The Impact of a National Accreditation Program on Patient Safety Culture in a Tertiary Hospital: Pre- and Post-Evaluation Study

Perception of Health Care Professionals Toward Hospital Accreditation at Johns Hopkins Aramco Healthcare

BACKGROUND AND OBJECTIVES

The quality of health care relies on achieving the best quality and patient safety goals, and accreditation plays a fundamental role in achieving these goals through compliance with standards that guide excellence. Accreditation also helps streamline operations and supports evidence-based quality improvement plans. This study aims to evaluate the perception of health care professionals on the accreditation process and its impact on the quality of health care and patient safety.

METHODS

This is a cross-sectional questionnaire survey distributed via the SuccessFactors website and made accessible to all hospital staff.

RESULTS

The online questionnaire was completed by 2047 participants, representing 51% of the entire hospital staff at Johns Hopkins Aramco Healthcare (JHAH). Overall analysis indicated a positive perception of accreditation benefits among health care employees (as indicated by participation in accreditation activities and/or preparation for the survey visits) and reflected on patient health care quality and safety dimensions, with an overall Likert median score of 4.0 (interquartile range = 3.7-5.0; P < .05).

CONCLUSION

The outcomes of our study confirm that JHAH employees perceived a positive impact of accreditation on health care quality improvement and patient safety. Also, the study supports considering accreditation as a fundamental requirement to improve health care system processes. However, it is critical to sustain quality of services over time during accreditation cycles.

The Attitude of Hospital Directors Towards Normalising Accreditation Standards: A Qualitative Descriptive Study for Saudi Arabia

Background

Accreditation is an important performance management tool. The engagement of stakeholders in pursuing accreditation plays a critical role in integrating standards into routine practice.

Objective

This study explores the attitude of hospital directors towards accreditation and investigates the mechanisms of normalising standards in Saudi Arabian hospitals.

Methods

Fifteen hospital directors across Saudi Arabia participated in semi-structured qualitative interviews. The interviews were conducted virtually, audiotaped, transcribed verbatim, and then analysed thematically using the NVivo-12 software package. The normalisation process theory (i.e. coherence, participation, actions and monitoring) was adopted to frame the study and describe the findings on normalising accreditation standards heuristically.

Results

Overall, the hospital directors perceived accreditation favourably, particularly by those with more experience or previous exposure to accreditation. This attitude was a factor in normalising standards into daily operations. The clarity of standards, availability of full-time quality professionals and alignment of accreditation standards with hospital strategies assisted hospital directors in making sense of accreditation (coherence) and moving towards engaging hospital teams in the process (cognitive participation). This motivation-driven engagement catalysed the initiation of purposeful operational activities to integrate standards in operations (collective actions). The integration included distributing standard sets to relevant owners, conducting gap analysis, constructing a corrective plan and prioritising tasks within timeframes. Despite the financial and structural constraints experienced, the integration resulted in enhanced organisational safety culture, team spirit, communication, public trust, reporting of safety concerns and standardising of procedures. Following the integration, the objective appraisal of accreditation benefits (reflexive monitoring) was critical in addressing what went wrong, what worked well, and subsequently in sustaining performance gains.

Conclusion

The effectiveness of integrating accreditation standards heavily relies on making sense of accreditation and understanding the mechanisms through which standards are routinised into operations. This study, using normalisation process theory constructs, indicates that standards integration phases are sequential, interlinked and influenced by culture, teamwork and leadership engagement. The findings helped in clarifying the accreditation operating process which may provide advantages to policymakers and stakeholders in making informed decisions on the implementation of accreditation.

Stakeholders’ Perception of the Palestinian Health Workforce Accreditation and Regulation System: A Focus on Conceptualization, Influencing Factors and Barriers, and the Way Forward

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.

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

Introduction

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

Methods

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

Results

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

Conclusions

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