The attitude of health care professionals towards accreditation: A systematic review of the literature

Challenges and Strategies in Implementing Hospital Accreditation Standards Among Healthcare Professionals in Healthcare Systems in Yemen: A Phenomenological Study

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.

Engaging healthcare professionals and patient representatives in the development of a quality model for hospitals: a mixed-method study

Top-down and externally imposed quality requirements can lead to improvement but do not seem as sustainable as intended. There is a need for a quality model that intrinsically motivates healthcare professionals to contribute to quality and safe care in hospitals. This study shows how a quality model that matches the identity and the quality vision of the organization was developed. A multimethod design with three phases was used in the development of the model at a large teaching hospital in Belgium. In the first phase, 14 focus groups and 19 interviews with staff members were conducted to obtain an overview of the quality and safety challenges, complemented by a plenary discussion with the members of the patient advisory council. In the second phase, the challenges that had been captured were further assessed using a hospital-wide survey for all hospital staff. Finally, a newly established quality review board (with internal and external stakeholders) critically evaluated the input of Phases 1 and 2 and defined the basic quality standards to be implemented in the hospital. A first evaluation 2 years after the implementation was conducted based on (i) patients' perceptions of quality of care and patient safety by publicly available indicators collected in 2016, 2019, and 2022 and (ii) staff experiences and perceptions regarding the acceptability of the new model gathered through (grouped) interviews and an open questionnaire. The quality model consists of eight broad themes, including norms for the hospital staff (n = 27), sustained with quality systems (n = 8), and organizational support (n = 6), with aid from adequate management and leadership (n = 6). The themes were converted into 46 standards. These should be supported within a safe, efficient, and caring work environment. The new model was launched in the hospital in June 2021. The evaluation shows a significant difference in quality and safety on different dimensions as perceived by hospitalized patients. The perceived added value of the participatory model is a better fit with the needs of employees and the fact that the model can be adjusted to the specific context of the different hospital departments. The lack of hard indicators is seen as a challenge in monitoring quality and safety. The participation of various stakeholders inside and outside the organization in defining the quality challenges resulted in the creation of a participatory quality model for the hospital, which leads towards a better-supported quality policy in the hospital.

Barriers and Facilitators to Implementing the National Patient Safety Implementation Framework in Public Health Facilities in Tamil Nadu: A Qualitative Study

BACKGROUND

In 2017, the National Patient Safety Implementation Framework (NPSIF) was introduced in India to ensure patient safety at different levels of the health care delivery system by 2025. Evaluating the implementation status, feasibility, and challenges and obtaining suggestions for improvement are key to the successful and sustainable implementation of any national health framework. Hence, we explored the facilitators and challenges in implementing the NPSIF and sought suggestions to address the challenges.

METHODS

We adopted a descriptive qualitative approach to inquire about NPSIF implementation. Health care workers were selected using maximum variability sampling from 18 secondary- and tertiary-level public health care facilities in Tamil Nadu, India. From August to October 2021, we conducted a total of 80 key informant interviews and in-depth interviews with the relevant officers in-charge and HCWs of varied cadres.

RESULTS

Facilitating factors reported were facilities obtaining/working toward quality certification; availability of standard protocols and checklists; and government rewards for the best-performing hospitals, doctors, and staff. Major implementation challenges reported were staff shortages; lack of infrastructure, facilities, and equipment; lack of awareness about patient safety, noncompliance to standard guidelines, and lack of patient cooperation. Recommendations suggested to overcome these challenges included providing educational materials to patients, offering regular continuing medical education and training, improving record maintenance, having a dedicated staff/team and surveillance system setup for patient safety and dedicated staff for data entry, filling existing staff vacancies, and using a carryover option for funding.

CONCLUSION

Based on the current situation of patient safety practices in public health facilities in Tamil Nadu, it will be difficult to achieve full-scale implementation of the NPSIF by 2025. However, as a first step, a core patient safety committee can be formed at the state level to develop a Gantt chart for implementation based on the priorities over the next 2 years.

Impact of hospital accreditation on quality improvement in healthcare: A systematic review

OBJECTIVE

This is the first systematic review aims to build the evidence for the impact of accreditation on quality improvement of healthcare services, as well as identify and develop an understanding of the contextual factors influencing accreditation implementation in the hospital setting through the lens of Normalisation Process Theory (NPT).

DATA SOURCES

Data were gathered from five databases; MEDLINE, PUBMED, EMBASE, CINAHL, and the Cochrane Library. And supplemental sources.

STUDY DESIGN

This systematic review is reported following PRISMA guidelines with a quality assessment. Data were analysed using a thematic analysis guided by the NPT theoretical framework.

DATA COLLECTION/EXTRACTION METHODS

Data were extracted and summarized using prespecified inclusion/exclusion criteria and a data extraction sheet encompassing all necessary information about the studies included in the review.

PRINCIPAL FINDINGS

There are inconsistent findings about the impact of accreditation on improving healthcare quality and outcomes, and there is scant evidence about its effectiveness. The findings also provide valuable insights into the key factors that may influence hospital accreditation implementation and develop a better understanding of their potential implications. Using the NPT shows a growing emphasis on the enactment work of the accreditation process and how this may drive improving the quality of healthcare services. However, little focus is given to accreditation's effects on health professionals' roles and responsibilities, strategies and ways for engaging health professionals for effective implementation, and ensuring that the goals and potential benefits of accreditation are made clear and transparent through ongoing evaluation and feedback to all health professionals involved in the accreditation process.

CONCLUSIONS

While there are contradictory findings about the impact of accreditation on improving the quality of healthcare services, accreditation continues to gain acceptance internationally as a quality assurance tool to support best practices in evaluating the quality outcomes of healthcare delivered. Policymakers, healthcare organisations, and researchers should proactively consider a set of key factors for the future implementation of accreditation programmes if they are to be effectively implemented and sustained within the hospital setting. Systematic review registration: International Prospective Register of Systematic Reviews PROSPERO 2020 CRD42020172390 Available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=172390.

Factors that influence the implementation of (inter)nationally endorsed health and social care standards: a systematic review and meta-summary

BACKGROUND

Health and social care standards have been widely adopted as a quality improvement intervention. Standards are typically made up of evidence-based statements that describe safe, high-quality, person-centred care as an outcome or process of care delivery. They involve stakeholders at multiple levels and multiple activities across diverse services. As such, challenges exist with their implementation. Existing literature relating to standards has focused on accreditation and regulation programmes and there is limited evidence to inform implementation strategies specifically tailored to support the implementation of standards. This systematic review aimed to identify and describe the most frequently reported enablers and barriers to implementing (inter)nationally endorsed standards, in order to inform the selection of strategies that can optimise their implementation.

METHODS

Database searches were conducted in Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SocINDEX, Google Scholar, OpenGrey and GreyNet International, complemented by manual searches of standard-setting bodies' websites and hand searching references of included studies. Primary qualitative, quantitative descriptive and mixed methods studies that reported enablers and barriers to implementing nationally or internationally endorsed standards were included. Two researchers independently screened search outcomes and conducted data extraction, methodological appraisal and CERQual (Confidence in Evidence from Reviews of Qualitative research) assessments. An inductive analysis was conducted using Sandelowski's meta-summary and measured frequency effect sizes (FES) for enablers and barriers.

RESULTS

4072 papers were retrieved initially with 35 studies ultimately included. Twenty-two thematic statements describing enablers were created from 322 descriptive findings and grouped under six themes. Twenty-four thematic statements describing barriers were created from 376 descriptive findings and grouped under six themes. The most prevalent enablers with CERQual assessments graded as high included: available support tools at local level (FES 55%); training courses to increase awareness and knowledge of the standards (FES 52%) and knowledge sharing and interprofessional collaborations (FES 45%). The most prevalent barriers with CERQual assessments graded as high included: a lack of knowledge of what standards are (FES 63%), staffing constraints (FES 46%), insufficient funds (FES 43%).

CONCLUSIONS

The most frequently reported enablers related to available support tools, education and shared learning. The most frequently reported barriers related to a lack of knowledge of standards, staffing issues and insufficient funds. Incorporating these findings into the selection of implementation strategies will enhance the likelihood of effective implementation of standards and subsequently, improve safe, quality care for people using health and social care services.

Perception of the Accreditation of the National Commission for Academic Accreditation and Assessment at Different Health Colleges in Jeddah, Saudi Arabia

Introduction Following the guidelines for maintaining quality set forth by the National Commission for Academic Accreditation and Assessment (NCAAA) accreditation procedure, Saudi higher education institutions, including health sciences colleges, must adhere to these guidelines. This study aims to assess the perception of personnel involved in NCAAA accreditation processes about the purpose, process, motivation, and level of involvement in the NCAAA accreditation at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). Methods The study was conducted at KSAU-HS, Jeddah. The participants included 15 administrators and 32 faculties from the College of Medicine, College of Applied Medical Sciences, and College of Nursing with experience in the NCAAA process. A questionnaire was used to determine how motivated and involved people feel about the accreditation process. Data were examined statistically with SPSS (Version 23; IBM Corp., Armonk, NY, USA), and descriptive statistics were used. Results Forty-seven participants (23 men, 24 women, ages 36 to 55) took part in the study, of which 68% were faculty members and 32% were administrators with a variety of skill sets from the three colleges. Most participants displayed a positive attitude toward the NCAAA accreditation's motive and level of commitment. Conclusions Most of the participants in the current study contended with the NCAAA process and deemed it substantial long-term improvements.

Implementing a quality improvement initiative for private healthcare facilities to achieve accreditation: experience from India

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.

Medical laboratory accreditation status and associated factors in selected private and government health facilities of Addis Ababa, Ethiopia

Introduction

quality medical laboratory service(s) is a key to patient safety with a great emphasis on medical diagnoses and treatment. ISO 15189 laboratory accreditation is an effective way to demonstrate competency. Despite the benefits, there are considerable exigent efforts towards achieving its target, mainly in sub-Saharan Africa. Hence, determining those factors that hinder laboratory quality services and the process of accreditation is important to address and resolve. Thus, this study aimed to assess medical laboratory accreditation process and in selected private and government health facility laboratories in Addis Ababa, Ethiopia.

Methods

institutional-based cross-sectional study design was conducted in Addis Ababa from July 1 to August 30, 2018. Data was entered into EPI-data version 3.1 and analyzed by SPSS version 23. Data from focus group discussions were categorized and discussed thematically. Additionally, logistic regression analyses were computed to examine the relationship between the explanatory and response variable.

Results

a total of 411 professionals participated in this study, of which 117(28.8%) participants were female, 280 (68.2%) participants with a bachelor´s degree, and 352 (85.6%) participants had information about accreditation. The current laboratory accreditation status in Addis Ababa is 3.6%. The primary identified factors were gaps related to method verification/validation, equipment calibration, and continual program quality improvement.

Conclusion

strengthening laboratory management standards towards accreditation (SLMTA) will significantly improve the accreditation process. However, there are internal and external factors may hinder the current accreditation process. Therefore, all responsible agencies/services should give more attention to solving those identified major barriers to achieving accreditation.

Evaluation of National Patient Safety Implementation Framework in Selected Public Healthcare Facilities of Tamil Nadu: An Operational Research

BACKGROUND

The Ministry of Health and Family Welfare has introduced the "National Patient Safety Implementation Framework" to ensure the patient safety at different levels of healthcare delivery system. However, there is limited effort made in evaluating the implementation status of this framework. Hence, we have performed the process evaluation of National Patient Safety Implementation Framework across the public healthcare facilities in Tamil Nadu.

METHODS

This was a facility-level survey conducted by research assistants who visited 18 public health facilities across 6 districts of Tamil Nadu, India, for the purpose of documenting the presence of structural support systems and strategies to promote patient safety. We developed a tool for data collection based on the framework. It comprised a total of 100 indicators under the following domains and subdomains: structural support, systems for reporting, workforce, infection prevention and control, biomedical waste management, sterile supplies, blood safety, injection safety, surgical safety, antimicrobial safety, and COVID-19 safety.

RESULTS

Only one facility (subdistrict hospital) belonged to the high-performing category with a score of 79.5 on the implementation of patient safety practices. About 11 facilities (4 medical colleges and 7 Government Hospitals) belonging to medium-performing category. The best-performing medical college had a score of 61.5 for patient safety practices. Six facilities (2 medical colleges, 4 Government Hospitals) belonged to low-performing category in terms of patient safety. The least-performing facilities (both subdistrict hospitals) had scores of 29.5 and 26 for patient safety practices, respectively. Because of COVID-19, there was a positive effect on biomedical waste management and infectious disease safety across all facilities. Most performed poor in the domain with structural systems to support quality and efficiency of healthcare and patient safety.

CONCLUSIONS

The study concludes that based on the current situation of patient safety practices in public health facilities, it will be difficult to perform full-fledged implementation of patient safety framework by the year 2025.

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.

The deployment of balanced scorecard in health care organizations: is it beneficial? A systematic review

BACKGROUND

Balanced Scorecard (BSC) has been implemented for three decades to evaluate and improve the performance of organizations. To the best of the researchers' knowledge, no previous systematic review has performed a comprehensive and rigorous methodological approach to figure out the impact of BSC implementation in Health Care Organizations (HCO).

AIMS

The current work was intended to assess the impact of implementing the BSC on Health Care Workers' (HCW) satisfaction, patient satisfaction, and financial performance.

METHODS

The authors prepared the present systematic review according to PRISMA guidelines. Further, the authors customized the search strategy for PubMed, Embase, Cochrane, Google Scholar databases, and Google's search engine. The obtained studies were screened to isolate those measuring scores related to HCW satisfaction, patient satisfaction, and financial performance. The Risk of Bias (RoB) in the non-Randomized Intervention Studies (ROBINS-I) tool was used to assess the quality of observational and quasi-experimental studies. On the other hand, for the Randomized Controlled Trials (RCTs), the Cochrane (RoB 2) tool was used.

RESULTS

Out of 4031 studies, the researchers included 20 studies that measured the impact of BSC on one or more of the three entities (HCW satisfaction, patient satisfaction, and financial performance). Throughout these 20 studies, it was found that 17 studies measured the impact of the BSC on patient satisfaction, seven studies measured the impact on HCW satisfaction, and 12 studies measured the impact on financial performance.

CONCLUSION

This systematic review provides managers and policymakers with evidence to support utilizing BSC in the health care sector. BSC implementation demonstrated positive outcomes for patient satisfaction and the financial performance of HCOs. However, only a mild impact was demonstrated for effects related to HCW satisfaction. However, it is worth noting that many of the studies reflected a high RoB, which may have affected the impacts on the three primary outcomes measured. As such, this systematic review reflects the necessity for further focus on this area in the future. Moreover, future research is encouraged to measure the real and current impact of implementing BSC in HCO during the pandemic since we did not find any.

The perceptions of healthcare professionals about accreditation and its impact on quality of healthcare in Kuwait: a qualitative study

RATIONALE, AIMS, AND OBJECTIVES

The accreditation of healthcare organizations has been applied as a quality assurance mechanism of healthcare services. Kuwait health authorities implemented a national healthcare accreditation program at the governmental healthcare system. This study aimed to explore the perceptions of healthcare professionals (HCPs) about healthcare accreditation, perceived challenges to implementing accreditation, and views on how to overcome these challenges.

METHODS

A phenomenological qualitative framework was adopted to conduct focus group interviews to explore perceptions of HCPs about accreditation in governmental healthcare system. Data were collected from 30 HCPs using seven focus group interviews. The verbatim transcripts of the interviews were analysed using the framework approach.

RESULTS

The HCPs indicated that accreditation enhanced patient safety culture at their organizations through staff adherence to good practices, improved documentation and patient handover practices, and incident reporting. The facilitators to the implementation of accreditation that emerged from interviews included administrative support, staff training about accreditation, and expansion in application of electronic systems. Participants reported several challenges to implementing accreditation including challenges related to staff (eg, high workload, burdens imposed by accreditation requirements), challenges related to organizational system and resources (eg, poor teamwork among HCPs, inadequate infrastructure in some facilities), and challenges related to patients (eg, poor understanding about accreditation). However, most participants expressed positive attitudes towards accreditation and appreciated its impact on quality of healthcare. Participants suggested ways to support accreditation such as increasing staff numbers to reduce workload, enhancing staff motivation and education about accreditation, developing proactive leadership and staff teamwork, and improving patients' awareness about accreditation.

CONCLUSIONS

HCPs in Kuwait expressed positive attitudes towards accreditation while also recognizing the challenges that may hinder its implementation. The collaboration between different stakeholders in this process is essential to overcome these challenges and support HCPs to meet accreditation standards and improve quality of healthcare services.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The future of hospital quality of care policy: A multi-stakeholder discrete choice experiment in Flanders, Belgium

BACKGROUND

Collaboration between policymakers, patients and healthcare workers in hospital quality of care policy setting can improve the integration of new initiatives. The aim of this study was to quantify preferences for various characteristics of a future quality policy in a broad group of stakeholders.

MATERIALS AND METHODS

450 policymakers, clinicians, nurses, patient representatives and hospital board members in Flanders (Belgium) participated in five discrete choice experiments (DCE) on quality control, quality improvement, inspection, patient incidents and transparency. For each DCE, various attributes and levels were defined from a literature review and interviews with 12 international quality and patient safety experts.

RESULTS

For the attributes with the highest relative importance, participants exhibited a strong preference for quality control by an independent national organization and coordination of quality improvement initiatives at the level of hospital networks. The individual hospital was chosen over the government for setting up an action plan following patient complaints. Respondents also strongly preferred mandatory reporting of severe patient incidents and transparency by publicly reporting quality indicators at the hospital level.

CONCLUSIONS

A future quality model should focus on a multicomponent approach with external quality control, improvement actions on hospital network level and public transparency. DCEs provide an opportunity to incorporate the attitudes and views for individual components of a new policy recommendation.

Laboratory professionals' attitudes towards ISO 15189:2012 accreditation: an anonymous survey of three Croatian accredited medical laboratories

Introduction

Effective implementation and continual compliance with ISO 15189:2012 require ongoing commitment and active involvement of laboratory staff. Our aim was to assess attitudes regarding accreditation implementation by conducting a survey in three Croatian accredited medical laboratories.

Materials and methods

An anonymous survey consisting of 34 questions was distributed either electronically or in a paper form a week prior to scheduled annual audits. Distributions of answers regarding age, work experience, laboratory workplace, and education level and according to the respective laboratory were compared.

Results

The overall response rate was 76% (225/297). Preference towards working in an accredited laboratory and a positive attitude were revealed by 70% and 56% participants, respectively, with better process documentation as the main advantage. Only 14% of responders considered themselves completely familiar with ISO 15189:2012. Total of 68% of responders felt that accreditation increases the usual workload, with excessive paperwork as the main contributor. Half of the responders declared partial agreement that accreditation requirements and expectations were clearly explained and claimed that their suggestions were taken into account only occasionally, which was especially emphasized by technical staff. The vast majority (89%) completely follow the prescribed protocols. Only 27% consider turnaround time monitoring useful. Competence assessment is considered efficient by 41% of responders. The majority (73%) prefer an online audit in times of COVID-19.

Conclusions

Despite an overall positive attitude towards accreditation, further efforts are needed in providing better education about ISO 15189:2012 for technical staff and modifying formats of competence assessment, in order to achieve better adherence to ISO 15189:2012 requirements.

Perception of Hospital Accreditation Impact among Quality Management Professionals in India: A Survey-Based Multicenter Study

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.

The development of hospital accreditation in low- and middle-income countries: a literature review

Hospital accreditation has been transferred from high-income countries (HICs) to many low- and middle-income countries (LMICs), supported by a variety of advocates and donor agencies. This review uses a policy transfer theoretical framework to present a structured analysis of the development of hospital accreditation in LMICs. The framework is used to identify how governments in LMICs adopted accreditation from other settings and what mechanisms facilitated and hindered the transfer of accreditation. The review examines the interaction between national and international actors, and how international organizations influenced accreditation policy transfer. Relevant literature was found by searching databases and selected websites; 78 articles were included in the analysis process. The review concludes that accreditation is increasingly used as a tool to improve the quality of healthcare in LMICs. Many countries have established national hospital accreditation programmes and adapted them to fit their national contexts. However, the implementation and sustainability of these programmes are major challenges if resources are scarce. International actors have a substantial influence on the development of accreditation in LMICs, as sources of expertise and pump-priming funding. There is a need to provide a roadmap for the successful development and implementation of accreditation programmes in low-resource settings. Analysing accreditation policy processes could provide contextually sensitive lessons for LMICs seeking to develop and sustain their national accreditation programmes and for international organizations to exploit their role in supporting the development of accreditation in LMICs.

Private Providers' Experiences Implementing a Package of Interventions to Improve Quality of Care in Kenya: Findings From a Qualitative Evaluation

INTRODUCTION

Quality of care is an important element in health care service delivery in low- and middle-income countries. Innovative strategies are critical to ensure that private providers implement quality of care interventions. We explored private providers' experiences implementing a package of interventions intended to improve the quality of care in small and medium-sized private health facilities in Kenya.

METHODS

Data were collected as part of the qualitative evaluation of the African Health Markets for Equity (AHME) program in Kenya between June and July 2018. Private providers were purposively selected from 2 social franchise networks participating in AHME: the Amua network run by Marie Stopes Kenya and the Tunza network run by Population Services Kenya. Individual interviews (N=47) were conducted with providers to learn about their experiences with a package of interventions that included social franchising, SafeCare (a quality improvement program), National Hospital Insurance Fund (NHIF) accreditation assistance, and business support.

RESULTS

Private providers felt they benefited from trainings in clinical methods and quality improvement offered through AHME. Providers especially appreciated the mentorship and guidelines offered through programs like social franchising and SafeCare, and those who received support for NHIF accreditation felt they were able to offer higher quality services after going through this process. However, quality improvement was sometimes prohibitively expensive for private providers in smaller facilities that already realize relatively low revenue and the NHIF accreditation process was difficult to navigate without the help of the AHME partners due to complexity and a lack of transparency.

CONCLUSION

Our findings suggest that engaging private providers in a comprehensive package of quality improvement activities is achievable and may be preferable to a simpler program. However, further research that looks at the implications for cost and return on investment is required.

"All about the money?" A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States

BACKGROUND

Despite decades of ethical, empirical, and policy support, shared decision-making (SDM) has failed to become standard practice in US cancer care. Organizational and health system characteristics appear to contribute to the difficulties in implementing SDM in routine care. However, little is known about the relevance of the different characteristics in specific healthcare settings. The aim of the study was to explore how organizational and health system characteristics affect SDM implementation in US cancer care.

METHODS

We conducted semi-structured interviews with diverse cancer care stakeholders in the USA. Of the 36 invited, 30 (83%) participants consented to interview. We used conventional content analysis to analyze transcript content.

RESULTS

The dominant theme in the data obtained was that concerns regarding a lack of revenue generation, or indeed, the likely loss of revenue, were a major barrier preventing implementation of SDM. Many other factors were prominent as well, but the view that SDM might impair organizational or individual profit margins and reduce the income of some health professionals was widespread. On the organizational level, having leadership support for SDM and multidisciplinary teams were viewed as critical to implementation. On the health system level, views diverged on whether embedding tools into electronic health records (EHRs), making SDM a criterion for accreditation and certification, and enacting legislation could promote SDM implementation.

CONCLUSION

Cancer care in the USA has currently limited room for SDM and is prone to paying lip service to the idea. Implementation efforts in US cancer care need to go further than interventions that target only the clinician-patient level. On a policy level, SDM could be included in alternative payment models. However, its implementation would need to be thoroughly assessed in order to prevent further misdirected incentivization through box ticking.

Challenges of implementing the accreditation model in military and university hospitals in Iran: a qualitative study

Background

The aim of this study was to present challenges of implementing the accreditation model in university and military hospitals in Iran.

Methods

In this qualitative study, purposive sampling was used to select hospital managers and implementers of the model working in 3 hospitals affiliated to Kerman University of Medical Sciences and in 3 military hospitals in Kerman, Iran. A total of 39 participants were interviewed, and semi-structured questionnaires and thematic analysis were used for data collection and analysis, respectively.

Results

In this study, 5 major codes and 17 subcodes were identified: (1) perspectives on accreditation model with 5 subcodes: a difficult and time-consuming model, less attention to the patient, accreditation as a way of money acquisition, not being cost-effective, and accreditation means incorrect documentation; (2) absence of appropriate executive policy, with 3 subcodes: lack of financial funds and personnel, disregarding local conditions in implementation and evaluation, and absence of the principle of unity of command; (3) training problems of the accreditation model, with 2 subcodes: absence of proper training and incoordination of training and evaluation; (4) human resources problems, with 3 subcodes: no profit for nonphysician personnel, heavy workload of the personnel, and physicians’ nonparticipation; (5) evaluation problems, with 4 subcodes: no precise and comprehensive evaluation, inconformity of authorities’ perspectives on evaluation, considerable change in evaluation criteria, and excessive reliance on certificates.

Conclusions

This study provided useful data on the challenges of implementing hospitals’ accreditation, which can be used by health policymakers to revise and modify accreditation procedures in Iran and other countries with similar conditions. The accreditation model is comprehensive and has been implemented to improve the quality of services and patients’ safety. The basic philosophy of hospital accreditation did not fully comply with the underlying conditions of the hospitals. The hospital staff considered accreditation as the ultimate goal rather than a means for achieving quality of service. The Ministry of Health and Medical Education performed accreditation hastily for all Iranian hospitals, while the hospitals were not prepared and equipped to implement the accreditation model.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVE

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

DESIGN

A cross-sectional online questionnaire survey.

SETTING

All 26 somatic and psychiatric public hospitals in Denmark.

PARTICIPANTS

All senior and middle managers.

METHODS

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

RESULTS

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

CONCLUSION

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

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

Background

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Greek gynecology healthcare professionals towards quality management systems

PURPOSE

Today, quality management systems (QMS) are a promising candidate for the improvement of healthcare services. The purpose of this paper is to investigate the opinions/attitudes of gynecology healthcare professionals toward quality and quality management in healthcare facilities (HFs) in Greece.

DESIGN/METHODOLOGY/APPROACH

An anonymous self-administered questionnaire was distributed to healthcare professionals, asking for opinions on quality objectives associated with the everyday workflow in HFs (e.g. management of patients, resources, etc.) and on QMS. The study was conducted in Hippokration Hospital of Thessaloniki, including 187 participants. Statistical assessment and analysis of the questionnaires were carried out.

FINDINGS

Although 87.5 percent recognized the importance of potential QMS implementation and accreditation, over 50 percent believed that it would lead rather to increased workload and bureaucracy than to any considerable quality improvement. More than 60 percent were completely unaware of the implementation of quality objectives such as quality handbook, quality policy, audit meetings and accreditation status in their HFs. This unawareness was also reported in terms of patient, data, human and general resources management. Finally, awareness over medical malpractice and positive attitude toward official reporting were detected.

ORIGINALITY/VALUE

Most respondents acknowledged the significance of quality, QMS implementation and accreditation in Greek hospitals. However, there was a critical gap in knowledge about quality management objectives/processes that could be possibly resolved by expert teams and well-organized educational programs aiming to educate personnel regarding the various quality objectives in Greek HFs.

Healthcare accreditation as trigger of organisational change: The view of professionals

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.

Introduction of safety and quality standards for private health care providers: a case-study from the Republic of Srpska, Bosnia and Herzegovina

BACKGROUND

Regulation of private health care providers (PHPs) in middle-income countries can be challenging. Mandatory safety and quality standards for PHPs have been in place in the Republic of Srpska since 2012, but not all PHPs have adopted them yet. Adoption rates have differed among different types of providers. We studied three predominant types of PHPs to determine why the rate of adoption of the standards varies among them.

METHODS

This study used a mixed methods approach, which allowed the integration of both quantitative and qualitative data, to develop an explanatory case study. The case study covered three types of private PHPs: pharmacies, dental practices and specialist practices. Primary data were collected through face-to-face semi-structured in-depth interviews and a self-administered postal survey of private health care providers. Our study's theoretical framework was based on the diffusion of innovation theory.

RESULTS

The rate of adoption of mandatory standards varied among different types of PHP mainly due to four factors: (1) level of concern about negative financial consequences, such as the risk of fines or of losing contracts with the Health Insurance Fund of the Republic of Srpska; (2) availability of information on the standards and implementation process; (3) level of the relevant professional association's support for the introduction of standards; and (4) provider's perceptions of the relevant health chamber's attitude toward the standards. Opinions conveyed to PHPs by peers slightly negatively influenced adoption of the standards at the attitude-forming stage. Perceived gains in professional status did not have a major influence on the decision to adopt standards. All three types of PHPs perceived the same disadvantages of the introduction of safety and quality standards: associated expense, increased administrative burden and disruption of service provision.

CONCLUSIONS

When introducing mandatory quality and safety standards for PHPs, national health authorities need to: ensure adequate availability of information on the relative advantages of adhering to standards; support the introduction of standards with relevant incentives and penalties; and work in partnership with relevant professional associations and health chambers to get their buy-in for regulation of quality and safety of health services.

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

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.

Understanding the impact of accreditation on quality in healthcare: A grounded theory approach

Objective

To explore how organizations respond to and interact with the accreditation process and the actual and potential mechanisms through which accreditation may influence quality.

Design

Qualitative grounded theory study.

Setting

Organizations who had participated in Accreditation Canada's Qmentum program during January 2014-June 2016.

Participants

Individuals who had coordinated the accreditation process or were involved in managing or promoting quality.

Results

The accreditation process is largely viewed as a quality assurance process, which often feeds in to quality improvement activities if the feedback aligns with organizational priorities. Three key stages are required for accreditation to impact quality: coherence, organizational buy-in and organizational action. These stages map to constructs outlined in Normalization Process Theory. Coherence is established when an organization and its staff perceive that accreditation aligns with the organization's beliefs, context and model of service delivery. Organizational buy-in is established when there is both a conceptual champion and an operational champion, and is influenced by both internal and external contextual factors. Quality improvement action occurs when organizations take purposeful action in response to observations, feedback or self-reflection resulting from the accreditation process.

Conclusions

The accreditation process has the potential to influence quality through a series of three mechanisms: coherence, organizational buy-in and collective quality improvement action. Internal and external contextual factors, including individual characteristics, influence an organization's experience of accreditation.

The Impact of Applying Quality Management Practices on Patient Centeredness in Jordanian Public Hospitals: Results of Predictive Modeling

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.

Accreditation Is Perceived to Improve Echocardiography Laboratory Quality: Results of an Intersocietal Accreditation Commission Survey

The Intersocietal Accreditation Commission (IAC) began accrediting echocardiography laboratories in 1996 to improve quality in diagnostic imaging facilities. With no existing data linking accreditation to improved outcomes, the aim of this study was to examine the perceived value of accreditation among individuals who have successfully achieved IAC echocardiography accreditation. An electronic survey was sent to accredited facilities soliciting demographic data along with questions regarding the perceived value of accreditation related to 15 quality indicators; 10.455 emails were sent with 999 responses (9.6%), and 63% of respondents reported improvement in results due to accreditation. Of the 15 quality indicators, the process was perceived as leading to improvement by a majority for 10 of the quality indicators. Nonphysicians tended to report more improvement compared with physicians (64% vs. 54%, P = .056). The perceptions from hospital-based respondents were more favorable than nonhospital-based respondents (67% vs. 59%, P < .001). More than 90% of respondents reported that maintaining accreditation was important for improved quality and better reimbursement. The study showed that IAC echocardiography facility accreditation is perceived by most facilities to improve operations for most quality indicators, particularly regarding study quality and reporting.

Application of Analytical Hierarchy Process Approach for Service Quality Evaluation in Radiology Departments: A Cross-Sectional Study

BACKGROUND

Radiology department as a service provider organization requires realization of quality concept concerning service provisioning knowledge, satisfaction and all issues relating to the customer as well as quality assurance and improvement issues. At present, radiology departments in hospitals are regarded as income generating units and they should continuously seek performance improvement so that they can survive in the changing and competitive environment of the health care sector.

OBJECTIVES

The aim of this study was to propose a method for ranking of radiology departments in selected hospitals of Tehran city using analytical hierarchical process (AHP) and quality evaluation of their service in 2015.

MATERIALS AND METHODS

This study was an applied and cross-sectional study, carried out in radiology departments of 6 Tehran educational hospitals in 2015. The hospitals were selected using non-probability and purposeful method. Data gathering was performed using customized joint commission international (JCI) standards. Expert Choice 10.0 software was used for data analysis. AHP method was used for prioritization.

RESULTS

"Management and empowerment of human resources'' (weight = 0.465) and "requirements and facilities" (weight = 0.139) were of highest and lowest significance respectively in the overall ranking of the hospitals. MS (weight = 0.316), MD (weight = 0.259), AT (weight = 0.14), TS (weight = 0.108), MO (weight = 0.095), and LH (0.082) achieved the first to sixth rankings respectively.

CONCLUSION

The use of AHP method can be promising for fostering the evaluation method and subsequently promotion of the efficiency and effectiveness of the radiology departments. The present model can fill in the gap in the accreditation system of the country's hospitals in respect with ranking and comparing them considering the significance and value of each individual criteria and standard. Accordingly, it can predict an integration of qualitative and quantitative criteria involved and thereby take a decisive step towards further efficiency and effectiveness of the health care evaluation systems.

Accreditation and improvement in process quality of care: a nationwide study

OBJECTIVE

To examine whether performance measures improve more in accredited hospitals than in non-accredited hospital.

DESIGN AND SETTING

A historical follow-up study was performed using process of care data from all public Danish hospitals in order to examine the development over time in performance measures according to participation in accreditation programs.

PARTICIPANTS

All patients admitted for acute stroke, heart failure or ulcer at Danish hospitals.

INTERVENTION

Hospital accreditation by either The Joint Commission International or The Health Quality Service.

MEASUREMENTS

The primary outcome was a change in opportunity-based composite score and the secondary outcome was a change in all-or-none scores, both measures were based on the individual processes of care. These processes included seven processes related to stroke, six processes to heart failure, four to bleeding ulcer and four to perforated ulcer.

RESULTS

A total of 27 273 patients were included. The overall opportunity-based composite score improved for both non-accredited and accredited hospitals (13.7% [95% CI 10.6; 16.8] and 9.9% [95% 5.4; 14.4], respectively), but the improvements were significantly higher for non-accredited hospitals (absolute difference: 3.8% [95% 0.8; 8.3]). No significant differences were found at disease level. The overall all-or-none score increased significantly for non-accredited hospitals, but not for accredited hospitals. The absolute difference between improvements in the all-or-none score at non-accredited and accredited hospitals was not significant (3.2% [95% -3.6:9.9]).

CONCLUSIONS

Participating in accreditation was not associated with larger improvement in performance measures for acute stroke, heart failure or ulcer.

A systematic review of hospital accreditation: the challenges of measuring complex intervention effects

Background

The increased international focus on improving patient outcomes, safety and quality of care has led stakeholders, policy makers and healthcare provider organizations to adopt standardized processes for evaluating healthcare organizations. Accreditation and certification have been proposed as interventions to support patient safety and high quality healthcare. Guidelines recommend accreditation but are cautious about the evidence, judged as inconclusive. The push for accreditation continues despite sparse evidence to support its efficiency or effectiveness.

Methods

We searched MEDLINE, EMBASE and The Cochrane Library using Medical Subject Headings (MeSH) indexes and keyword searches in any language. Studies were assessed using the Cochrane Risk of Bias Tool and AMSTAR framework. 915 abstracts were screened and 20 papers were reviewed in full in January 2013. Inclusion criteria included studies addressing the effect of hospital accreditation and certification using systematic reviews, randomized controlled trials, observational studies with a control group, or interrupted time series. Outcomes included both clinical outcomes and process measures. An updated literature search in July 2014 identified no new studies.

Results

The literature review uncovered three systematic reviews and one randomized controlled trial. The lone study assessed the effects of accreditation on hospital outcomes and reported inconsistent results. Excluded studies were reviewed and their findings summarized.

Conclusion

Accreditation continues to grow internationally but due to scant evidence, no conclusions could be reached to support its effectiveness. Our review did not find evidence to support accreditation and certification of hospitals being linked to measurable changes in quality of care as measured by quality metrics and standards. Most studies did not report intervention context, implementation, or cost. This might reflect the challenges in assessing complex, heterogeneous interventions such as accreditation and certification. It is also may be magnified by the impact of how accreditation is managed and executed, and the varied financial and organizational healthcare constraints. The strategies hospitals should impelment to improve patient safety and organizational outcomes related to accreditation and certification components remains unclear.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-015-0933-x) contains supplementary material, which is available to authorized users.

How Do Noninvasive Imaging Facilities Perceive the Accreditation Process? Results of an Intersocietal Accreditation Commission Survey

The Intersocietal Accreditation Commission (IAC) accredits vascular, echocardiography, nuclear medicine, computed tomography, and magnetic resonance imaging laboratories. How facilities involved in the accreditation process view accreditation is unknown. The objective of this study was to examine the perception of laboratory accreditation from those who had undergone the process. An electronic survey request was sent to all facilities that had received IAC accreditation at least once. Demographic information, as well as opinions on the perceived value of accreditation as it relates to 15 quality metrics was acquired. Responses were obtained from 2782 facilities. Of the 15 quality metrics examined, the process was perceived as leading to improvements by a majority of respondents for 10 (67%) metrics including: report standardization, adherence to guidelines, test standardization, report completeness, identification of deficiencies, improved staff knowledge, report timeliness, distinguished facility, correction of deficiencies, and image quality. Overall, the perceived improvement was greater for hospital-based facilities (global 66% vs 59%; P < 0.001). Survey data demonstrate that the accreditation process has a positive perceived impact on the majority of examined metrics. These findings suggest that those undergoing the process find value in accreditation.

Staff perceptions of change resulting from participation in a European cancer accreditation programme: a snapshot from eight cancer centres

Background

Healthcare accreditation is considered to be an essential quality improvement tool. However, its effectiveness has been critiqued.

Methods

Twenty-four interviews were conducted with clinicians (five), nurses (six), managers (eight), and basic/translational researchers (five) from eight European cancer centres on changes observed from participating in a European cancer accreditation programme. Data were thematically analysed and verified with participants and checked against auditor’s feedback.

Results

Four change categories emerged: (i) the growing importance of the nursing and supportive care field (role change). Nurses gained more autonomy/clarity on their daily duties. Importance was given to the hiring and training of supportive care personnel (ii) critical thinking on data integration (strategic change). Managers gained insight on how to integrate institutional level data (iii) improved processes within multidisciplinary team (MDT) meetings (procedural change). Clinical staff experienced improved communication between MDTs (iv) building trust (organisational change). Accreditation improved the centre’s credibility with its own staff and externally with funders and patients. No motivational changes were perceived. Researchers perceived no changes. The auditor’s feedback included changes in 13 areas: translational research, biobanks, clinical trials, patient privacy and satisfaction, cancer registries, clinical practice guidelines, patient education, screening, primary prevention, role of nurses, MDT, supportive care, and data integration. However, our study revealed that staff perceived changes only in the last four areas.

Conclusion

Staff perceived changes in data integration, nursing and supportive care, and in certain clinical aspects. Accreditation programmes must pay attention to the needs of different stakeholder groups, track changes, and observe how/why change happens.

Perceptions and attitudes toward SLMTA amongst laboratory and hospital professionals in Ethiopia

Background

Strengthening Laboratory Management Toward Accreditation (SLMTA) is a competency-based management training programme. Assessing health professionals’ views of SLMTA provides feedback to inform program planning, implementation and evaluation of SLMTA's training, communication and mentorship components.

Objectives

To assess laboratory professionals’ and hospital chief executive officers’ (CEOs) perceptions and attitudes toward the SLMTA programme in Ethiopia.

Methods

A cross-sectional descriptive survey was conducted in March 2013 using a structured questionnaire to collect qualitative data from 72 laboratory professionals and hospital CEOs from 17 health facilities, representing all regions and two city administrations in Ethiopia. Focus groups were conducted with laboratory professionals and hospital administration to gain insight into the strengths and challenges of the SLMTA programme so as to guide future planning and implementation.

Results

Ethiopian laboratory professionals at all levels had a supportive attitude toward the SLMTA programme. They believed that SLMTA substantially improved laboratory services and acted as a catalyst for total healthcare reform and improvement. They also noted that the SLMTA programme achieved marked progress in laboratory supply chain, sample referral, instrument maintenance and data management systems. In contrast, nearly half of the participating hospital CEOs, especially those associated with low-scoring laboratories, were sceptical about the SLMTA programme, believing that the benefits of SLMTA were outweighed by the level of human resources and time commitment required. They also voiced concerns about the cost and sustainability of SLMTA.

Conclusion

This study highlights the need for stronger engagement and advocacy with hospital administration and the importance of addressing concerns about the cost and sustainability of the SLMTA programme.

Effects of hospital accreditation on medical students: a national qualitative study in Taiwan

PURPOSE

Hospital accreditation has become a global trend for improving the quality of health care services. In Taiwan, nearly all hospitals are accredited. However, there is a paucity of literature on the effects of hospital accreditation on medical students and the universal applicability of hospital accreditation as developed in the West. The purpose of this study was to investigate the effects of hospital accreditation on medical students in Taiwan.

METHOD

From 2010 to 2012, the authors conducted semistructured interviews with 34 senior, clinical year students at 11 different medical schools in Taiwan. Following a grounded theory approach, the authors transcribed and analyzed the transcripts concurrently with data collection in order to identify emergent themes.

RESULTS

Aside from the intended positive effects of hospital accreditation, this study revealed several unintended impacts on medical students, including decreased clinical learning opportunities, increased trivial workload, and violation of professional integrity. Taiwanese students expressed doubt and frustration concerning the value of hospital accreditation and reflected on the cultural and systemic context in which accreditation takes place. Their commentary addressed the challenges associated with the globalization of hospital accreditation processes.

CONCLUSIONS

This study suggests that, beyond the improvement of patient safety and quality assurance, medical educators must recognize the unintended negative effects of hospital accreditation on medical education and take into account differences in culture and health care systems amid the globalization of medicine.

The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon

BACKGROUND

In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC.

METHODS

The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors.

RESULTS

The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages.

CONCLUSIONS

To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well.