need for national strategic direction for laboratory accreditation, hospital and laboratory management support for the accreditation acquisition and maintenance processes, and sufficient technical assistance in the form of training and mentorship.
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Affiliation(s)
- Seth Attoh
- JM Wadhwani Department of Anatomical Pathology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Francis K.M. Tetteh
- Department of Microbiology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Mary McAddy
- JM Wadhwani Department of Anatomical Pathology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Kingsley Ackah
- Department of Microbiology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Richmond Kyei
- JM Wadhwani Department of Anatomical Pathology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Marcus Moroti
- Department of Microbiology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Cynthia Boateng
- Department of Chemical Pathology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Laurinda Adusu-Donkor
- Department of Chemical Pathology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Joseph Boafo
- Department of Haematology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Alhassan Yakubu
- Department of Quality Assurance, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Sarah Kwao
- Department of Quality Assurance, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Emmanuel Sarkodie
- Department of Haematology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Nana-Banyin Koranteng
- Department of Chemical Pathology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Monica A. Addo
- Department of Chemical Pathology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Frederick Hobenu
- JM Wadhwani Department of Anatomical Pathology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Kwasi Agyeman-Bediako
- JM Wadhwani Department of Anatomical Pathology, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
| | - Raymond D. Fatchu
- Department of Quality Assurance, Pathology Division Laboratory, 37 Military Hospital, Accra, Ghana
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Najjar S, Hafez S, Al Basuoni A, Obaid HA, Mughnnamin I, Falana H, Sultan H, Aljeesh Y, Alkhaldi M. Stakeholders' Perception of the Palestinian Health Workforce Accreditation and Regulation System: A Focus on Conceptualization, Influencing Factors and Barriers, and the Way Forward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8131. [PMID: 35805791 PMCID: PMC9265623 DOI: 10.3390/ijerph19138131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022]
Abstract
The Health Workforce Accreditation and Regulation (HWAR) is a key function of the health system and is the subject of increasing global attention. This study provides an assessment of the factors affecting the Palestinian HWAR system, identifies existing gaps and offers actionable improvement solutions. Data were collected during October and November 2019 in twenty-two semi-structured in-depth interviews conducted with experts, academics, leaders, and policymakers purposely selected from government, academia, and non-governmental organizations. The overall perceptions towards HWAR were inconsistent. The absence of a consolidated HWAR system has led to a lack of communication between actors. Environmental factors also affect HWAR in Palestine. The study highlighted the consensus on addressing further development of HWAR and the subsequent advantages of this enhancement. The current HWAR practices were found to be based on personal initiatives rather than on a systematic evidence-based approach. The need to strengthen law enforcement was raised by numerous participants. Additional challenges were identified, including the lack of knowledge exchange and salary adjustments. HWAR in Palestine needs to be strengthened on the national, institutional, and individual levels through clear and standardized operating processes. All relevant stakeholders should work together through an integrated national accreditation and regulation system.
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Affiliation(s)
- Shahenaz Najjar
- Faculty of Graduate Studies, Arab American University, Ramallah P.O. Box 240, Palestine; (I.M.); (H.F.); (H.S.)
| | - Sali Hafez
- London School of Hygiene and Tropical Medicine (LSHTM), London WC1H 9SH, UK;
| | - Aisha Al Basuoni
- Projects Department, Gaza Community Mental Health Programme (GCMHP), Gaza P.O. Box P860, Palestine;
| | - Hassan Abu Obaid
- Indonesian General Hospital, Ministry of Health, Gaza P.O. Box P860, Palestine;
- Faculty of Medical Science, Israa University, Gaza P.O. Box P860, Palestine
- School of Public Health, Tehran University of Medical Sciences TUMS, P.O. Box 14155-6559, Tehran 14455-6446, Iran
| | - Ibrahim Mughnnamin
- Faculty of Graduate Studies, Arab American University, Ramallah P.O. Box 240, Palestine; (I.M.); (H.F.); (H.S.)
- Yatta General Hospital, Ministry of Health, Hebron P.O. Box 785, Palestine
| | - Hiba Falana
- Faculty of Graduate Studies, Arab American University, Ramallah P.O. Box 240, Palestine; (I.M.); (H.F.); (H.S.)
- Department of Pharmacy, Nursing and Health Professions, Birzeit University, Ramallah P.O. Box 14, Palestine
| | - Haya Sultan
- Faculty of Graduate Studies, Arab American University, Ramallah P.O. Box 240, Palestine; (I.M.); (H.F.); (H.S.)
- Department of Pharmacy, Nursing and Health Professions, Birzeit University, Ramallah P.O. Box 14, Palestine
| | - Yousef Aljeesh
- Scientific Research and Postgraduate Studies, Faculty of Nursing, Islamic University of Gaza, Gaza P.O. Box 108, Palestine;
| | - Mohammed Alkhaldi
- Department of Medicine, McGill University Health Center (MUHC), Montreal, QC H3H 2R9, Canada
- Faculty of Medicine, School of Physical & Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
- Department of Environmental Health Sciences, Faculty of Communication, Arts and Sciences, Canadian University Dubai (CUD), Dubai P.O. Box 117781, United Arab Emirates
- Health System Impact Fellowship, Canadian Institutes of Health Research (CIHR), Ottawa, ON K1A 0W9, Canada
- Faculty of Science, University of Basel, 4003 Basel, Switzerland
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), 4123 Allschwil, Switzerland
- Research Fairness Initiative Team, Council on Health Research for Development (COHRED), 1211 Geneva, Switzerland
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15
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Qurashi AA, Alsharif WM. Saudi Radiologists’ and Radiographers’ Perceptions of Accreditation Programmes in Clinical Radiology Departments: A Cross-Sectional Study. J Multidiscip Healthc 2022; 15:401-411. [PMID: 35261545 PMCID: PMC8898186 DOI: 10.2147/jmdh.s350989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The hospital accreditation programme is an assessment tool that involves a comprehensive evaluation by an external independent accreditation body to ensure consistency in clinical practice by adhering to the established standards and guidelines. The study aims to investigate Radiology professionals’ perceptions of the impact of accreditation and implementation of change towards the quality-of-service delivery in Radiology Departments. Methods A cross-sectional prospective study was conducted in Saudi Arabia among radiology professionals (ie, radiographers and radiologists) from July to September 2021. After obtaining institutional review board approval from the local ethics committee and using a non-probability convenient sampling technique, 335 participants completed the survey, which was distributed via social media channels, and through professional networks within hospitals across the country. Results A total of 335 participants agreed to participate. The study’s participants strongly agreed that the accreditation programmes have positively impacted customer satisfaction and care provided to patients. A significant difference was identified in the level of agreement on the effect of accreditation programmes when hospital types and personnel qualifications were tested (P < 0.05). Radiology personnel who worked in academic hospitals and who had diplomas and PhDs degrees showed a significantly higher level of agreement than other participants (P < 0.05). Conclusion Saudi radiologists and radiographers showed strong agreement or agreement towards hospital accreditation programmes domains’ criteria. The results of the study support the need to bridge the gap between higher-level management and employees in order to facilitate change and enhance the standards of quality and practice in radiology departments. Additional policies are needed to continue and strengthen quality improvement programmes.
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Affiliation(s)
- Abdulaziz A Qurashi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
- Correspondence: Abdulaziz A Qurashi, Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Anadah Bin Umayyah Road, Taibah, Madinah, 42353, Saudi Arabia, Tel +966 014 861 8888 Ext. 3603, Email
| | - Walaa M Alsharif
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
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Ajay K, Poka A, Narayan M. Impact of accreditation on documentation and staff perception in the ophthalmology department of an Indian medical college. Indian J Ophthalmol 2021; 69:337-342. [PMID: 33463587 PMCID: PMC7933869 DOI: 10.4103/ijo.ijo_848_20] [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] [Indexed: 11/04/2022] Open
Abstract
Purpose National Accreditation Board for Hospitals and Healthcare Providers operates the health-care accreditation program in India. Research on impact of accreditation on eye-care centers is scarce. This article was conceptualized to scientifically evaluate the changes in documentation brought about by accreditation and its effects on staff in the Ophthalmology Department of an Indian Medical College. Methods This was conducted as a quasi-experimental study in four steps. First, a point-based evaluation of case sheets in both pre-accreditation and postaccreditation phase, along with statistical analysis of the results, was done. Step two involved analysis of quality indicators and patient safety indices in successive years from inception of data to post-accreditation phase. Step three comprised a survey of staff employing a validated tool, and finally, face-to-face semistructured interviews with designated authorities, including finance departmental head, completed the study. Results A statistically significant difference was seen in scores achieved by the pre and postaccreditation case sheets, with the postphase case sheets achieving 15% increased scores over the prephase case sheets. Quality indicator indices displayed improvements post-accreditation. There was an accompanying increase in quantity of documentation. Financial data analysis showed increased expenditure for accreditation under multiple heads. Staff believed that accreditation led to increased workload but did not express decreased satisfaction and felt that accreditation was eventually beneficial. However, staff believed rewards for improving quality can be enhanced. Conclusion Accreditation increases quality and quantity of documentation, and staff workload. Increased financial costs also ensue.Staff believe that accreditation improves quality, is beneficial, but desire enhanced rewards.
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Affiliation(s)
- K Ajay
- Department of Ophthalmology, P. E. S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
| | - Avinash Poka
- Department of Ophthalmology, P. E. S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
| | - M Narayan
- Department of Ophthalmology, P. E. S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
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Joseph L, Agarwal V, Raju U, Mavaji A, Rajkumar P. Perception of Hospital Accreditation Impact among Quality Management Professionals in India: A Survey-Based Multicenter Study. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2021; 4:58-64. [PMID: 37260787 PMCID: PMC10228987 DOI: 10.36401/jqsh-20-44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/13/2021] [Accepted: 03/09/2021] [Indexed: 06/02/2023]
Abstract
Introduction Accreditation ensures the standard of healthcare, yet accreditation effects on service quality are much debated. Some perceive it as improving quality and organizational performance, whereas others see it as overly bureaucratic and time-consuming, so adding it has limited advantage. The aim of the present study was to understand the perception of hospital staff working in quality management (i.e., doctors, nurses, and administrators) on accreditation, and determine whether years of accreditation have had any impact on their perception. Methods This was a cross-sectional, descriptive, data-based study initiated by the Consortium of Accredited Healthcare Organizations. It consisted of primary data obtained in form of responses to a 30-item questionnaire and collected from 415 respondents. A probability (p) value of less than 0.05 was considered statistically significant. Results For all 30 items, a significantly greater number of participants had a favorable response (p < 0.001). A greater number of administrators, as compared with doctors and nurses, responded positively on the impact of accreditation (p < 0.05). Participants from hospitals with 1-4 years of accreditation, as compared with participants from hospitals with 4-12 years of accreditation, gave a favorable response (p < 0.05). Conclusion One of the most important hurdles to implementing accreditation programs is the dilemma of healthcare professionals, especially senior hospital staff, regarding the positive impact of accreditation. The need to educate healthcare professionals about the potential benefits of accreditation, which should resolve any cynical attitude of healthcare professionals towards accreditation, is of utmost importance.
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Affiliation(s)
- Lallu Joseph
- Quality Management Cell, Christian Medical College, Vellore, India
| | - Vijay Agarwal
- Consortium of Accredited Healthcare Organizations, Delhi, India
| | - Umashankar Raju
- Department of Quality, Ramaiah Memorial Hospital, Bengaluru, India
| | - Arun Mavaji
- Department of Hospital Administration, Ramaiah Medical College, Bengaluru, India
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Al Saffer Q, Al-Ghaith T, Alshehri A, Al-Mohammed R, Al Homidi S, Hamza MM, Herbst CH, Alazemi N. The capacity of primary health care facilities in Saudi Arabia: infrastructure, services, drug availability, and human resources. BMC Health Serv Res 2021; 21:365. [PMID: 33879136 PMCID: PMC8056511 DOI: 10.1186/s12913-021-06355-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primary healthcare (PHC) is an essential component of an effective healthcare system. The Kingdom of Saudi Arabia's (KSA) health reforms prioritize tackling the increasing noncommunicable disease burden by prioritizing PHC, centering it as the core of the newly proposed Model of Care. To identify challenges and opportunities to scale up PHC capacity, understanding the current capacity of primary health care centers (PHCC) is critical. A limited number of publications review PHC capacity in KSA, focusing on specific regions/sectors; this paper is a first to examine PHC capacity on a national level. METHODS The study uses a countrywide Facility Survey that collected data in 2018 from 2319 PHCCs, generating information on their characteristics, number of health workers, services provided, and capacity elements captured through the Service Availability and Drug Availability constructed indices. Descriptive analysis was performed by rural-urban classification. Ordinary Least Squares (OLS) regressions were used to understand correlates to health workers and equipment availability. Finally, a logistic regression was fitted for selected services. Regressions controlled for various measures to determine correlates with facilities' capacity. RESULTS On a national level, there are 0.74 PHCCs per 10,000 population in KSA. There are variations in the distribution of PHCCs across regions and within regions across rural and urban areas. PHCCs in urban areas have more examination rooms but lower examination room densities. Offering 24 × 7 services in PHCCs is infrequent and dependency on paper-based medical recording remains common. More urban regions are more likely to offer general services but less likely to offer burn management and emergency services. PHCCs are mostly staffed with general medicine, family medicine, and obstetrics & gynecology physicians, whose numbers are more concentrated in urban areas; however, their densities are higher in rural areas. Finally, psychiatrists and nutritionists are rare to find in PHCCs. CONCLUSIONS Decision-makers need to consider several factors when designing PHC policies. For instance, PHC accreditation needs to be prioritized given its positive correlation with service provision and health workers availability. PHC 24 × 7 operation also needs considerations in rural areas due to the high dependency on PHCCs. Finally, there is a substantial need for improvements in e-health.
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Hovlid E, Braut GS, Hannisdal E, Walshe K, Bukve O, Flottorp S, Stensland P, Frich JC. Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis. BMJ Open 2020; 10:e038850. [PMID: 32868366 PMCID: PMC7462249 DOI: 10.1136/bmjopen-2020-038850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Einar Hovlid
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Geir Sverre Braut
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Western Norway University of Applied Sciences, Haugesund, Norway
| | - Einar Hannisdal
- Department of health, County Governor in Oslo and Akershus, Oslo, Norway
| | - Kieran Walshe
- The University of Manchester Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Oddbjørn Bukve
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
| | | | - Per Stensland
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Jan C Frich
- Institute of Health and Society, Universitetet i Oslo, Oslo, Norway
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Kakemam E, Rajabi MR, Raeissi P, Ehlers LH. Attitudes Towards Accreditation and Quality Improvement Activities Among Hospital Employees in Iran: A Quantitative Study. J Multidiscip Healthc 2020; 13:799-807. [PMID: 32884279 PMCID: PMC7431451 DOI: 10.2147/jmdh.s263811] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose The hospital accreditation system in Iran is relatively young, having been introduced in 2012. Therefore, there is a real need for research on the status and impact of hospital accreditation in Iran. The purpose of this study was to evaluate and compare attitudes towards accreditation and quality improvement activities among hospital employees, specifically the attitudes towards the impact of accreditation on the quality of healthcare and its benefits in Iran. Materials and Methods A cross-sectional survey was carried out at 23 teaching hospitals in three metropolises in Iran, all of which successfully passed national accreditation surveys. Some 1213 hospital managers, administrative staff, nurses, and para-clinical staff participated in the survey. The main outcome measures were quality results, and the activities related to quality improvement include senior managers' commitment and support, strategic quality planning, education and training, rewards and recognition, quality management, use of data, the involvement of professionals in accreditation, and accreditation benefits. The questionnaire was applied using a 5-point Likert scale ranging from 1 “strongly disagree” to 5 “strongly agree”. One-way analysis of variance (ANOVA) was used to compare mean values between respondent groups. Results Among nurses and managers, there was low support for accreditation and even less among para-clinical staff who fail to see accreditation having a positive impact on healthcare quality. Also, nurses' attitudes toward the accreditation benefits were more positive compared with the two other groups. Staff stated that the main reasons for low support were a lack of education and training to act upon the accreditation survey results and a lack of management visibility and support for quality improvement. Conclusion Improving quality through means of hospital accreditation is a complex process with high demands for management and employees. Questionnaires on employees’ attitudes and perceptions of the impact of accreditation and quality improvement-related activities in the hospitals can provide valuable information on the current problems of a hospital accreditation program.
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Affiliation(s)
- Edris Kakemam
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Pouran Raeissi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Institute of Business and Management, Faculty of Social Sciences, Aalborg University, Aalborg, Denmark
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Alshamsi AI, Thomson L, Santos A. What Impact Does Accreditation Have on Workplaces? A Qualitative Study to Explore the Perceptions of Healthcare Professionals About the Process of Accreditation. Front Psychol 2020; 11:1614. [PMID: 32754096 PMCID: PMC7365862 DOI: 10.3389/fpsyg.2020.01614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/15/2020] [Indexed: 12/02/2022] Open
Abstract
Aim This study seeks to explore the emerging psychosocial risks of healthcare accreditation in workplaces and understand healthcare professionals’ (HCPs) perceptions of work demands and the unexpected consequences such accreditation has created for them. Methods Twenty-seven semi-structured interviews and four focus group discussions were conducted with a variety of HCPs, including doctors, nurses, pharmacists, and allied health professionals. The study was conducted in three public hospitals and a network of primary healthcare centers in the United Arab Emirates. Interviews and focus group discussions were transcribed and analyzed using a theoretical thematic analysis approach. Results The results showed that a number of psychosocial risks were prevalent during the course of accreditation. HCPs faced increased work demands during such a process, including increased working hours, increased working pace, perceived time pressure, and conflicting information. Such demands were perceived to influence not only their health but also their families as well as patients’ care. In contrast, teamwork and coworker support were vital to mitigate the effect of such demands. Implications This study identified emerging risks during the process of accreditation. The findings show that the process of accreditation increases work-related risks before the inspection visit. These findings have significant implications for understanding how accreditation processes increase psychosocial risks; they also consolidate the idea that appropriate systems and support for HCPs should be a priority when planning for accreditation.
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Affiliation(s)
- Amna I Alshamsi
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Louise Thomson
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Angeli Santos
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Tomasich F, Oliveira AVDE, Oliveira ADEJ, Correia MITD. The history of quality and safety of the surgical patient: from the initial standards to the present day. Rev Col Bras Cir 2020; 47:e20202650. [PMID: 32638915 DOI: 10.1590/0100-6991e-20202650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022] Open
Abstract
There are currently various concepts related to quality, which have been implemented by many hospitals and other healthcare institutions. The search for continuous improvement, the implementation of a quality culture and hospital accreditation have also been common, in these institutions. However, the history of hospital audits and accreditation is complex and full of dynamic concepts. The American College of Surgeons was pioneer in publishing, more than a century ago, the first document pertaining quality standards. After that, various programs and concepts have been developed and remodeled by distinct entities. In this article, we briefly review the history of quality in the world and Brazil. We also discuss related concepts regarding its assessment in healthcare.
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Affiliation(s)
- FlÁvio Tomasich
- Departamento de Cirurgia, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Inspecting teams' and organisations' expectations regarding external inspections in health care: a qualitative study. BMC Health Serv Res 2020; 20:627. [PMID: 32641038 PMCID: PMC7346447 DOI: 10.1186/s12913-020-05475-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022] Open
Abstract
Background There is a gap in the literature regarding what takes place between the announcement of a regulatory intervention, such as an external inspection of a health care organisation, and the inspecting body’s site visit. This study aimed to explore inspecting bodies’ expectations of how inspected organisations should prepare before an external inspection and to elucidate how inspected health care organisations prepare before site visits. Methods This qualitative study was based on data from 17 group interviews with a total of 75 participants representing inspection teams, organisation leaders and clinicians in inspected health care organisations. The data were analysed using a qualitative content analysis method. Results We identified two approaches to how the inspection teams expected that the inspected organisations should prepare before site visits. In the first approach the inspection teams did not expect any improvement activities to be initiated during this period and focused on identifying inadequacies that the inspected organisations should subsequently improve. In the second approach the inspection teams expected organisations to review their own practices and begin improvement activities if necessary. The inspected organisations responded in different ways to an upcoming site visit, and the organisations’ leaders were important in determining which activities would be initiated. Organisations in which leaders involved clinicians in assessing care delivery tended to initiate action to improve and expected inspection teams to assess their ongoing improvement work and provide guidance on further improvements. Leaders who did not involve clinicians in assessing the quality of care tended to perceive the current quality of care as adequate on the basis of reviewing written guidelines. They did not initiate action to improve care delivery apart from updating written guidelines describing how care should be delivered, and they expected the inspection team to confirm that their current practices were in line with the guidelines and external standards. Conclusions To promote anticipatory effects in inspected organisations, inspecting bodies should stress the importance of assessing clinical practice and involving frontline clinical staff and leaders in the assessment and in improvement work before the site visit.
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Afrizal SH, Hidayanto AN, Handayani PW, Besral B, Martha E, Markam H, Budiharsana M, Eryando T. Evaluation of integrated antenatal care implementation in primary health care. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-07-2019-0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study was aimed to evaluate the implementation of an integrated antenatal care (ANC) scheme through a retrospective document study using a checklist for measuring the adequacy of the cohort ANC register documented by midwives in an urban area and to describe the barriers for the midwives during the ANC record process.Design/methodology/approachAn exploratory descriptive study using a sequential mixed method was utilised where a quantitative method was employed by collecting secondary data of 150 entries of the cohort ANC register and followed by in-depth interviews among midwives and community health workers.FindingsThe results show that the cohort registry indicators for integrated care such as laboratory and management were poorly recorded. Several barriers were found and categorised during the implementation of the integrated ANC, namely (1) governance and strategy, (2) process of care, (3) organisation and management support.Research limitations/implicationsThe contribution of this present research is that it provides empirical data of the integrated ANC implementation in primary health care (PHC) which has the responsibility to deliver an integrated level of care for ANC using a cohort registry for pregnancy registration monitoring which facilitates the continuity and quality of care.Practical implicationsPractical implication of the finding is that functional integration such as the clinical information system to facilitate an efficient and effective approach during the implementation of integrated ANC in primary care should be considered to support the clinical, professional, organisational, system and normative integration.Originality/valueSince only limited studies have been conducted to assess the quality of the cohort ANC registry and to investigate the barriers against integrated ANC implementation in Indonesia, the research findings are valuable information for the national and local governments to improve the ANC service in Indonesia.
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Tashayoei N, Raeissi P, Nasiripour AA. Challenges of implementation of hospital accreditation in Iran: an exploratory factor analysis. J Egypt Public Health Assoc 2020; 95:5. [PMID: 32813055 PMCID: PMC7364711 DOI: 10.1186/s42506-019-0033-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/29/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Today, accreditation is considered as the most commonly used health assessment approach. Considering the importance and application of the process of this approach in the hospital, this study aimed to investigate the challenges of implementation of hospital accreditation in Iran using exploratory factor analysis. METHODS A cross-sectional study design was carried out from July to December 2017, consisting of 200 managers in the seven hospitals accredited by the MOH in Tehran, Iran. Samples were selected through the purposive sampling method, and data were collected using a structured questionnaire in which validity and reliability were confirmed. Likert's five-choice range was used for the rating of items. Exploratory factor analysis was used to categorize the identified challenges and extract the mathematical model on them. RESULTS Exploratory factor analysis identified six dimensions (implementation, evaluation, content, structural, psychological, and managerial) with 40 items using a 5-point Likert scale. Each dimension accounted for greater than 63.20% of the total variance. The scale had strong content validity (indices = 0.84). Each dimension of Cronbach's alpha ranged from 0.74 to 0.94. Implementation, evaluation, content, structural, psychological, and managerial components also formed the final identified areas. CONCLUSION The present study showed that there were major challenges in the path to successful deployment of Iranian hospital accreditation, requiring serious action by managers and policymakers in this field.
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Affiliation(s)
- Narges Tashayoei
- Department of Health Services Management, School of Medical Sciences, Tehran Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Amir Ashkan Nasiripour
- Department of Health Services Management, School of Medical Sciences, Tehran Science and Research Branch, Islamic Azad University, Tehran, Iran
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K.S. S, Barkur G, G. S. Impact of accreditation on performance of healthcare organizations. INTERNATIONAL JOURNAL OF QUALITY AND SERVICE SCIENCES 2020. [DOI: 10.1108/ijqss-10-2018-0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Pires DEPD, Vandresen L, Forte ECN, Machado RR, Melo TAPD. Management in primary health care: implications on managers workloads. ACTA ACUST UNITED AC 2019; 40:e20180216. [PMID: 31596341 DOI: 10.1590/1983-1447.2019.20180216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 03/12/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify which aspects of primary health care management, evidenced in current literature, can influence manager workloads. METHODOLOGY Integrative literature review with data collection conducted in April 2016, in five databases, with articles published in English, Spanish and Portuguese between 2006 and 2016. RESULTS The results of the 78 studies were organized into two macro categories: increased workloads, especially due to the challenge of managing a new care model and deficits in working conditions; and workloads reduction related to the training of the teams and managers, the autonomy and the support for the managers. CONCLUSION In addition to identifying factors that increase and decrease the workloads of managers, this study highlights the promising line of research, given the importance of management for the health sector and effectiveness of Primary Health Care.
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Affiliation(s)
- Denise Elvira Pires de Pires
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil
| | - Lara Vandresen
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil
| | - Elaine Cristina Novatzki Forte
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil
| | - Rosani Ramos Machado
- Universidade Federal de Santa Catarina (UFSC), Departamento de Enfermagem. Florianópolis, Santa Catarina, Brasil
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El-Kak F, Kabakian-Khasholian T, Ammar W, Nassar A. A review of maternal mortality trends in Lebanon, 2010-2018. Int J Gynaecol Obstet 2019; 148:14-20. [PMID: 31596955 DOI: 10.1002/ijgo.12994] [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] [Received: 05/08/2019] [Revised: 09/11/2019] [Accepted: 10/07/2019] [Indexed: 11/11/2022]
Abstract
Lebanon invested in the prevention of maternal mortality after the civil war, which left a deficient vital registration system leading to unreliable estimates of maternal mortality ratio (MMR). Starting in 2004, the Ministry of Public Health integrated reproductive health into primary health care and established a national notification system of maternal and neonatal deaths. From 1990 to 2013, Lebanon achieved an annual change in MMR of -7.5%, which was the highest rate of reduction in the region and met the requirements of Millennium Development Goal 5. For the period 2010-2018, data collected through the national notification system indicate an MMR of 14.9, which is below the officially reported MMR of 23. Since the influx of Syrian refugees, Lebanon has experienced a rise in the number of live births with a slightly increasing trend in MMR, especially in regions with the highest concentration of refugees. Causes of maternal mortality in Lebanon align with the three-delays model, pointing to deficiencies in the quality of maternity care. More efforts are needed toward strengthening the national notification system to include cases that occur outside hospitals, identifying near-miss cases, reinforcing the emergency response system, and engaging with all stakeholders to improve quality of care.
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Affiliation(s)
- Faysal El-Kak
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Walid Ammar
- Ministry of Public Health, Beirut, Republic of Lebanon
| | - Anwar Nassar
- Department of Obstetrics and Gynecology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Khoury J, Krejany CJ, Versteeg RW, Lodewyckx MA, Pike SR, Civil MS, Jiwa M. A process for developing standards to promote quality in general practice. Fam Pract 2019; 36:166-171. [PMID: 29868888 PMCID: PMC6425464 DOI: 10.1093/fampra/cmy049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 1991, the Royal Australian College of General Practitioners' (RACGP) Standards for General Practices (the Standards) have provided a framework for quality care, risk management and best practice in the operation of Australian general practices. The Standards are also linked to incentives for general practice remuneration. These Standards were revised in 2017. OBJECTIVE The objective of this study is to describe the process undertaken to develop the fifth edition Standards published in 2017 to inform future standards development both nationally and internationally. METHOD A modified Delphi process was deployed to develop the fifth edition Standards. Development was directed by the RACGP and led by an expert panel of GPs and representatives of stakeholder groups who were assisted and facilitated by a team from RACGP. Each draft was released for stakeholder feedback and tested twice before the final version was submitted for approval by the RACGP board. RESULTS Four rounds of consultation and two rounds of piloting were carried out over 32 months. The Standards were redrafted after each round. One hundred and fifty-two individuals and 225 stakeholder groups participated in the development of the Standards. Twenty-three new indicators were recommended and grouped into three sections in a new modular structure that was different from the previous edition. CONCLUSION The Standards represent the consensus view of national stakeholders on the indicators of quality and safety in Australian general practice and primary care.
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Affiliation(s)
- Julie Khoury
- Policy, Practice and Innovation, Royal Australian College of General Practitioners, Melbourne, Australia
| | - Catherine J Krejany
- Melbourne Clinical School, School of Medicine Sydney, University of Notre Dame Australia, Victoria, Australia
| | - Roald W Versteeg
- Policy, Practice and Innovation, Royal Australian College of General Practitioners, Melbourne, Australia
| | - Michaela A Lodewyckx
- North West Melbourne Primary Health Network, Health Systems Integration, Melbourne, Australia
| | - Simone R Pike
- Policy, Practice and Innovation, Royal Australian College of General Practitioners, Melbourne, Australia
| | - Michael S Civil
- Policy, Practice and Innovation, Royal Australian College of General Practitioners, Perth, Australia
| | - Moyez Jiwa
- Melbourne Clinical School, School of Medicine Sydney, University of Notre Dame Australia, Victoria, Australia
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Carrasco-Peralta JA, Herrera-Usagre M, Reyes-Alcázar V, Torres-Olivera A. Healthcare accreditation as trigger of organisational change: The view of professionals. J Healthc Qual Res 2019; 34:59-65. [PMID: 30713136 DOI: 10.1016/j.jhqr.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Healthcare accreditation seeks to promote the organisational change in healthcare organisations from an approach that values the level of progress achieved through a validated reference framework. The aim of this paper is to analyse the role played by accreditation through the experience perceived by health professionals during the process of self-assessment and external evaluation, taking into account three dimensions of analysis: focus on the patient, internal organisation and leadership, and impact on the clinical aspects of healthcare. MATERIAL AND METHODS Design: Semi-structured interviews with key informants from clinical management units (CMU) within the Andalusian Health System (Spain). PARTICIPANTS The key informants in each CMU were the clinical leader, the head of nursing and two health professionals (doctors and nurses). A qualitative research protocol was employed to conduct the semi-structured interviews (n=52 interviews) with physicians and nurses, in order to analyse their experience with the accreditation process. RESULTS The analysis identified four main outcomes related to the accreditation process perceived by professionals: (1) A benchmarking conceptualisation of the process; (2) Improvements in patient-centred care, quality of clinical records, and organisational culture of the units; (3) Improvement of patient safety culture; (4) As negative outcomes, a slight perception of bureaucratisation and standardisation of the clinical practice. CONCLUSIONS The described initiative of accreditation process in Andalusia (Spain) is widely perceived as positive by health professionals since it fosters the organisational change, although it also has a slightly negative bureaucratisation effect on clinical practice.
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Affiliation(s)
- J A Carrasco-Peralta
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
| | - M Herrera-Usagre
- Andalusian Agency for Healthcare Quality/Pablo de Olavide University, Department of Sociology, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain.
| | - V Reyes-Alcázar
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
| | - A Torres-Olivera
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
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Pires DEPD, Vandresen L, Machado F, Machado RR, Amadigi FR. PRIMARY HEALTHCARE MANAGEMENT: WHAT IS DISCUSSED IN THE LITERATURE. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2016-0426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to identify what is discussed in studies published in Brazilian and international literature in the last ten years on Primary Health Care management. Method: an integrative review with a search carried out from 2006 to 2016, in the SciELO®, LILACS®, Scopus®, PubMed® and CINAHL® databases in the Portuguese, English and Spanish languages. The review followed the steps: formulation of the research question, definition of the inclusion and exclusion criteria, identification and selection of the studies, and summary of the subjects found in the studies. Resources from The Atlas.ti® software was used for data organization and analysis. Results: the corpus include 90 studies which predominantly originated from LILACS® and were performed in Brazil. The themes covered in the publications were: health policy and management in Primary Health Care, material resources management, human resources management, financial management, quality management, planning, characterization of managers, management role/ activities, challenges/difficulties in management, potentialities/facilities in management. There was a prevalence of studies that dealt with Primary Health Care management in the context of reflections on health policies and those dealing with the challenges/difficulties faced in Primary Health Care management. These findings demonstrate that the Primary Health Care model is complex and challenging, both for policymakers and for those managing it. Conclusion: the number of studies on Primary Health Care management is significant in the current literature and the predominance of health policy and difficulties in performing management issues reinforce the recognition of the centrality of the management for effective Primary Health Care.
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Corrêa JÉ, Turrioni JB, Mello CHP, Santos ACO, da Silva CES, de Almeida FA. Development of a System Measurement Model of the Brazilian Hospital Accreditation System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2520. [PMID: 30423866 PMCID: PMC6266958 DOI: 10.3390/ijerph15112520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 11/23/2022]
Abstract
The purpose of this study is to develop and validate a measurement model that evaluates the Brazilian hospital accreditation methodology (ONA), based on a multivariate model using structural equation modeling (SEM). The information used to develop the model was obtained from a questionnaire sent to all organizations accredited by the ONA methodology. A model was built based on the data obtained and tested through a structural equation modeling (SEM) technique using the LISREL® software (Scientific Software International, Inc., Skokie, IL, USA). Four different tests were performed: Initial, calibrated, simulated, and cross-validation models. By analyzing and validating the proposed measurement model, it can be verified that the selected factors satisfy the required criteria for the development of a structural model. The results show that leadership action is one of the most important factors in the process of health services accredited by ONA. Although, leadership, staff management, quality management, organizational culture, process orientation, and safety are strongly linked to the development of health organizations, and directly influence the accreditation process.
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Affiliation(s)
- João Éderson Corrêa
- Institute of Industrial Engineering and Management, Federal University of Itajubá, Av. BPS, 1303, Itajubá, Minas Gerais 37500-903, Brazil.
| | - João Batista Turrioni
- Institute of Industrial Engineering and Management, Federal University of Itajubá, Av. BPS, 1303, Itajubá, Minas Gerais 37500-903, Brazil.
| | - Carlos Henrique Pereira Mello
- Institute of Industrial Engineering and Management, Federal University of Itajubá, Av. BPS, 1303, Itajubá, Minas Gerais 37500-903, Brazil.
| | - Ana Carolina Oliveira Santos
- Institute of Integrated Engineering, Itabira Campus, Federal University of Itajubá, Rua Irmã Ivone Drumond, 200, Itabira, Minas Gerais 35903-087, Brazil.
| | - Carlos Eduardo Sanches da Silva
- Institute of Industrial Engineering and Management, Federal University of Itajubá, Av. BPS, 1303, Itajubá, Minas Gerais 37500-903, Brazil.
| | - Fabrício Alves de Almeida
- Institute of Industrial Engineering and Management, Federal University of Itajubá, Av. BPS, 1303, Itajubá, Minas Gerais 37500-903, Brazil.
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Ghareeb A, Said H, El Zoghbi M. Examining the impact of accreditation on a primary healthcare organization in Qatar. BMC MEDICAL EDUCATION 2018; 18:216. [PMID: 30236105 PMCID: PMC6146520 DOI: 10.1186/s12909-018-1321-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 08/31/2018] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although a modest body of literature exists on accreditation, little research was conducted on the impact of accreditation on primary healthcare organizations in the Middle East. This study assessed the changes resulting from the integration of Accreditation Canada International's accreditation program in a primary healthcare organization in the State of Qatar. METHODS The study investigated how accreditation helped introduce organizational changes through promoting organizational learning as well as quality improvement initiatives. Applying a quantitative design, a structured questionnaire was used to collect data from 500 staff. The study used Spearman's correlation coefficient to analyze the collected survey data. RESULTS Overall employees agreed on the positive impact of accreditation. The results showed a significantly positive correlation between staff perception of accreditation and of quality of care. The two dominant cultures at Primary Health Care Corporation were "group" (with a score of 28.61) and "hierarchical" (with a score of 26.59). The results showed a positive correlation between staff perception of accreditation and their perception of culture type whenever the culture was identified as "group". CONCLUSIONS This study provided much-needed insight on the possible changes that organizations might go through in relation to quality improvement and organizational learning.
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Affiliation(s)
- Alia Ghareeb
- Quality Management Department, Primary Health Care Corporation, PO Box 26555, Doha, Qatar
| | - Hana Said
- Quality Management Department, Primary Health Care Corporation, PO Box 26555, Doha, Qatar
| | - Mohamad El Zoghbi
- Quality Management Department, Primary Health Care Corporation, PO Box 26555, Doha, Qatar
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Girma M, Desale A, Hassen F, Sisay A, Tsegaye A. Survey-Defined and Interview-Elicited Challenges That Faced Ethiopian Government Hospital Laboratories as They Applied ISO 15189 Accreditation Standards in Resource-Constrained Settings in 2017. Am J Clin Pathol 2018; 150:303-309. [PMID: 29992301 DOI: 10.1093/ajcp/aqy049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The World Health Organization African Regional Office recommends ISO 15189 standards to improve performance quality in sub-Saharan African laboratories. We specify challenges Ethiopian laboratorians encountered applying ISO 15189 standards. METHODS From a structured survey at 12 Ethiopian government hospitals, 175 laboratory staff replied; all were aware of the ISO standards and 138 had been involved in the ISO 15189 inspection process. In addition, 11 laboratory heads, 10 quality officers, and three medical directors were interviewed in depth. RESULTS Half or more respondents identified six challenges obstructing accreditation to a "large" or "very large" degree: (1) low management support, (2) inadequate training, (3) insufficient infrastructure, (4) excessive documentation, (5) little mentorship, and (6) increased accreditation-related workload. Interviewees added (7) poor equipment, (8) unavailable/poor-quality reagents, and (9) high staff turnover. CONCLUSIONS The survey and interviews specified nine major challenges for Ethiopian government hospital laboratories that seriously obstruct meeting ISO 15189 demands.
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Affiliation(s)
- Mekonnen Girma
- School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Department of Medical Laboratory Sciences, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adinew Desale
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fatuma Hassen
- Department of Medical Laboratory Sciences, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abay Sisay
- Department of Medical Laboratory Sciences, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Reisi N, Raeissi P, Sokhanvar M, Kakemam E. The impact of accreditation on nurses' perceptions of quality of care in Iran and its barriers and facilitators. Int J Health Plann Manage 2018; 34:e230-e240. [PMID: 30156711 DOI: 10.1002/hpm.2642] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Iran national hospital accreditation was initiated as a government and mandatory program in 2012. The aim of this study was to examine the impact of accreditation on nurses' perceptions of quality of care and to determine those barriers and facilitators needed for effective implementation of accreditation. METHODS A cross-sectional survey conducted in 43 tertiary public hospitals in 5 metropolises, Iran, which successfully passed national accreditation surveys. Participants included nurses with at least 5-year work experience. Overall response rate was 76%, with 1312 of 1706 valid responses included in the data analysis. A questionnaire was applied using a 5-point Likert scale ranging from 1 "strongly disagree" to 5 "strongly agree". In addition, the questionnaire included 2 open-ended questions allowing the respondent to identify barriers and facilitators to the process of for improving accreditation implementation. The relationship between the quality of results and the independent variables was tested using multiple regression analysis. RESULTS The scales measuring benefits of accreditation had the highest mean score followed by strategic quality planning, education and training, and staff involvement. Regression analysis indicated that leadership, commitment, and support; education and training; rewards and recognition; and staff involvement were factors affecting quality results. Barriers encountered included financial and capital resources, staff, institutional, and patients. Hospital accreditation has a positive impact on quality of care. CONCLUSIONS The findings of this study provide valuable information to policymakers and hospital managers on which to base the process of accreditation and its requirements, and to help reap its benefits.
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Affiliation(s)
- Nahid Reisi
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mobin Sokhanvar
- Student Research Committee, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Edris Kakemam
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Saut AM, Berssaneti FT, Moreno MC. Evaluating the impact of accreditation on Brazilian healthcare organizations: A quantitative study. Int J Qual Health Care 2018; 29:713-721. [PMID: 28992152 DOI: 10.1093/intqhc/mzx094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 07/04/2017] [Indexed: 01/25/2023] Open
Abstract
Objective The aim of this study was to evaluate the impact of accreditation programs on Brazilian healthcare organizations. Design A web-based questionnaire survey was undertaken between February and May 2016. Setting Healthcare organizations from the Federal District and from 18 Brazilian states. Participants The quality managers of 141 Brazilian healthcare organizations were the main respondents of the study. Intervention The questionnaire was applied to not accredited and accredited organizations. Main Outcome Measures The main outcome measures were patient safety activities, quality management activities, planning activities-policies and strategies, patient involvement, involvement of professionals in the quality programs, monitoring of patient safety goals, organizational impact and financial impacts. Results The study identified 13 organizational impacts of accreditation. There was evidence of a significant and moderate correlation between the status of accreditation and patient safety activities, quality management activities, planning activities-policies and strategies, and involvement of professionals in the quality programs. The correlation between accreditation status and patient involvement was significant but weak, suggesting that this issue should be treated with a specific policy. The impact of accreditation on the financial results was not confirmed as relevant; however, the need for investment in the planning stage was validated. Conclusions The impact of accreditation is mainly related to internal processes, culture, training, institutional image and competitive differentiation.
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Affiliation(s)
- Ana Maria Saut
- Department of Production Engineering, University of São Paulo (USP), Polytechnic School, Av. Prof. Almeida Prado, Trav 2, 128 São Paulo, SP 05508-900, Brazil
| | - Fernando Tobal Berssaneti
- Department of Production Engineering, University of São Paulo (USP), Polytechnic School, Av. Prof. Almeida Prado, Trav 2, 128 São Paulo, SP 05508-900, Brazil
| | - Maria Carolina Moreno
- Guarulhos Municipal Heatlh Department, Rua Íris, 300 Guarulhos, SP 07051-080, Brazil
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Hijazi HH, Harvey HL, Alyahya MS, Alshraideh HA, Al abdi RM, Parahoo SK. The Impact of Applying Quality Management Practices on Patient Centeredness in Jordanian Public Hospitals: Results of Predictive Modeling. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2018; 55:46958018754739. [PMID: 29482410 PMCID: PMC5833210 DOI: 10.1177/0046958018754739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 12/17/2017] [Accepted: 12/22/2017] [Indexed: 01/22/2023]
Abstract
Targeting the patient's needs and preferences has become an important contributor for improving care delivery, enhancing patient satisfaction, and achieving better clinical outcomes. This study aimed to examine the impact of applying quality management practices on patient centeredness within the context of health care accreditation and to explore the differences in the views of various health care workers regarding the attributes affecting patient-centered care. Our study followed a cross-sectional survey design wherein 4 Jordanian public hospitals were investigated several months after accreditation was obtained. Total 829 clinical/nonclinical hospital staff members consented for study participation. This sample was divided into 3 main occupational categories to represent the administrators, nurses, as well as doctors and other health professionals. Using a structural equation modeling, our results indicated that the predictors of patient-centered care for both administrators and those providing clinical care were participation in the accreditation process, leadership commitment to quality improvement, and measurement of quality improvement outcomes. In particular, perceiving the importance of the hospital's engagement in the accreditation process was shown to be relevant to the administrators (gamma = 0.96), nurses (gamma = 0.80), as well as to doctors and other health professionals (gamma = 0.71). However, the administrator staff (gamma = 0.31) was less likely to perceive the influence of measuring the quality improvement outcomes on the delivery of patient-centered care than nurses (gamma = 0.59) as well as doctors and other health care providers (gamma = 0.55). From the nurses' perspectives only, patient centeredness was found to be driven by building an institutional framework that supports quality assurance in hospital settings (gamma = 0.36). In conclusion, accreditation is a leading factor for delivering patient-centered care and should be on a hospital's agenda as a strategy for continuous quality improvement.
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Affiliation(s)
- Heba H. Hijazi
- Jordan University of Science and Technology, Irbid, Jordan
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van Weel C, Alnasir F, Farahat T, Usta J, Osman M, Abdulmalik M, Nashat N, Alsharief WM, Sanousi S, Saleh H, Tarawneh M, Goodyear-Smith F, Howe A, Kassai R. Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries. Eur J Gen Pract 2017; 24:39-44. [PMID: 29168411 PMCID: PMC5795637 DOI: 10.1080/13814788.2017.1397624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. Objectives: This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC. Methods: Data were collected during a workshop at the WONCA East Mediterranean Regional Conference in 2017. Academic family physicians (FP) presented their country, using the WONCA framework of 11 PowerPoint slides with queries of the country demographics, main health challenges, and the position of PHC in the health system. Results: All six countries have improved the health of their populations, but currently face challenges of non-communicable diseases, aging populations and increasing costs. Main concerns were a lack of trained FPs in community settings, underuse of prevention and of equitable access to care. Countries differed in the extent to which this had resulted in coherent policy. Conclusion: Priorities were (i) advocacy for community-based PHC to policymakers, including the importance of coordination of healthcare at the community level, and UHC to respond to the needs of populations; (ii) collaboration with universities to include PHC as a core component of every medical curriculum; (iii) collaboration with communities to improve public understanding of PHC; (iv) engagement with the private sector to focus on PHC and UHC.
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Affiliation(s)
- Chris van Weel
- a Department of Primary and Community Care , Radboud University Medical Centre , Nijmegen , The Netherlands.,b Department of Health Services Research and Policy , Australian National University , Canberra , Australia
| | - Faisal Alnasir
- c Department of Primary Care and Public Health , Imperial College , London , UK
| | - Taghreed Farahat
- d Department of Family Medicine , Menoufia University , Menoufia , Egypt
| | - Jinan Usta
- e Department of Family Medicine , American University of Beirut , Beirut , Lebanon
| | - Mona Osman
- e Department of Family Medicine , American University of Beirut , Beirut , Lebanon
| | | | - Nagwa Nashat
- d Department of Family Medicine , Menoufia University , Menoufia , Egypt
| | | | - Salwa Sanousi
- h Department of Family and Community Medicine , University of Gezira , Gezira , Sudan
| | - Hassan Saleh
- i Department of Health System Development , WHO EMR Office , Cairo , Egypt
| | | | - Felicity Goodyear-Smith
- k Department of General Practice and Primary Health Care , University of Auckland , Auckland , New Zealand
| | - Amanda Howe
- l Department of Population Health and Primary Care , University of East Anglia , Norwich , UK
| | - Ryuki Kassai
- m Department of Community and Family Medicine , Fukushima Medical University , Fukushima , Japan
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Abi Nader H, Watfa W. Why be a refugee camp doctor: the challenges, rewards and medical education aspects. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8:307-308. [PMID: 28829329 PMCID: PMC5572099 DOI: 10.5116/ijme.5985.c959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 08/05/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Hanina Abi Nader
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - William Watfa
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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El-Jardali F, Fadlallah R. A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan. BMC Health Serv Res 2017; 17:568. [PMID: 28814341 PMCID: PMC5559834 DOI: 10.1186/s12913-017-2528-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background Improving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems. Methods We used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources. Results Both Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking. Importantly, incentive systems that link contractual agreement, regulations, accreditation, and performance indicators are underutilized in Lebanon and absent in Jordan. At the healthcare organizational level, there is a need to instill a culture of continuous quality improvement and promote professional training in quality improvement and patient safety. Conclusion Study findings highlight the importance of aligning policies, organizations, methods, capacities and resources in order to institutionalize quality improvement and patient safety practices in health systems. Gaps and dysfunctions identified can help inform national deliberations and dialogues among key stakeholders in each study country. Findings can also inform future quality improvement efforts in the EMR and beyond, with a particular emphasis on LMICs. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2528-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fadi El-Jardali
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon. .,Center for Systematic Review in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
| | - Racha Fadlallah
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon.,Center for Systematic Review in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
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Debono D, Greenfield D, Testa L, Mumford V, Hogden A, Pawsey M, Westbrook J, Braithwaite J. Understanding stakeholders’ perspectives and experiences of general practice accreditation. Health Policy 2017; 121:816-822. [DOI: 10.1016/j.healthpol.2017.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 04/29/2017] [Accepted: 05/12/2017] [Indexed: 01/19/2023]
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Silva SD, Fonseca A. Portuguese primary healthcare – sustainability through quality management. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2017. [DOI: 10.1108/ijqrm-05-2015-0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to apply quality management tools and practices in the design of an integrated accreditation model for Local Health Trusts, in order to contribute to the sustainability of the Portuguese Primary HealthCare Service. Following the guidelines of the Portuguese Health Quality Strategy, the proposed model is an adaptation of the model from Agencia para la Calidad Sanitaria de Andaluzia.
Design/methodology/approach
The development of the integrated accreditation model was based on a literature review, complemented with observation and analysis of the usual working methods in a Local Health Trust (Western Oporto Health Trust).
Findings
Local Health Trusts include not only clinical management units but also non-clinical administrative units. Therefore, the National Model for Accreditation of HealthCare Institutions is not easily or directly applicable to them. To overcome this problem, the model proposed in this study incorporates ISO 9001 principles, widely accepted regarding organizational management. The success of the application of this model is highly dependent on the ability of public Primary HealthCare organizations to deal with potential problems such as resistance to change, lack of leadership and inadequate people management and involvement.
Originality/value
The integrated accreditation model proposed in this research is expected to promote the cohesion of Local Health Trust units, encouraging integrated quality management practices and continuous improvement strategies, leading Local Health Trusts, Primary Care and HealthCare in a global perspective toward sustainability.
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Healthcare Providers' Knowledge and Current Practice of Pain Assessment and Management: How Much Progress Have We Made? Pain Res Manag 2016; 2016:8432973. [PMID: 27965524 PMCID: PMC5124689 DOI: 10.1155/2016/8432973] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/08/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022]
Abstract
Context. Despite improvement in pain management and availability of clinical treatment guidelines, patients in Jordan are still suffering from pain. Negative consequences of undertreated pain are being recognized as a reason for further illnesses and poor quality of life. Healthcare providers (HCPs) are responsible for relieving pain of their patients. Objective. To evaluate the knowledge and attitudes of HCPs toward pain management in Jordan. Methods. A 16-item questionnaire with agree or disagree options was given to 662 HCPs in seven hospitals in Jordan who volunteered to participate in the study. Following data collection, the responses were coded and entered into SPSS. Results. There was a statistically significant difference (p < 0.004) in percentage scores between physicians (36%) and pharmacists (36%) versus nurses (24%). The level of knowledge was the best among physicians, followed by pharmacists specifically in the area of cancer pain management. Nurses scored the lowest for knowledge of pain assessment and management among HCPs. However, HCPs overall scores indicated insufficient knowledge specifically in relation to pain assessment and management among children.
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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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