Nursing in the hospital accreditation process: practice and implications in the work quotidian

Nurses' stress and resilience before and after evaluation for hospital accreditation

OBJECTIVES

to analyze and compare levels of stress and resilience in nurses before and after the assessment for maintenance of the Hospital Accreditation Certification.

METHODS

quantitative, observational, and longitudinal research, with 53 nurses from a philanthropic hospital, in the Rio Grande do Sul. Data collected in two stages, March, and July 2019, before the assessment visit and 60 days after, using the Bianchi Stress Scale and Resilience Scale. Descriptive and analytical statistics were employed.

RESULTS

the majority of participants showed an average stress level before and after the evaluation. The highest stress scores were related to Domains E (coordination of unit activities) and C (activities related to personnel administration). In both moments of the study, the participants had medium and high resilience.

CONCLUSIONS

managing people, processes, and assistance are stressful activities in the Accreditation process and increase the nurses' stress levels.

A framework for the implementation of certification procedures in nurse level: a mixed approach study

Background

The implementation of certification procedures across healthcare systems is an essential component of the management process. Several promising approaches were developed toward a successful implementation of such policies; however, a precise adaptation and implementation to each local context was essential. Local activities must be considered in order to generate more pragmatic recommendations for managers. In this study, we built a framework for the implementation of certification procedures at nurse activity level. This was developed using two objectives: the identification of key implementation process components, and the integration of these components into a framework which considered the local socio-material context of nurses’ work.

Methods

We used a two-step mixed approach. The first was inductive and consisted of a qualitative case study conducted between April and December 2019. Here, we analyzed the implementation of certification procedures in a French teaching hospital. Data were collected using semi-structured interviews and observations. In the second approach, emerging data were deductively analyzed using the Quality Implementation Tool (QIT) and Translational Mobilization Theory (TMT). Analyses were combined to construct an implementation framework.

Results

Sixteen interviews were conducted with participants from different organizational levels, managers, mid-managers, and nurses. Additionally, 83 observational hours were carried out in two different wards. Our results showed that, (1) All retrieved elements during the process were successfully captured by the QIT components, only one component was not applicable. (2) We identified elements related to the local activity context, with the different interrelationships between actors, actions, and contexts using the TMT. (3) Our analyses were integrated and translated into a framework that presents the implementation of certification procedures in healthcare facilities, with a specific interest to the nurse/mid-manager level. By initially using QIT, the framework components took on a transversal aspect which were then adapted by TMT to the local work context.

Conclusions

We successfully generated a framework that supports the implementation of certification procedures at the activity level. Our approach identified a broader vision of the interactions between proximity managers, teams, and contexts during change mobilization, which were not encompassed by transversal framework only, such as QIT. In the future, more empirical studies are needed to test this framework.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06940-0.

Association and correlation between stress, musculoskeletal pain and resilience in nurses before hospital accreditation maintenance assessment

OBJECTIVE

to associate and correlate musculoskeletal pain, stress and resilience of nurses in the maintenance of Hospital Accreditation Certification.

METHOD

longitudinal study in two moments, before and after the Accreditation maintenance visit, March and June 2019, with 53 nurses from a hospital institution. The data collected was: sociodemographic, clinical and occupational variables, stress, osteomuscular pain and resilience. Descriptive variables, Chi-square test, t test, Fisher's exact test, Pearson's correlation and Spearman's correlation coefficient were used.

RESULTS

most of the study participants had average stress levels before and after the evaluation. Most of those who reported pain were at medium stress levels at both times. The resilience capacity increased after the evaluation, which demonstrates that the experienced stressors were adequately addressed. There was no significant association between the cortisol levels and the perceived stress.

CONCLUSION

occupational stress and musculoskeletal pain were experienced by nurses during the Accreditation processes. It was evident that individuality permeated the perception of stress and resilience allowed to overcome the tensions experienced. The study identified that there is a need for planning and implementation of actions to collaborate with the nurses in the best confrontation, aiming to promote resilience.

Preparing for a Joint Commission Survey: An Innovative Approach to Learning

Graduate nurses report feeling unprepared for accreditation site visits, including the promotion of a safe, functional, supportive environment to preserve safety and quality through the provision of care, treatment, and services for patients. To address this gap, an academic health system's department of quality and a school of nursing collaborated on a three-phase capstone course for senior-level BSN students. The course included simulation training for all students; volunteers performed Environment of Care rounds and patient care record audits in the hospital setting. Nineteen students, who performed 74 rounds and 193 audits, reported feeling more knowledgeable during site visits.

Quality as perceived by nursing professionals in an accredited specialized hospital

OBJECTIVE

To identify quality of service in an accredited specialized hospital according to nursing professionals' expectations and perceptions.

METHOD

This is a cross-sectional quantitative study with the participation of 34 employees, conducted from August to October 2017 by administration of an adapted and validated version of the SERVQUAL scale.

RESULTS

The interviewees reported as their highest expectations the transmission of confidence and provision of safe services, the latter also turning out to be the best perception of service. Promotional materials were considered as the least important expectation. The perception with the lowest scores was related to the time of service delivery at the institution, which may be associated with specific factors. Safety of service was considered as the quality dimension with greater relevance.

CONCLUSION

It is highlighted the importance of measures for maintenance of schedules and preservation of good forms of promotion, communication and team training.

Role of a hospital accreditation program in developing a process management system

Purpose

The purpose of this paper is to clarify the effects of the Iranian Hospital Accreditation Program (IHAP) on hospital processes from the viewpoint of the staff charged with establishing the program.

Design/methodology/approach

This qualitative study is based on the data collected in semi-structured interviews conducted in 2016, which involved eight questions. Interviews were held with 70 staff members at 14 hospitals. Managerial staff were purposively interviewed based on their familiarity and involvement with the program. The hospitals were divided into five groups, comprising public, private, charity, military and social service hospitals. A thematic analysis was carried out using the collected data.

Findings

Three themes emerged from the data, which together comprise a process management cycle: the establishment, implementation, and control phases of the program. For each phase, various positive trends, as well as hurdles for establishing the program, declared which were framed two sub-themes as positive effects and challenges.

Originality/value

The findings contribute to the body of evidence used by policy-makers and hospital managers to improve the change management processes related to the Iranian IHAP. Although positive changes in the process management cycles at Iranian hospitals were noted, successful implementation of the program demands a thorough assessment of the hospitals’ technical and financial needs (taking into account disparities between hospitals), and there is an urgent requirement for a plan to meet these needs.

Effect of Health Care Accreditation Council survey site visit on perceived stress level among Jordanian healthcare providers

AIM

To assess perceived stress levels among healthcare providers in public and private hospitals before and after Health Care Accreditation Council (HCAC) survey site visits.

METHODS

A cross-sectional, descriptive design was used in this study. A convenience sampling technique was used to recruit study participants. A self-administered questionnaire (PSS-10) was used to collect data. Descriptive statistics, dependent sample t test, independent sample t test, and multiple linear regression analysis were used to analyze data.

RESULT

The results showed that stress levels were higher before a HCAC survey site visit (M = 18.39, SD = 4.3) than after ( M = 14.09, SD = 6.1) ( t(210) = 8.7, P ≤ 0.000) among healthcare providers. Between hospitals, the perceived stress level of healthcare providers was higher in the public hospital ( M = 19.03, SD = 4.3) compared with the private hospital ( M = 17.8, SD = 4.2) ( t(209) = 2.16, P = 0.031) before the HCAC survey site visit. In contrast, there were no differences in perceived stress level for the public and private hospitals ( t(209) = 0.001, P = 0.999) after the HCAC survey site visit. Finally, the type of hospital was the only sociodemographic characteristic that predicted the perceived stress level before the HCAC survey site visit ( β = -0.157, P = 0.040). In contrast, there were no sociodemographic characteristics that predicted the perceived stress level after the HCAC survey site visit.

CONCLUSIONS

The current study indicated that hospital accreditation is a process associated with significant stress (P = 0.000) among healthcare providers in both hospitals before and after an HCAC survey site visit. Moreover, there was a significant level of stress before an HCAC survey site visit in the public hospital ( M = 19.03) compared with the private hospital ( M = 17.8, P = 0.031).

Comparative study: TQ and Lean Production ownership models in health services

Objective:

compare the application of Total Quality (TQ) models used in processes of a health service, cases of lean healthcare and literature from another institution that has also applied this model.

Method:

this is a qualitative research that was conducted through a descriptive case study.

Results:

through critical analysis of the institutions studied it was possible to make a comparison between the traditional quality approach checked in one case and the theoretical and practice lean production approach used in another case and the specifications are described below.

Conclusion:

the research identified that the lean model was better suited for people that work systemically and generate the flow. It also pointed towards some potential challenges in the introduction and implementation of lean methods in health.

Quality Program: what influences the opinion of nursing team

Objective

To analyze the major impact variables in the opinion of nursing staff about the Quality Program of a teaching hospital.

Methods

An exploratory-descriptive study was performed with 72 nursing staff. Data were collected through self-administered questionnaire containing 24 statements about the Quality Program; and the degree of agreement of the participants was expressed in a Likert scale. The collected data were analyzed by factor analysis and Pearson’s correlation coefficient.

Results

The analysis grouped the statements in six factors. The Pearson’s correlation coefficient defined a scale of influence of the variables within each factor, whose variable with the greatest impact in each factor is the priority issue for improving worker opinion about the Quality Program. The priority variables were to believe the Quality Program contributes to the hospital; to understand the program orientations; interest in hospital quality direction; and do not feel exhausted due to the program.

Conclusion

These variables must be focused during the implementation and execution of Quality Program, as they have greater impact on improving opinion regarding the Quality Program and thus helping to increase compliance of the nursing staff to the program.

Perception of the nursing team of a Surgical Center regarding Hospital Accreditation at a University Hospital

Objective To analyze the perception of nursing teams at a surgical center regarding the process of hospital accreditation, in the evaluative aspects of structure, process, and result. Method The study takes a quantitative and exploratory-descriptive approach, carried out at a university hospital. Result The population consisted of 69 nursing professionals, and the data collection was performed in the months of January and February 2014 by way of a questionnaire, utilizing the Likert scale. The methodology used a Cronbach's Alpha equal to 0.812. In the comparison of the three aspects, the one with the highest favorability score was "result", with an average of 47.12 (dp±7.23), and the smallest was "structure," with an average of 40.70 (dp±5.19). Conclusion This situational diagnostic can assist in the restructuring of the vulnerable areas evaluated in these three aspects, mainly in the aspect of structure, with a goal of level 2 accreditation by the ONA (Brazilian's National Organization for Accreditation) defended by the Institution.

Best practice of nurse managers in risk management

OBJECTIVE

To identify the actions, undertaken by nurse managers in a risk management program, considered as best practice.

METHOD

A case study undertaken in a private hospital in the south of Brazil. A risk manager and nurse managers working in a risk management program participated in this study. The data was collected between May and September 2011 through analysis of documents, semi-structured interviews and non-participant observation. Based on the triangulation, the data was analyzed through practical measures.

RESULTS

Educational actions, the critical analysis of the context, and the multiple dimensions of the management were evidenced as best practice.

CONCLUSIONS

The broadening of understanding regarding risk management best practice offers further support for nurse managers to achieve excellence in their actions and thus provide safe and quality care.

Perceptions of nurses on the impact of accreditation on quality of care

Purpose

– This article aims to investigate perceptions of Turkish nurses on the impact of accreditation on quality of care and the effect of accreditation on quality results.

Design/methodology/approach

– This study was performed as a cross-sectional, questionnaire-based survey on 258 nurses who started working in the hospital before it was accredited and continued to work during and after accrediation and who therefore knew both the hospital's pre-accrediation and post-accreditation periods. In this study, descriptive statistical analyses (means and standard deviations) were carried out to explore the views of the participants on “quality results,” “benefits of accreditation” and “participation of employees.” “Quality results” was considered to be the dependent variable, while “benefits of accreditation” and “participation of employees” were accepted as the independent variables. The relationship between the dependent variable and the independent variables was tested using Pearson correlation and multiple regression analysis. External patient satisfaction data collected by the quality department of the hospital before and after accreditation were also investigated.

Findings

– It was found that nurses had generally high scores for the items concerning the benefits of accreditation. There was a statistically significant positive correlation between the dependent variable (quality results) and the independent variables (benefits of accreditation and participation of employees). Regression analysis indicated that R2=0.461 and the extent to which the independent variables explained the dependent variable was 46.1 per cent, which is a high rate. Patient satisfaction scores increased after accreditation.

Practical implications

– Our study suggest that providing support for nurses, especially nurses with administrative responsibilities and incorporating employees into the process are important for exercising quality standards.

Originality/value

– Hospital accreditation has a positive impact on quality results especially on quality of care provided to patients and patient satisfaction. Study findings could guide policy makers and hospital managers in Turkey and in other countries who are preparing or implementing accreditation.

Influência da comunicação no processo de acreditação hospitalar

O objetivo do estudo foi analisar, na perspectiva de profissionais, as principais barreiras de comunicação vivenciadas no decorrer do processo de acreditação em um hospital privado de médio porte de Belo Horizonte. Trata-se de um estudo qualitativo, envolvendo 34 profissionais de saúde de categorias diferentes. Os resultados da pesquisa mostraram que a escassez de informação, a falta de objetividade, clareza e integridade no repasse de conhecimento favorecem a ruptura da prestação de serviços de qualidade. A comunicação organizacional é uma ferramenta eficaz para subsidiar mudanças importantes nas empresas, como o alcance da acreditação hospitalar. Articulando a mudança de forma concisa e clara no que se refere à comunicação, poderá ser alcançado perenemente o padrão de qualidade.