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Gutiérrez JP, Rodriguez MA, Torres-Pereda P, Reyes-Morales H. Hospital accreditation in Mexico fails to improve the quality of healthcare: lessons from an impact evaluation. Front Public Health 2024; 12:1386667. [PMID: 38957207 PMCID: PMC11217480 DOI: 10.3389/fpubh.2024.1386667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/24/2024] [Indexed: 07/04/2024] Open
Abstract
Healthcare quality in low- and middle-income countries poses a significant challenge, contributing to heightened mortality rates from treatable conditions. The accreditation of health facilities was part of the former health reform in Mexico, proposed as a mechanism to enhance healthcare quality. This study assesses the performance of hospital accreditation in Mexico, utilizing indicators of effectiveness, efficiency, and safety. Employing a longitudinal approach with controlled interrupted time series analysis (C-ITSA) and fixed effects panel analysis, administrative data from general hospitals in Mexico is scrutinized. Results reveal that hospital accreditation in Mexico fails to enhance healthcare quality and, disconcertingly, indicates deteriorating performance associated with increased hospital mortality. Amidst underfunded health services, the implemented accreditation model proves inadequately designed to uplift care quality. A fundamental redesign of the public hospital accreditation model is imperative, emphasizing incentives for structural enhancement and standardized processes. Addressing the critical challenge of improving care quality is urgent for Mexico's healthcare system, necessitating swift action to achieve effective access as a benchmark for universal healthcare coverage.
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Affiliation(s)
- Juan Pablo Gutiérrez
- Center for Policy, Population and Health Research, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Pilar Torres-Pereda
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
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Kabrah SM, Abuzerr S, Flemban A, Jambi L, Kabrah A, Alghamdi S, Alghamdi SM, Alshareef AA, Melibary SM, Al-Ghamdi DH, Filfilan NO, Ralsan TS, Alzhrani AA. Perceptions, Attitudes, and Barriers towards the Use of Central Board for Accreditation of Healthcare Institutions (CBAHI) Standards among Saudi Healthcare Providers. Healthcare (Basel) 2024; 12:183. [PMID: 38255071 PMCID: PMC10815121 DOI: 10.3390/healthcare12020183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Quality improvement is a strategic priority for all healthcare systems. However, the engagement of healthcare providers in pursuing accreditation plays a critical role in integrating standards into routine practice. Therefore, the current study assessed the perceptions, attitudes, and barriers towards using the Central Board for Accreditation of Healthcare Institutions (CBAHI) standards among Saudi healthcare providers. METHOD This cross-sectional study was conducted in 2023 among a representative sample (364) of Saudi healthcare providers (both genders, aged 20-60) working at twenty governmental CBAHI-accredited hospitals in Saudi Arabia. The study participants were selected using a cluster random sampling method. Data regarding the perceptions, attitudes, and barriers toward using CBAHI standards among Saudi healthcare providers were evaluated using a validated questionnaire. Additional information regarding demographic-socioeconomic variables was obtained with an interview-based questionnaire. Statistical analysis was performed using SPSS version 28. RESULTS A total of 364 healthcare providers participated in the current study. Of them, 54.4% were males, and 45.6% were females. Almost half (48.6%) of the study participants held bachelor's degrees. For the variables of age group, marital status, monthly income, and years of work experience, statistically significant associations were found between males and females (p-value < 0.05). The means of overall item agreement percentage of the participating healthcare providers for perceptions and attitudes towards using CBAHI standards and attitudes towards using CBAHI standards as a tool for quality improvement were 80.1%, 76.4%, and 72.0%, respectively. The highest item agreement percentage of the participating healthcare providers regarding the barriers that inhibit the hospital from obtaining the full benefit from the CBAHI accreditation was for the inexpedient IT tools (59.6%). CONCLUSION The current study's results demonstrated accepted perceptions and attitudes toward using CBAHI standards among Saudi healthcare providers. In addition, the identified barriers should be alleviated to improve the quality, effectiveness, and efficiency of the hospitals in Saudi Arabia. The findings also help clarify the accreditation operating process, which may be helpful to policymakers and stakeholders in making informed decisions on integrating accreditation standards.
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Affiliation(s)
- Saeed M. Kabrah
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.K.); (S.A.)
| | - Samer Abuzerr
- Department of Medical Sciences, University College of Science & Technology-Khan Younis, Gaza P.O. Box 8, Palestine;
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC H3C 3J7, Canada
| | - Arwa Flemban
- Pathology Department, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Layal Jambi
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
| | - Ahmed Kabrah
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.K.); (S.A.)
| | - Saad Alghamdi
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.K.); (S.A.)
| | - Saeed M. Alghamdi
- Respiratory Care Program, Clinical Technology Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Ahmad A. Alshareef
- Laboratory and Blood Bank, PCR Department, AlNoor Specialist Hospital, Ministry of Health Makkah, Makkah 24241, Saudi Arabia;
| | - Seham M. Melibary
- Quality Department, Regional Laboratory and Blood Banks, Ministry of Health Jeddah, Jeddah 22421, Saudi Arabia;
| | | | - Najeeb O. Filfilan
- Safety and Sterilization Department, Regional Laboratory and Blood Banks, Ministry of Health Makkah, Makkah 25215, Saudi Arabia;
| | - Tahani S. Ralsan
- Quality Management MOH Laboratory Accreditation Supportive CBAHI/CAP, Dammam 34116, Saudi Arabia;
| | - Adel A. Alzhrani
- Quality Department, Regional Laboratory and Blood Banks, Ministry of Health Makkah, Makkah 25215, Saudi Arabia;
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Alhawajreh MJ, Paterson AS, Jackson WJ. Impact of hospital accreditation on quality improvement in healthcare: A systematic review. PLoS One 2023; 18:e0294180. [PMID: 38051746 DOI: 10.1371/journal.pone.0294180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023] Open
Abstract
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.
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Affiliation(s)
| | - Audrey S Paterson
- Business School, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - William J Jackson
- Business School, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Alotaibi SY. Accreditation of primary health care centres in the KSA: Lessons from developed and developing countries. J Taibah Univ Med Sci 2023; 18:711-725. [PMID: 36852254 PMCID: PMC9957815 DOI: 10.1016/j.jtumed.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/09/2022] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
Background/Objectives In 2013, the KSA made Central Board for Accreditation of Healthcare Institutions (CBAHI) accreditation mandatory for all healthcare facilities, including primary health care centres (PHCs) and set a target to have 502 PHCs accredited by 2020. However, there is a real gap in knowledge and research on the impact of CBAHI accreditation on PHCs. This absence of research has been linked to the lack of understanding of the accreditation programme. Therefore, it was recommended by scholars that the KSA could learn from the experience of other countries to improve policy implementation and avoid future complications. Methods This study aimed to explore lessons that KSA can draw from developed and developing countries that have implemented accreditation programmes for PHCs. We performed a literature review using a systematic approach to identify articles related to the accreditation of PHCs. The identified articles were examined by applying evaluation criteria in respect of prospective policy transfer. Results The research results yielded 22 publications from different countries. There were variations among the countries in the specific information acquired. However, Denmark had the highest number of articles providing detailed information. Regarding their aims, most studies shared the same goal of improving quality and patient safety. Generally, there was limited discussion of policy failure compared with policy success. In addition, most of the countries were in the process of implementing local accreditation. Almost all of the countries that had implemented external programmes were developing countries. In terms of application criteria, most cases made recommendations for the programme or for PHCs. Conclusion Analysis indicated that because of the differences in information between countries and settings, there is no ideal country-based experience from which the KSA can transfer lessons. Lessons from outside the KSA would need careful consideration when adopting them in the local context of the Kingdom.
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Affiliation(s)
- Shaymaa Y. Alotaibi
- Health Service and Hospital Management Department, College of Business, King Abdul-Aziz University, Rabigh, Saudi Arabia,Health Services Management Centre, College of Social Sciences, University of Birmingham, Birmingham, UK
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A taxonomy of Chinese hospitals and application to medical dispute resolutions. Sci Rep 2022; 12:18234. [PMID: 36309554 PMCID: PMC9617920 DOI: 10.1038/s41598-022-23147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/25/2022] [Indexed: 12/31/2022] Open
Abstract
Medical disputes can be viewed as a negative indicator of health care quality and patient satisfaction. However, dispute prevention from the perspective of systematic supervision is unexplored. This study examines hospital clustering based on diagnosis-related group (DRG) indicators and explores the association between hospital clusters and medical disputes. Health administrative data from Sichuan Province in 2017 were used. A twostep cluster analysis was performed to cluster hospitals based on DRG indicators. A multiple regression analysis was conducted to evaluate the relationship between clusters and the incidence/number of medical disputes. The 1660 hospitals were grouped into three DRG clusters: basic (62.5%, n = 1038), diverse (31.0%, n = 515), and lengthy (6.4%, n = 107). After adjusting for covariates, the diverse hospitals were associated with an increased probability of having medical disputes (OR 5.24, 95% CI 2.97-9.26), while the diverse and lengthy hospitals were associated with a greater number of medical disputes (IRR 10.67, 95% CI 6.58-17.32; IRR 4.06, 95% CI 1.22-13.54). Our findings highlighted that the cluster-level performance of hospitals can be monitored. Future studies could examine this relationship using a longitudinal design and explore ways to reduce medical disputes in hospitals.
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Brouwers J, Seys D, Claessens F, Van Wilder A, Bruyneel L, De Ridder D, Eeckloo K, Vanhaecht K, Kesteloot K. The Cost of a First and Second Hospital-Wide Accreditation in Flanders, Belgium. Int J Qual Health Care 2022; 34:6650077. [PMID: 35880736 DOI: 10.1093/intqhc/mzac062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/07/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospital accreditation is a popular and widely used quality control and improvement instrument. Despite potential benefits, questions are raised whether it constitutes appropriate use of hospitals' limited financial resources. This study aims to calculate the cost of preparing for and undergoing a first and second accreditation by the Joint Commission International or Qualicor Europe in acute-care hospitals. METHODS All (n=53) acute-care hospitals in Flanders (Belgium) were invited to participate and report on the costs in preparing for and undergoing a first and/or second accreditation cycle. To measure costs, a questionnaire with six domains and 90 questions was developed based on literature review, policy documents and a multidisciplinary expert group. All costs were recalculated to 2020 EUR to correct for inflation and reported as medians with interquartile range (IQR). RESULTS Twenty-five hospitals (47%) participated in the study. Additional investments and direct operational costs for a first accreditation cycle amounted to 879.45 EUR (IQR:794.81) per bed and 3.8 FTE per hospital additional new staff members were recruited for coordination and implementation of the trajectory. A second accreditation survey costed remarkably less with a total cost of extra investments and direct operational cost of 222.88 EUR (IQR: 244.04) per bed and less investment in additional staff (1.50 FTE). Most of the costs were situated in consulting costs and investments in infrastructure. The median total extra cost (direct operational cost and additional investments) amounted to 0.2% of the hospital's operating income for a first accreditation cycle and 0.05% for a second cycle. CONCLUSION A first accreditation cycle requires a strong financial commitment of hospitals, as many costs result from the preparation in the years prior to an accreditation survey. A second survey is less expensive for hospitals, but still requires a considerable effort in terms of budget and staff. Policy makers should be aware of these significant costs as hospitals are operating with public resources and budget is scarce. The identification of these costs is a necessary building block to evaluate cost-effectiveness of accreditation versus other quality improvement systems and the continuation of these accreditation systems and their costs needs further study and a thorough debate.
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Affiliation(s)
- Jonas Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium & Department of Orthopaedics, University Hospitals Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium & Department of Quality, University Hospitals Leuven, Belgium
| | - Kristof Eeckloo
- Department of Primary Care and Public Health, UGent & Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium & Department of Quality, University Hospitals Leuven, Belgium
| | - Katrien Kesteloot
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium & Financial department, University Hospitals Leuven, Leuven Belgium
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Qurashi AA, Alsharif WM. Saudi Radiologists’ and Radiographers’ Perceptions of Accreditation Programmes in Clinical Radiology Departments: A Cross-Sectional Study. J Multidiscip Healthc 2022; 15:401-411. [PMID: 35261545 PMCID: PMC8898186 DOI: 10.2147/jmdh.s350989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The hospital accreditation programme is an assessment tool that involves a comprehensive evaluation by an external independent accreditation body to ensure consistency in clinical practice by adhering to the established standards and guidelines. The study aims to investigate Radiology professionals’ perceptions of the impact of accreditation and implementation of change towards the quality-of-service delivery in Radiology Departments. Methods A cross-sectional prospective study was conducted in Saudi Arabia among radiology professionals (ie, radiographers and radiologists) from July to September 2021. After obtaining institutional review board approval from the local ethics committee and using a non-probability convenient sampling technique, 335 participants completed the survey, which was distributed via social media channels, and through professional networks within hospitals across the country. Results A total of 335 participants agreed to participate. The study’s participants strongly agreed that the accreditation programmes have positively impacted customer satisfaction and care provided to patients. A significant difference was identified in the level of agreement on the effect of accreditation programmes when hospital types and personnel qualifications were tested (P < 0.05). Radiology personnel who worked in academic hospitals and who had diplomas and PhDs degrees showed a significantly higher level of agreement than other participants (P < 0.05). Conclusion Saudi radiologists and radiographers showed strong agreement or agreement towards hospital accreditation programmes domains’ criteria. The results of the study support the need to bridge the gap between higher-level management and employees in order to facilitate change and enhance the standards of quality and practice in radiology departments. Additional policies are needed to continue and strengthen quality improvement programmes.
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Affiliation(s)
- Abdulaziz A Qurashi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
- Correspondence: Abdulaziz A Qurashi, Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Anadah Bin Umayyah Road, Taibah, Madinah, 42353, Saudi Arabia, Tel +966 014 861 8888 Ext. 3603, Email
| | - Walaa M Alsharif
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
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Hussein M, Pavlova M, Ghalwash M, Groot W. The impact of hospital accreditation on the quality of healthcare: a systematic literature review. BMC Health Serv Res 2021; 21:1057. [PMID: 34610823 PMCID: PMC8493726 DOI: 10.1186/s12913-021-07097-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Accreditation is viewed as a reputable tool to evaluate and enhance the quality of health care. However, its effect on performance and outcomes remains unclear. This review aimed to identify and analyze the evidence on the impact of hospital accreditation. METHODS We systematically searched electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, MEDLINE (OvidSP), CDSR, CENTRAL, ScienceDirect, SSCI, RSCI, SciELO, and KCI) and other sources using relevant subject headings. We included peer-reviewed quantitative studies published over the last two decades, irrespective of its design or language. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers independently screened initially identified articles, reviewed the full-text of potentially relevant studies, extracted necessary data, and assessed the methodological quality of the included studies using a validated tool. The accreditation effects were synthesized and categorized thematically into six impact themes. RESULTS We screened a total of 17,830 studies, of which 76 empirical studies that examined the impact of accreditation met our inclusion criteria. These studies were methodologically heterogeneous. Apart from the effect of accreditation on healthcare workers and particularly on job stress, our results indicate a consistent positive effect of hospital accreditation on safety culture, process-related performance measures, efficiency, and the patient length of stay, whereas employee satisfaction, patient satisfaction and experience, and 30-day hospital readmission rate were found to be unrelated to accreditation. Paradoxical results regarding the impact of accreditation on mortality rate and healthcare-associated infections hampered drawing firm conclusions on these outcome measures. CONCLUSION There is reasonable evidence to support the notion that compliance with accreditation standards has multiple plausible benefits in improving the performance in the hospital setting. Despite inconclusive evidence on causality, introducing hospital accreditation schemes stimulates performance improvement and patient safety. Efforts to incentivize and modernize accreditation are recommended to move towards institutionalization and sustaining the performance gains. PROSPERO registration number CRD42020167863.
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Affiliation(s)
- Mohammed Hussein
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Department of Hospitals Accreditation, Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI), Riyadh, Saudi Arabia.
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mostafa Ghalwash
- Department of Hospitals Accreditation, Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI), Riyadh, Saudi Arabia
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Bergholt MD, Falstie-Jensen AM, Hibbert P, Eysturoy BJ, Guttesen G, Róin T, Valentin JB, Braithwaite J, von Plessen C, Johnsen SP. The association between first-time accreditation and the delivery of recommended care: a before and after study in the Faroe Islands. BMC Health Serv Res 2021; 21:917. [PMID: 34482842 PMCID: PMC8418753 DOI: 10.1186/s12913-021-06952-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022] Open
Abstract
Background Significant resources are spent on hospital accreditation worldwide. However, documentation of the effects of accreditation on processes, quality of care and outcomes in healthcare remain scarce. This study aimed to examine changes in the delivery of patient care in accordance with clinical guidelines (recommended care) after first-time accreditation in a care setting not previously exposed to systematic quality improvement initiatives. Methods We conducted a before and after study based on medical record reviews in connection with introducing first-time accreditation. We included patients with stroke/transient ischemic attack, bleeding gastric ulcer, diabetes, chronic obstructive pulmonary disease (COPD), childbirth, heart failure and hip fracture treated at public, non-psychiatric Faroese hospitals during 2012–2013 (before accreditation) or 2017–2018 (after accreditation). The intervention was the implementation of a modified second version of The Danish Healthcare Quality Program (DDKM) from 2014 to 2016 including an on-site accreditation survey in the Faroese hospitals. Recommended care was assessed using 63 disease specific patient level process performance measures in seven clinical conditions. We calculated the fulfillment and changes in the opportunity-based composite score and the all-or-none score. Results We included 867 patient pathways (536 before and 331 after). After accreditation, the total opportunity-based composite score was marginally higher though the change did not reach statistical significance (adjusted percentage point difference (%): 4.4%; 95% CI: − 0.7 to 9.6). At disease level, patients with stroke/transient ischemic attack, bleeding gastric ulcer, COPD and childbirth received a higher proportion of recommended care after accreditation. No difference was found for heart failure and diabetes. Hip fracture received less recommended care after accreditation. The total all-or-none score, which is the probability of a patient receiving all recommended care, was significantly higher after accreditation (adjusted relative risk (RR): 2.32; 95% CI: 2.03 to 2.67). The improvement was particularly strong for patients with COPD (RR: 16.22; 95% CI: 14.54 to 18.10). Conclusion Hospitals were in general more likely to provide recommended care after first-time accreditation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06952-w.
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Affiliation(s)
- Maria Daniella Bergholt
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Allé 43-45, DK-8200, Aarhus N, Denmark. .,Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark.
| | | | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, New South Wales, 2109, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Barbara Joensen Eysturoy
- Surgical Centre, National Hospital of the Faroe Islands, J.C Svabosgøta 41-49, 100, Tórshavn, Faroe Islands
| | - Gunnvá Guttesen
- Medical Centre, National Hospital of the Faroe Islands, J.C Svabosgøta 41-49, 100, Tórshavn, Faroe Islands
| | - Tóra Róin
- Department of Quality Improvement and Patient Safety, National Hospital of the Faroe Islands, J.C Svabosgøta 41-49, 100, Tórshavn, Faroe Islands
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, DK-9220, Aalborg, Denmark
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, New South Wales, 2109, Australia
| | - Christian von Plessen
- Unisanté, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.,Institute for Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, DK-9220, Aalborg, Denmark
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Al-Alawy K, Moonesar IA, Mubarak Obaid HA, Al-Abed Bawadi EI, Gaafar R. Hospital Accreditation: A Review of Evidence, Regulatory Compliance, and Healthcare Outcome Measures. DUBAI MEDICAL JOURNAL 2021. [DOI: 10.1159/000516483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Hospitals are increasingly under pressure to provide safe and high-quality care at an affordable cost. In response to this challenge, many have adopted accreditation as an internationally recognized tool to facilitate improvements in healthcare quality and patient safety. The objectives of the study were to (a) evaluate the impact of international hospital accreditation in Dubai and (b) inform policy decision-making. <b><i>Methods:</i></b> We adopted a literature review, analysis of violation data, and clinical performance measures. <b><i>Results:</i></b> The literature review suggests insufficient evidence to link accreditation to healthcare outcomes. We report a gradual increase in hospital violations and an improvement of clinical outcomes over three years, however the improvement in clinical outcome measures were not statistically significant. <b><i>Conclusions:</i></b> There is limited evidence to determine the impact of international hospital accreditation. Performance measures for accreditation are needed to validate the contribution accreditation may have on reducing non-compliance and improving clinical performance measures. Further research is needed to explore how well accreditation models fit within the Donabedian framework for healthcare quality.
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A. Rahim AI, Ibrahim MI, Musa KI, Chua SL. Facebook Reviews as a Supplemental Tool for Hospital Patient Satisfaction and Its Relationship with Hospital Accreditation in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147454. [PMID: 34299905 PMCID: PMC8306730 DOI: 10.3390/ijerph18147454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 02/05/2023]
Abstract
Patient satisfaction is one indicator used to assess the impact of accreditation on patient care. However, traditional patient satisfaction surveys have a few disadvantages, and some researchers have suggested that social media be used in their place. Social media usage is gaining popularity in healthcare organizations, but there is still a paucity of data to support it. The purpose of this study was to determine the association between online reviews and hospital patient satisfaction and the relationship between online reviews and hospital accreditation. We used a cross-sectional design with data acquired from the official Facebook pages of 48 Malaysian public hospitals, 25 of which are accredited. We collected all patient comments from Facebook reviews of those hospitals between 2018 and 2019. Spearman’s correlation and logistic regression were used to evaluate the data. There was a significant and moderate correlation between hospital patient satisfaction and online reviews. Patient satisfaction was closely connected to urban location, tertiary hospital, and previous Facebook ratings. However, hospital accreditation was not found to be significantly associated with online reports of patient satisfaction. This groundbreaking study demonstrates how Facebook reviews can assist hospital administrators in monitoring their institutions’ quality of care in real time.
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Affiliation(s)
- Afiq Izzudin A. Rahim
- Department of Community Medicine, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (A.I.A.R.); (K.I.M.)
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (A.I.A.R.); (K.I.M.)
- Correspondence: ; Tel.: +60-97676621; Fax: +60-97653370
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (A.I.A.R.); (K.I.M.)
| | - Sook-Ling Chua
- Faculty of Computing and Informatics, Persiaran Multimedia, Multimedia University, Cyberjaya 63100, Selangor, Malaysia;
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Kim Y(A. The impact of accreditation on advanced-nascent technology adoption: evidence from the U.S. healthcare industry. INNOVATION-ORGANIZATION & MANAGEMENT 2021. [DOI: 10.1080/14479338.2021.1932516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Yeongsu (Anthony) Kim
- Department of Management, Gordon Ford College of Business, Western Kentucky University, Bowling Green, KY, USA
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Ajay K, Poka A, Narayan M. Impact of accreditation on documentation and staff perception in the ophthalmology department of an Indian medical college. Indian J Ophthalmol 2021; 69:337-342. [PMID: 33463587 PMCID: PMC7933869 DOI: 10.4103/ijo.ijo_848_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose National Accreditation Board for Hospitals and Healthcare Providers operates the health-care accreditation program in India. Research on impact of accreditation on eye-care centers is scarce. This article was conceptualized to scientifically evaluate the changes in documentation brought about by accreditation and its effects on staff in the Ophthalmology Department of an Indian Medical College. Methods This was conducted as a quasi-experimental study in four steps. First, a point-based evaluation of case sheets in both pre-accreditation and postaccreditation phase, along with statistical analysis of the results, was done. Step two involved analysis of quality indicators and patient safety indices in successive years from inception of data to post-accreditation phase. Step three comprised a survey of staff employing a validated tool, and finally, face-to-face semistructured interviews with designated authorities, including finance departmental head, completed the study. Results A statistically significant difference was seen in scores achieved by the pre and postaccreditation case sheets, with the postphase case sheets achieving 15% increased scores over the prephase case sheets. Quality indicator indices displayed improvements post-accreditation. There was an accompanying increase in quantity of documentation. Financial data analysis showed increased expenditure for accreditation under multiple heads. Staff believed that accreditation led to increased workload but did not express decreased satisfaction and felt that accreditation was eventually beneficial. However, staff believed rewards for improving quality can be enhanced. Conclusion Accreditation increases quality and quantity of documentation, and staff workload. Increased financial costs also ensue.Staff believe that accreditation improves quality, is beneficial, but desire enhanced rewards.
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Affiliation(s)
- K Ajay
- Department of Ophthalmology, P. E. S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
| | - Avinash Poka
- Department of Ophthalmology, P. E. S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
| | - M Narayan
- Department of Ophthalmology, P. E. S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
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Zhou S, Dong X, Liu F, Zhang Y, Yue D, Zhou Q, Jin Y, Zheng ZJ. A stepped wedge cluster randomized control trial to evaluate the implementation and effectiveness of optimized initiatives in improving quality of care for ST segment elevation myocardial infarction in response to the COVID-19 outbreak. Implement Sci 2021; 16:38. [PMID: 33845863 PMCID: PMC8040354 DOI: 10.1186/s13012-021-01107-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/29/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The National Chest Pain Center Accreditation Program (CHANGE) is the first hospital-based, multifaceted, nationwide quality improvement (QI) initiative, to monitor and improve the quality of the ST segment elevation myocardial infarction (STEMI) care in China. The QI initiatives, as implementation strategies, include a bundle of evidence-based interventions adapted for implementation in China. During the pandemic of coronavirus disease 2019 (COVID-19), fear of infection with severe acute respiratory syndrome coronavirus 2, national lockdowns, and altered health care priorities have highlighted the program's importance in improving STEMI care quality. This study aims to minimize the adverse impact of the COVID-19 pandemic on the quality of STEMI care, by developing interventions that optimize the QI initiatives, implementing and evaluating the optimized QI initiatives, and developing scale-up activities of the optimized QI initiatives in response to COVID-19 and other public health emergencies. METHODS A stepped wedge cluster randomized control trial will be conducted in three selected cities of China: Wuhan, Suzhou, and Shenzhen. Two districts have been randomly selected in each city, yielding a total of 24 registered hospitals. This study will conduct a rollout in these hospitals every 3 months. The 24 hospitals will be randomly assigned to four clusters, and each cluster will commence the intervention (optimized QI initiatives) at one of the four steps. We will conduct hospital-based assessments, questionnaire surveys among health care providers, community-based household surveys, and key informant interviews during the trial. All outcome measures will be organized using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, including implementation outcomes, service outcomes (e.g., treatment time), and patient outcomes (e.g., in-hospital mortality and 1-year complication). The Consolidated Framework for Implementation Research framework will be used to identify factors that influence implementation of the optimized QI interventions. DISCUSSION The study findings could be translated into a systematic solution to implementing QI initiatives in response to COVID-19 and future potential major public health emergencies. Such actionable knowledge is critical for implementors of scale-up activities in low- and middle-income settings. TRIAL REGISTRATION ChiCTR 2100043319 . Registered on 10 February 2021.
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Affiliation(s)
- Shuduo Zhou
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health, Peking University, Beijing, China
| | - Xuejie Dong
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health, Peking University, Beijing, China
| | - Fangjing Liu
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health, Peking University, Beijing, China
| | - Yan Zhang
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Dahai Yue
- University of Maryland, College Park, USA
| | - Qiang Zhou
- Shenzhen Center for Prehospital Care, Shenzhen, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
- Institute for Global Health, Peking University, Beijing, China.
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health, Peking University, Beijing, China
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Hut-Mossel L, Ahaus K, Welker G, Gans R. Understanding how and why audits work in improving the quality of hospital care: A systematic realist review. PLoS One 2021; 16:e0248677. [PMID: 33788894 PMCID: PMC8011742 DOI: 10.1371/journal.pone.0248677] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care. METHODS A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context-mechanism-outcome configurations (CMOcs). RESULTS From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration. CONCLUSIONS This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. PROSPERO REGISTRATION CRD42016039882.
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Affiliation(s)
- Lisanne Hut-Mossel
- Centre of Expertise on Quality and Safety, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Kees Ahaus
- Department Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Gera Welker
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk Gans
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Falstie-Jensen AM, Bogh SB, Johnsen SP. Consecutive cycles of accreditation and quality of in-hospital care: a Danish population-based study. Int J Qual Health Care 2021; 33:6183633. [PMID: 33755173 DOI: 10.1093/intqhc/mzab048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/17/2021] [Accepted: 03/23/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Little is known about whether repeated cycles of hospital accreditation are a robust method to improve quality of care continuously. OBJECTIVE We aimed to examine the association between compliance with consecutive cycles of accreditation and quality of in-hospital care. METHODS We conducted a Danish nationwide population-based study including patients aged 18 years treated for acute stroke, chronic obstructive pulmonary disease, diabetes, heart failure or hip fracture at public, non-psychiatric hospitals. From 2012 to 2015, two cycles of national hospital accreditation were completed, resulting in 12 high and 14 low compliant hospitals (Low = partially accredited in both cycles). Our outcome measure was quality of in-hospital care measured by 39 process performance measures (PPMs), reflecting recommendations from the national clinical guidelines by adherence to (i) individual PPMs and (ii) the full bundle of PPMs (all-or-none). We computed adjusted odds ratios (ORs) using logistic regression based on robust standard error estimation for cluster sampling of data at hospital level. RESULTS In total, 78 387 patient pathways covering 508 816 processes were included, of which 47% had been delivered at high compliant hospitals and 53% at low compliant hospitals, respectively. Compliance with consecutive cycles was not associated with improved quality of in-hospital care (individual: OR = 0.92, 95% confidence interval (CI): 0.77-1.10; All-or-none: OR = 0.87, 95% CI: 0.66-1.15). However, in the second cycle alone, patients treated at partially accredited hospitals had a lower adherence than patients treated at fully accredited hospitals (Individual: OR = 0.84, 95% CI: 0.71-0.99; All-or-none: OR = 0.78, 95% CI: 0.59-1.03). The association was particularly strong among patients treated at partially accredited hospitals required to submit additional documentation. CONCLUSION Compliance with consecutive cycles of hospital accreditation in Denmark was not associated with improved quality of in-hospital care. However, compliance with the second cycle alone was associated with improved quality of in-hospital care.
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Affiliation(s)
| | - Søren Bie Bogh
- Institute of Regional Health Research, OPEN Odense Patient data Explorative Network, University of Southern Denmark, J. B. Winsløws Vej 9 a, 3. sal, Odense C, Region of Southern Denmark 5000, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Mølleparkvej 10, Aalborg 9000, Denmark
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Titi MA, Baksh MM, Zubairi B, Abdalla RAM, Alsaif FA, Amer YS, Jamal D, El-Jardali F. Staying ahead of the curve: avigating changes and maintaining gains in patient safety culture - a mixed-methods study. BMJ Open 2021; 11:e044116. [PMID: 33664079 PMCID: PMC7934776 DOI: 10.1136/bmjopen-2020-044116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study examines how the results of the Hospital Survey on Patient Safety Culture changed between 2012 and 2019 and identifies organisational factors affecting these changes. DESIGN The study combined the use of quantitative surveys of staff and qualitative interviews with hospital leadership. Secondary data analysis was performed for previous surveys. SETTING This study was conducted in a tertiary care teaching multisite hospital in Riyadh, Saudi Arabia. PARTICIPANTS One thousand hospital staff participated in the survey. Thirty-one executive board members and directors and four focus groups of frontliners were qualitatively interviewed. PRIMARY AND SECONDARY OUTCOME MEASURES Twelve safety culture dimensions were assessed to study the patient safety culture as perceived by the healthcare professionals. An additional semi-structured interview was conducted to identify organisational factors, changes, and barriers affecting the patient safety culture. Furthermore, suggestions to improve patient safety were proposed. RESULTS Comparing the results revealed a general positive trend in scores from 2012 to 2019. The areas of strength included teamwork within and across units, organisational learning, managerial support, overall perception of safety and feedback and communication about error. Non-punitive response to error, staffing and communication and openness consistently remain the lowest-scoring composites. Interview results revealed that organisational changes may have influenced the answers of the participants on some survey composites. CONCLUSIONS Patient safety is a moving target with areas for improvement that are continuously identified. Effective quality improvement initiatives can lead to visible changes in the patient safety culture in a hospital, and consistent leadership commitment and support can maintain these improvements.
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Affiliation(s)
- Maher Abdelraheim Titi
- Quality Management, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
- Research Chair for Evidence Based Health Care and Knowledge Translation, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
| | - Maram Mohammed Baksh
- Quality Management, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
| | - Beena Zubairi
- Quality Management, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
| | | | - Faisal Abdullah Alsaif
- Surgery, King Saud University College of Medicine, Riyadh, Riyadh Province, Saudi Arabia
| | - Yasser S Amer
- Quality Management, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
- Research Chair for Evidence Based Health Care and Knowledge Translation, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
- Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Diana Jamal
- Health Management and Policy, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
| | - Fadi El-Jardali
- Health Management and Policy, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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El-Shal A, Cubi-Molla P, Jofre-Bonet M. Accreditation as a quality-improving policy tool: family planning, maternal health, and child health in Egypt. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:115-139. [PMID: 33219440 PMCID: PMC7822797 DOI: 10.1007/s10198-020-01240-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 10/15/2020] [Indexed: 06/02/2023]
Abstract
Accreditation of healthcare providers has been established in many high-income countries and some low- and middle-income countries as a tool to improve the quality of health care. However, the available evidence on the effectiveness of this approach is limited and of questionable quality, especially in low- and middle-income countries. We exploit the interventions introduced under Egypt's health sector reform program between 2000 and 2014 to estimate the effect of health facility accreditation on family planning, maternal health, and child health outcomes. We use difference-in-differences fixed-effects and propensity score matching difference-in-differences models. To do so, we spatially link women to their nearest mapped health facilities using their global positioning system coordinates. We find that accreditation had multiple positive effects, especially on delivery care and child morbidity prevalence. The effects appear to weaken over time though. Our findings suggest that facility accreditation can be effective in improving family planning, antenatal care, delivery care, and child health, but stress the need to study how the effects can be sustained.
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Affiliation(s)
- Amira El-Shal
- Department of Economics, Faculty of Economics and Political Science, Cairo University, Giza, Egypt.
| | - Patricia Cubi-Molla
- Office of Health Economics, London, UK
- Department of Economics, City, University of London, London, UK
| | - Mireia Jofre-Bonet
- Office of Health Economics, London, UK
- Department of Economics, City, University of London, London, UK
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The Perspective of Key Stakeholders on the Impact of Reaccreditation in a Large National Mental Health Institute. Jt Comm J Qual Patient Saf 2020; 46:699-705. [PMID: 33127333 DOI: 10.1016/j.jcjq.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Obtaining and maintaining accreditation is an important component of high-quality mental health care services. However, research is lacking, and explanations for quantitative observations surrounding the sustainability of improvements are unfounded in qualitative data. The aim of this study was to explore how accreditation, specifically that provided by Joint Commission International, affects service quality at the Institute of Mental Health in Singapore to advance our understanding of its effects and the durability of improvements. METHODS Researchers conducted 21 qualitative semistructured interviews with key informants to understand how obtaining reaccreditation was affecting the institute. The data were analyzed thematically to produce an understanding of the various ways in which accreditation improved care quality. RESULTS Accreditation contributed to the improvement of care via several mechanisms. Although participants universally endorsed the positive impact of accreditation on safety, it was harder to pinpoint specific outcomes that improved because of it. Accreditation, however, had unintended consequences: Unnecessary processes arising from overinterpretation of standards led to several staff behaviors that might ultimately compromise the sustainability of new processes. CONCLUSION Although accreditation drives improvement via clear mechanisms, policy makers must be aware of unintended consequences. Organizations struggling with accreditation must clearly communicate the rationale for the implementation of new processes linked to reaccreditation. With a clear purpose, changes may be more sustainable.
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Dewanto A, Febrina SS, Wardhani V. The importance of nurses’ cognitive and emotional engagement in developing hospital quality culture. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Prasanti I, Wardhani V. Exploring quality management system maturity of the accredited hospitals. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2020.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Frank JR, Taber S, van Zanten M, Scheele F, Blouin D. The role of accreditation in 21st century health professions education: report of an International Consensus Group. BMC MEDICAL EDUCATION 2020; 20:305. [PMID: 32981519 PMCID: PMC7520947 DOI: 10.1186/s12909-020-02121-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Accreditation is considered an essential ingredient for an effective system of health professions education (HPE) globally. While accreditation systems exist in various forms worldwide, there has been little written about the contemporary enterprise of accreditation and even less about its role in improving health care outcomes. We set out to 1) identify a global, contemporary definition of accreditation in the health professions, 2) describe the relationship of educational accreditation to health care outcomes, 3) identify important questions and recurring issues in twenty-first century HPE accreditation, and 4) propose a framework of essential ingredients in present-day HPE accreditation. METHODS We identified health professions accreditation leaders via a literature search and a Google search of HPE institutions, as well as by accessing the networks of other leaders. These leaders were invited to join an international consensus consortium to advance the scholarship and thinking about HPE accreditation. We describe the consensus findings from the International Health Professions Accreditation Outcomes Consortium (IHPAOC). RESULTS We define accreditation as the process of formal evaluation of an educational program, institution, or system against defined standards by an external body for the purposes of quality assurance and enhancement. In the context of HPE, accreditation is distinct from other forms of program evaluation or research. Accreditation can enhance health care outcomes because of its ability to influence and standardize the quality of training programs, continuously enhance curriculum to align with population needs, and improve learning environments. We describe ten fundamental and recurring elements of accreditation systems commonly found in HPE and provide an overview of five emerging developments in accreditation in the health professions based on the consensus findings. CONCLUSIONS Accreditation has taken on greater importance in contemporary HPE. These consensus findings provide frameworks of core elements of accreditation systems and both recurring and emerging design issues. HPE scholars, educators, and leaders can build on these frameworks to advance research, development, and operation of high-quality accreditation systems worldwide.
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Affiliation(s)
- Jason R. Frank
- Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Sarah Taber
- Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Marta van Zanten
- Foundation for Advancement of International Medical Education and Research, Philadelphia, PA USA
| | - Fedde Scheele
- OLVG Teaching Hospital, Amsterdam, The Netherlands
- VU Medical Center, School of Medical Sciences, Amsterdam, The Netherlands
- Athena Institute for Transdisciplinary Research, Amsterdam, The Netherlands
| | - Danielle Blouin
- Department of Emergency Medicine, Queen’s University, Kingston, Canada
| | - on behalf of the International Health Professions Accreditation Outcomes Consortium
- Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
- Foundation for Advancement of International Medical Education and Research, Philadelphia, PA USA
- OLVG Teaching Hospital, Amsterdam, The Netherlands
- VU Medical Center, School of Medical Sciences, Amsterdam, The Netherlands
- Athena Institute for Transdisciplinary Research, Amsterdam, The Netherlands
- Department of Emergency Medicine, Queen’s University, Kingston, Canada
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Sperling D, Pikkel RB. Promoting patients' rights through hospital accreditation. Isr J Health Policy Res 2020; 9:47. [PMID: 32958047 PMCID: PMC7504649 DOI: 10.1186/s13584-020-00405-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Over the past decade, hospitals in many countries, including Israel, have undergone an accreditation process aimed at improving the quality of services provided. This process also refers to the protection and promotion of patients' rights. However, reviewing the criteria and content included in this category in the Israeli context reveals definitions and implications that differ from those presented by the law - specifically the Patient's Rights Act 1995. Moreover, the rights included in it are not necessarily equally represented in other legislation. METHODS This study seeks to examine the question of whether and to what extent the scope, contents, and definitions of patients' rights in the JCI Standards are similar to or different from patients' rights as they are addressed and protected in national legislation. The article provides a comparison and examination of the different regulatory frameworks of patients' rights, especially those in the accreditation of healthcare institution and legislation, analyzes the gaps between such frameworks, and suggests possible implications on our understanding of the concept of patients' rights. RESULTS The patients' right chapter in the accreditation process introduces and promotes the concepts of patient and family rights, increases the awareness and compliance of such concepts, and may create greater consistency in their introduction and application. CONCLUSIONS Discussion of the Israeli case not only demonstrates how regulatory frameworks are instrumental - for broader policy purposes, especially in the area of patients' rights and the rights of patients' families - but also calls for a more general examination of the concept of patients' rights in health policies and its contribution to the quality of health services. Reference to patients' rights in accreditation of healthcare institutions may promote and enhance this concept and contribute to the delivery of care, thereby complementing a lacuna in the law.
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Affiliation(s)
| | - Rina B. Pikkel
- International Center for Health, Law and Ethics, Faculty of Law, University of Haifa, Haifa, Israel
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Poortaghi S, Salsali M, Ebadi A, Pourgholamamiji N. Accreditation of nursing clinical services: Development of an appraisal tool. Nurs Open 2020; 7:1338-1345. [PMID: 32802354 PMCID: PMC7424456 DOI: 10.1002/nop2.505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 04/04/2020] [Accepted: 04/10/2020] [Indexed: 11/06/2022] Open
Abstract
Aim This study aimed to determine comprehensive and applicable indicators for assessing the quality of nursing clinical services. Design Methodological research. Methods The checklist was designed in three phases (conceptualization, item generation and item reduction). In the first phase, a qualitative study using conventional content analysis was performed to clarify the concept of accreditation of clinical nursing services. In the second phase, using the views of experts was obtained in phase 1 and then by a review of the literature, related items were extracted, and item pool was formed. In the last phase, validity and reliability of the checklist were examined. Result Based on three phases (Conceptualization, Item Generation and Item Reduction), the accreditation indicators of clinical nursing services were extracted in three dimensions including structure, process and outcome at two levels of organizational (including structural and outcome indicators) and individual performance appraisal (process indicators) in 19 main categories.
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Affiliation(s)
- Sarieh Poortaghi
- Department of Community Health NursingSchool of Nursing & MidwiferyTehran University of Medical SciencesTehranIran
| | - Mahvash Salsali
- School of Nursing & MidwiferyTehran University of Medical SciencesTehranIran
| | - Abbas Ebadi
- Behavioral Sciences Research CenterLife Style InstituteBaqiyatallah University of Medical SciencesTehranIran
| | - Nima Pourgholamamiji
- Nursing Care Research Center (NCRC)School of Nursing and MidwiferyIran University of Medical SciencesTehranIran
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Hovlid E, Braut GS, Hannisdal E, Walshe K, Bukve O, Flottorp S, Stensland P, Frich JC. Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis. BMJ Open 2020; 10:e038850. [PMID: 32868366 PMCID: PMC7462249 DOI: 10.1136/bmjopen-2020-038850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections. METHODS We performed a literature search (1980-January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change. RESULTS We included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation's current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance. CONCLUSIONS External inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.
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Affiliation(s)
- Einar Hovlid
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Geir Sverre Braut
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Western Norway University of Applied Sciences, Haugesund, Norway
| | - Einar Hannisdal
- Department of health, County Governor in Oslo and Akershus, Oslo, Norway
| | - Kieran Walshe
- The University of Manchester Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Oddbjørn Bukve
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
| | | | - Per Stensland
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Jan C Frich
- Institute of Health and Society, Universitetet i Oslo, Oslo, Norway
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Johannesen DTS, Lindøe PH, Wiig S. Certification as support for resilience? Behind the curtains of a certification body - a qualitative study. BMC Health Serv Res 2020; 20:730. [PMID: 32771012 PMCID: PMC7414657 DOI: 10.1186/s12913-020-05608-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Certification in healthcare often involves independent private sector bodies performing legally required or voluntary external assurance activities. These certification practices are embedded in international standards founded in traditional beliefs about rational and predictable processes for quality and safety improvement. Certification can affect organizational and cultural changes, support collaboration and encourage improvement that may be conducive to resilient performance. This study explores whether ISO 9001 quality management system certification can support resilience in healthcare, by looking at characteristics in the objectives, methods, and practice of certification from a certification body's perspective. METHODS One of Norway's four certification bodies in healthcare was studied, using an explorative embedded single-case design. The study relies on document analysis of the international standards and associated guidances for the performance of certification bodies and thematic analyses of data from 60 h of observations of auditors in three certification processes and nine qualitative interviews with managers and personnel from the certification body. Results from the analyses were compared to identify discrepancies between the written and perceived certification approach and practice. RESULTS Standards and guidances for certification embed an elasticity between formal and consistent assessments of nonconformities in organizations and emphasize holistic approaches that brings added value. Auditors were then left with the latitude to navigate their auditing strategy during interaction with the auditees. Members of the certification body perceived and practiced a holistic and flexible auditing approach using opportunities to share knowledge, empower and make guidance for improvement. CONCLUSIONS ISO certification expects structures and systems to ensure consistent and objective certification processes. At the same time, it embodies a latitude to adopt flexible and context-specific certification approaches, as demonstrated by a certification body in this study, to give added value to the certified organizations. Such an ISO 9001 certification approach may support resilient performance in healthcare by nurturing the potential to respond and learn. These results are important for further development of methods that certification bodies use in the auditing encounter.
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Affiliation(s)
- Dag Tomas Sagen Johannesen
- Department of Media and Social Sciences, The Faculty of Social Sciences, University of Stavanger, 4036, Stavanger, Norway. .,Department of Health and Nursing Science, University of Agder, 4604, Kristiansand, Norway. .,SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Preben Hempel Lindøe
- Department of Safety, Economics and Planning, Faculty of Science and Technology, University of Stavanger, 4036, Stavanger, Norway
| | - Siri Wiig
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
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Asgari N, Hessam S, Masoudi Asl I, Vahdat S. Determining Core Components in Accreditation of Limited Surgery Facilities in Iran. Galen Med J 2020; 9:e1729. [PMID: 34466579 PMCID: PMC8343499 DOI: 10.31661/gmj.v9i0.1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/14/2019] [Accepted: 01/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Limited surgery facilities, or day-care centers, have been expanding in recent years with the approach of reducing the number of patients referred to hospitals for treatment in relation to limited and ambulatory surgeries. This study was conducted to perform a comparative review of accreditation models for limited surgery facilities of selected countries and to obtain expert opinions in the field of policymaking and accreditation in Iran. Materials and Methods: This applied and qualitative study was carried out by a comparative method in 2019. The accreditation standards of limited surgery facilities in nine selected countries/states were assessed. Semi-structured interviews were then held with 25 Iranian experts in policymaking as well as accreditation authorities. Results: Evaluation of the core components of accreditation standards for limited surgery facilities in selected countries showed that the main concepts of care and treatment, human resource management, patient safety, drug management, patient education, health information management, quality improvement, service recipient rights, infection prevention and control, physical structure, management and leadership, and general facilities were among the key recurring concepts in all models. In the study of factors affecting the accreditation model of limited surgery facilities in Iran, 5 main topics and 43 subtopics were identified. Conclusion: Although the current assessment model of limited surgery facilities is an appropriate tool for evaluation, it still needs to be improved because of the uncertainty of evaluation model, training of accreditors and the content of standards.
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Affiliation(s)
- Nader Asgari
- Department of Health Services Administration, South Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Somayeh Hessam
- Department of Health Services Administration, South Tehran Branch, Islamic Azad University, Tehran, Iran
- Correspondence to: Somayeh Hessam, Department of Health Services Administration, South Tehran Branch, Islamic Azad University, Tehran, Iran Telephone Number: 09122268534 Email Address:
| | - Irvan Masoudi Asl
- Department of Health Services Management, School of Management and Information, Iran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Vahdat
- Department of Health Services Administration, South Tehran Branch, Islamic Azad University, Tehran, Iran
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K.S. S, Barkur G, G. S. Impact of accreditation on performance of healthcare organizations. INTERNATIONAL JOURNAL OF QUALITY AND SERVICE SCIENCES 2020. [DOI: 10.1108/ijqss-10-2018-0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to review the accreditation research in specific to its effect on the performance of healthcare organizations.
Design/methodology/approach
A comprehensive search and analysis of literature on the effect of healthcare accreditation were conducted between June 2017 and May 2018. The study identified 62 empirical research studies that examined the effect of healthcare accreditation programmes. Study particulars such as year of publication, objectives, focus of the study, research settings and key findings were recorded. A content analysis was performed to identify the frequency of the main themes in the literature. Knowledge gaps needing further examination were identified.
Findings
Majority of the accreditation impact studies were carried out in the developed nations (n = 49). The thematic categories, that is the impact on “patient safety and healthcare quality” (n = 26), “healthcare professionals’ views” (n = 28) and “clinical process and outcomes” (n = 17) were addressed more times. Whereas the other two thematic categories “organizational performance” and “consumers’ views or satisfaction,” each was examined less than 10 instances. This review reveals mixed views on effect of healthcare accreditation. The varied quality of studies and the availability of a few studies on consumers’ perception of accreditation effectiveness were the important limiting factors of this review.
Originality/value
The findings are valuable to healthcare managers and hospital administrators in accreditation decisions, whereas findings are of value to researchers and academicians in terms of gaps identified for future research studies pertaining to the impact of healthcare accreditation. Future studies need to consider holistic theoretical frameworks for assessing the effect of accreditation on performance of healthcare organizations to achieve precise results.
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Yousefinezhadi T, Mosadeghrad AM, Hinchcliff R, Akbari-Sari A. Evaluation results of national hospital accreditation program in Iran: The view of hospital managers. J Healthc Qual Res 2020; 35:12-18. [PMID: 31964614 DOI: 10.1016/j.jhqr.2019.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Accreditation programs have a crucial role in improving the safety and effectiveness of hospital services. Many factors contribute to achieve accreditation goals. This study evaluated the national Iranian hospital accreditation program from the view of hospital managers in Iran. METHODS The study was conducted in 2015 using a validated questionnaire designed to collect feedback concerning accreditation processes and impacts. In total, 547 managers were surveyed using a stratified random sampling method. A 5-degree scale Likert from totally disagree=1 to totally agree=5 has been used for the evaluation. Descriptive and inferential statistics were used to analyze the data. RESULTS Approximately half of hospital managers were satisfied with the accreditation standards and surveying methods. The reason for their dissatisfaction was the high number of measures (2.38). The main challenges to the accreditation method were reported inadequate surveyor training (2.94) their satisfaction with the infrastructure was low because of a lack of hospital resources. Nonetheless, the accreditation program was perceived as being successful in improving patient safety (3.80), patient compliance (3.72), and error reduction (3.53). CONCLUSION An effective accreditation program requires reducing the number of standards and making them clearer as well as the infrastructure for the implementation of accreditation such as sufficient and sustainable funds, enough human resources and equipment should be provided. Appropriate surveyors should be selected and trained professionally to ensure inter-rater reliability among them.
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Affiliation(s)
- T Yousefinezhadi
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - A M Mosadeghrad
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - R Hinchcliff
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - A Akbari-Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
This paper sets out a conceptual framework by which quality improvement in primary dental care can be approached. We argue that seeking a unified definition for quality in dentistry is a distraction to the more important end of quality improvement. An approach to quality improvement that interfaces Donabedian's domains of structure, process and outcome with various dimensions of quality gives a rational approach by which quality can be assessed and improved. The importance of valid, evidence driven indicators and methods for their implementation in primary dental care is described. Further work is required in order to identify which dimensions of dentistry are most important, but the Institute of Medicine's dimensions of safety, effectiveness, patient centreedness, timeliness, equity, efficiency are a good starting point. Trying to develop an absolute list of dimensions of quality should not distract from implementing an approach-based paradigm of quality improvement. Bioinformatics offers new solutions by which quality measures may be implemented and reported in the primary care setting. The focus of future research should be in implementing data-driven quality indicators at the level of the primary care practitioner.
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Rusanganwa V, Gahutu JB, Evander M, Hurtig AK. Clinical Referral Laboratory Personnel's Perception of Challenges and Strategies for Sustaining the Laboratory Quality Management System. Am J Clin Pathol 2019; 152:725-734. [PMID: 31304959 PMCID: PMC6829011 DOI: 10.1093/ajcp/aqz092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To explore challenges explaining the decrease in quality performance and suggest strategies to improve and sustain laboratory quality services. METHODS Twenty key informants' interviews from laboratory personnel were conducted in five laboratories. Four had previously shown a decrease in quality performance. Interviews were transcribed verbatim and analyzed using inductive thematic analysis. RESULTS Two themes emerged: (1) insufficient coordination and follow-up system towards accreditation, where lack of coordination, follow-up, and audits explained the decrease in performance; (2) inadequate resource optimization, where insufficient knowledge in Laboratory Quality Management System (LQMS), ownership by laboratory workforce, and insufficient stakeholders' communication contributed to low-quality performance. CONCLUSIONS The coordination, follow-up, and assessments of LQMS, in conjunction with training of laboratory workforce, would establish an institutional culture of continuous quality improvement (CQI) towards accreditation and sustainment of quality health care. To achieve CQI culture, routine gap checking and planning for improvement using a system approach is required.
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Affiliation(s)
- Vincent Rusanganwa
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
- Ministry of Health, Kigali, Rwanda
| | - Jean Bosco Gahutu
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Magnus Evander
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Sharifi M, Raeissi P, Gorji HA, Aryankhesal A. Developing a Model for Accreditation of Iranian Teaching Hospitals: A Qualitative Study. Ethiop J Health Sci 2019; 29:657-668. [PMID: 31741636 PMCID: PMC6842710 DOI: 10.4314/ejhs.v29i6.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/08/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Among different factors, accreditation is being widely used across the world to improve quality and safety in hospitals. Therefore, the purpose of the present study was to develop an accreditation model for teaching hospitals in Iran. METHODS This qualitative study was conducted in four phases from January, 2017 to March, 2018. To this end; firstly, existing accreditation models were extracted and reviewed comparatively. Within the second stage, dimensions and components of the accreditation model were extracted through semi-structured interviews. In the third stage, a new instruction was developed via integrating the findings from the first and the second stages. Finally, the model was validated in two phases of Delphi method and a specialized forum in the fourth step. Qualitative findings were then analyzed using content analysis method. RESULTS Models of Joint Commission International (JCI) and Word Federation for Medical Education (WFME) in other 6 countries were reviewed and compared with the current Iranian model. Extracted dimensions discovered to complement the present model included learner assessment, continuous reviews and revisions, and educational productivity. The final model was also developed with 12 dimensions and 94 standards. Content validity ratio (CVR) and content validity index (CVI) were also estimated to be 0.40 and 0.80, respectively. As well, the second round of Delphi method could increase the number of model standards to 97. Moreover, Cohen's kappa coefficient was calculated to be at least 0.71. CONCLUSION This study led to the development of a comprehensive model for scientific accreditation of teaching hospitals through reviewing documentation, combining and comparing global approaches, as well as integrating them with the views of domestic experts.
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Affiliation(s)
- Marziye Sharifi
- Department of Health Services Management, School of Health Management and Information Sciences, International Campus (IUMS-IC), Iran University of Medical Sciences, Tehran, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abolghasem Gorji
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Uren H, Vidakovic B, Daly M, Sosnowski K, Matus V. Short-notice (48 hours) ACCREDITATION trial in Australia: stakeholder perception of assessment thoroughness, resource requirements and workforce engagement. BMJ Open Qual 2019; 8:e000713. [PMID: 31637325 PMCID: PMC6768343 DOI: 10.1136/bmjoq-2019-000713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Hailie Uren
- Logan Hospital Clinical Governance Unit, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
| | - Branislav Vidakovic
- Logan Hospital Clinical Governance Unit, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
| | - Michael Daly
- Clinical Governance Unit, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kellie Sosnowski
- Logan Hospital Intensive Care Unit, Metro South Health Service District, Meadowbrook, Queensland, Australia
| | - Vladimir Matus
- Logan Hospital Clinical Governance Unit, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
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Wardhani V, van Dijk JP, Utarini A. Hospitals accreditation status in Indonesia: associated with hospital characteristics, market competition intensity, and hospital performance? BMC Health Serv Res 2019; 19:372. [PMID: 31185984 PMCID: PMC6560753 DOI: 10.1186/s12913-019-4187-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background Hospital accreditation is widely adopted as a visible measure of an organisation’s quality and safety management standards compliance. There is still inconsistent evidence regarding the influence of hospital accreditation on hospital performance, with limited studies in developing countries. This study aims to explore the association of hospital characteristics and market competition with hospital accreditation status and to investigate whether accreditation status differentiate hospital performance. Methods East Java Province, with a total 346 hospitals was selected for this study. Hospital characteristics (size, specialty, ownership) and performance indicator (bed occupancy rate, turnover interval, average length of stay, gross mortality rate, and net mortality rate) were retrieved from national hospital database while hospital accreditation status were recorded based on hospital accreditation report. Market density, Herfindahl-Hirschman index (HHI), and hospitals relative size as competition indicators were calculated based on the provincial statistical report data. Logistic regression, Mann-Whitney U-test, and one sample t-test were used to analyse the data. Results A total of 217 (62.7%) hospitals were accredited. Hospital size and ownership were significantly associated with of accreditation status. When compared to government-owned, hospital managed by ministry of defense (B = 1.705, p = 0.012) has higher probability to be accredited. Though not statistically significant, accredited hospitals had higher utility and efficiency indicators, as well as higher mortality. Conclusions Hospital with higher size and managed by government have higher probability to be accredited independent to its specialty and the intensity of market competition. Higher utility and mortality in accredited hospitals needs further investigation. Electronic supplementary material The online version of this article (10.1186/s12913-019-4187-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Viera Wardhani
- Post Graduate Program in Hospital Management, Faculty of Medicine, Universitas Brawijaya, East Java, Jalan Veteran No 1, Malang, 65145, Indonesia. .,Doctoral Program in Medicine and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Farmako Sekip Utara, Yogyakarta, 55281, Indonesia.
| | - Jitse Pieter van Dijk
- Department of Community and Occupational Medicine, University Medisch Centrum, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands.,Department of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacký University, Hněvotínská 3, 775 15, Olomouc, Czech Republic
| | - Adi Utarini
- Department of Health Policy and Management, Faculty of Medicine, Public health and Nursing, Universitas Gadjah Mada, Jalan Farmako Sekip Utara, Yogyakarta, 55281, Indonesia
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Khoury J, Krejany CJ, Versteeg RW, Lodewyckx MA, Pike SR, Civil MS, Jiwa M. A process for developing standards to promote quality in general practice. Fam Pract 2019; 36:166-171. [PMID: 29868888 PMCID: PMC6425464 DOI: 10.1093/fampra/cmy049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 1991, the Royal Australian College of General Practitioners' (RACGP) Standards for General Practices (the Standards) have provided a framework for quality care, risk management and best practice in the operation of Australian general practices. The Standards are also linked to incentives for general practice remuneration. These Standards were revised in 2017. OBJECTIVE The objective of this study is to describe the process undertaken to develop the fifth edition Standards published in 2017 to inform future standards development both nationally and internationally. METHOD A modified Delphi process was deployed to develop the fifth edition Standards. Development was directed by the RACGP and led by an expert panel of GPs and representatives of stakeholder groups who were assisted and facilitated by a team from RACGP. Each draft was released for stakeholder feedback and tested twice before the final version was submitted for approval by the RACGP board. RESULTS Four rounds of consultation and two rounds of piloting were carried out over 32 months. The Standards were redrafted after each round. One hundred and fifty-two individuals and 225 stakeholder groups participated in the development of the Standards. Twenty-three new indicators were recommended and grouped into three sections in a new modular structure that was different from the previous edition. CONCLUSION The Standards represent the consensus view of national stakeholders on the indicators of quality and safety in Australian general practice and primary care.
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Affiliation(s)
- Julie Khoury
- Policy, Practice and Innovation, Royal Australian College of General Practitioners, Melbourne, Australia
| | - Catherine J Krejany
- Melbourne Clinical School, School of Medicine Sydney, University of Notre Dame Australia, Victoria, Australia
| | - Roald W Versteeg
- Policy, Practice and Innovation, Royal Australian College of General Practitioners, Melbourne, Australia
| | - Michaela A Lodewyckx
- North West Melbourne Primary Health Network, Health Systems Integration, Melbourne, Australia
| | - Simone R Pike
- Policy, Practice and Innovation, Royal Australian College of General Practitioners, Melbourne, Australia
| | - Michael S Civil
- Policy, Practice and Innovation, Royal Australian College of General Practitioners, Perth, Australia
| | - Moyez Jiwa
- Melbourne Clinical School, School of Medicine Sydney, University of Notre Dame Australia, Victoria, Australia
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Carrasco-Peralta JA, Herrera-Usagre M, Reyes-Alcázar V, Torres-Olivera A. Healthcare accreditation as trigger of organisational change: The view of professionals. J Healthc Qual Res 2019; 34:59-65. [PMID: 30713136 DOI: 10.1016/j.jhqr.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Healthcare accreditation seeks to promote the organisational change in healthcare organisations from an approach that values the level of progress achieved through a validated reference framework. The aim of this paper is to analyse the role played by accreditation through the experience perceived by health professionals during the process of self-assessment and external evaluation, taking into account three dimensions of analysis: focus on the patient, internal organisation and leadership, and impact on the clinical aspects of healthcare. MATERIAL AND METHODS Design: Semi-structured interviews with key informants from clinical management units (CMU) within the Andalusian Health System (Spain). PARTICIPANTS The key informants in each CMU were the clinical leader, the head of nursing and two health professionals (doctors and nurses). A qualitative research protocol was employed to conduct the semi-structured interviews (n=52 interviews) with physicians and nurses, in order to analyse their experience with the accreditation process. RESULTS The analysis identified four main outcomes related to the accreditation process perceived by professionals: (1) A benchmarking conceptualisation of the process; (2) Improvements in patient-centred care, quality of clinical records, and organisational culture of the units; (3) Improvement of patient safety culture; (4) As negative outcomes, a slight perception of bureaucratisation and standardisation of the clinical practice. CONCLUSIONS The described initiative of accreditation process in Andalusia (Spain) is widely perceived as positive by health professionals since it fosters the organisational change, although it also has a slightly negative bureaucratisation effect on clinical practice.
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Affiliation(s)
- J A Carrasco-Peralta
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
| | - M Herrera-Usagre
- Andalusian Agency for Healthcare Quality/Pablo de Olavide University, Department of Sociology, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain.
| | - V Reyes-Alcázar
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
| | - A Torres-Olivera
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
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Ghith N, Merlo J, Frølich A. Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance. BMJ Open Qual 2019; 8:e000449. [PMID: 30729192 PMCID: PMC6340563 DOI: 10.1136/bmjoq-2018-000449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background Studies assessing institutional performance regarding quality of care are frequently performed using single-level statistical analyses investigating differences between provider averages of various quality indicators. However, such analyses are insufficient as they do not consider patients’ heterogeneity around those averages. Hence, we apply a multilevel analysis of individual-patient heterogeneity that distinguishes between ‘general’ (‘latent quality’ or measures of variance) and ‘specific’ (measures of association) contextual effects. We assess general contextual effects of the hospital departments and the specific contextual effect of a national accreditation programme on adherence to the standard benchmark for albuminuria measurement in Danish patients with diabetes. Methods From the Danish Adult Diabetes Database, we extracted data on 137 893 patient cases admitted to hospitals between 2010 and 2013. Applying multilevel logistic and probit regression models for every year, we quantified general contextual effects of hospital department by the intraclass correlation coefficient (ICC) and the area under the receiver operating characteristic curve (AUC) values. We evaluated the specific effect of hospital accreditation using the ORs and the change in the department variance. Results In 2010, the department context had considerable influence on adherence with albuminuria measurement (ICC=21.8%, AUC=0.770), but the general effect attenuated along with the implementation of the national accreditation programme. The ICC value was 16.5% in 2013 and the rate of compliance with albuminuria measurement increased from 91.6% in 2010 to 96% in 2013. Conclusions Parallel to implementation of the national accreditation programme, departments’ compliance with the standard benchmark for albuminuria measurement increased and the ICC values decreased, but remained high. While those results indicate an overall quality improvement, further intervention focusing on departments with the lowest compliance could be considered.
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Affiliation(s)
- Nermin Ghith
- Research Unit of Chronic Conditions, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark.,Unit for Social Epidemiology, Lunds Universitet, Lund, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Lunds Universitet, Lund, Sweden
| | - Anne Frølich
- Research Unit of Chronic Conditions, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark
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Weske U, Boselie P, van Rensen E, Schneider M. Physician compliance with quality and patient safety regulations: The role of perceived enforcement approaches and commitment. Health Serv Manage Res 2018; 32:103-112. [PMID: 30463452 DOI: 10.1177/0951484818813324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The implementation of a quality and patient safety accreditation system is crucial for hospitals. Although control systems-such as accreditation-can contribute to quality improvements, they also run the risk of unintended consequences. As a result, ways should be found to avoid or reduce these undesirable consequences. This study aims to answer this call by exploring the association of different approaches to the enforcement of rules (punishment, based on monitoring and threats of sanctions; and persuasion, based on dialog and suggestion) with compliance. To test the relation between perceived enforcement and compliance, this study used survey data collected from medical specialists (N = 92) of a large academic medical center. The findings indicate that the same system is interpreted differently and that only a perceived persuasion approach is related to higher levels of compliance. This effect is fully mediated by affective commitment. No direct or indirect effects on compliance were found for a perceived coercive approach. These results suggest that control systems can be perceived in different ways and that the implementation of a control system does therefore not automatically lead to negative and unintended outcomes.
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Affiliation(s)
- Ulrike Weske
- 1 Utrecht University School of Governance, Utrecht University, Utrecht, Netherlands
| | - Paul Boselie
- 1 Utrecht University School of Governance, Utrecht University, Utrecht, Netherlands
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Falstie-Jensen AM, Bogh SB, Johnsen SP. Consecutive cycles of hospital accreditation: Persistent low compliance associated with higher mortality and longer length of stay. Int J Qual Health Care 2018; 30:382-389. [PMID: 29562332 DOI: 10.1093/intqhc/mzy037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/01/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To examine the association between compliance with consecutive cycles of accreditation and patient-related outcomes. Design A Danish nationwide population-based study from 2012 to 2015. Setting In-patients admitted with one of the 80 diagnoses at public, non-psychiatric hospitals. Participants In-patients admitted with one of 80 primary diagnoses which accounted for 80% of all deaths occuring within 30 dyas after admission. Intervention Admission to a hospital with high (n = 125 485 in-patients) or low compliance (n = 152 074 in-patients) in both cycles of accreditation by the Danish Healthcare Quality Programme. Main outcome measures A 30-day mortality, length of stay (LOS) and all-cause acute readmission. We computed adjusted odds ratios (OR) and hazard ratios (HR) using logistic and Cox Proportional Hazard regression including adjustment for six potential patient-related confounders. Results The 30-day mortality risk for in-patients admitted at high compliant hospitals was 3.95% (95% confidence interval (CI): 3.84-4.06) and 4.39% (95% CI: 4.29-4.49) at low compliant hospitals. In-patients admitted at low compliant hospitals had a substantially higher risk of dying within 30-day after admission (adjusted OR: 1.26 (95% CI: 1.11-1.43) and a longer LOS (adjusted HR of discharge: 0.89 (95% CI: 0.82-0.95) than in-patients at high compliant hospitals. No difference was seen for acute readmission (adjusted HR: 0.98 (95% CI: 0.90-1.06)). Focusing on the second cycle alone, in-patients at partially accredited hospitals had a higher 30-day mortality risk and longer LOS than admissions at fully accredited hospitals (30-day: adjusted OR: 1.12 (95% CI: 1.02-1.24) and LOS: adjusted HR: 0.91 (95% CI: 0.84-0.98)). Conclusion Persistent low compliance with the DDKM (in Danish: Den Danske Kvalitetsmodel) accreditation was associated with higher 30-day mortality and longer LOS.
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Affiliation(s)
- Anne Mette Falstie-Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark
| | - Søren Bie Bogh
- Institute of Regional Health Research, University of Southern Denmark and Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart, Denmark
| | - Søren Paaske Johnsen
- Department of medicine, Aalborg University, Niels Jernes Vej 10, Aalborg Øst, Denmark
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The Effects of Implementing an Accreditation Process on Health Care Quality Using Structural Equation Modeling. Health Care Manag (Frederick) 2018; 37:317-324. [DOI: 10.1097/hcm.0000000000000229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Reisi N, Raeissi P, Sokhanvar M, Kakemam E. The impact of accreditation on nurses' perceptions of quality of care in Iran and its barriers and facilitators. Int J Health Plann Manage 2018; 34:e230-e240. [PMID: 30156711 DOI: 10.1002/hpm.2642] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Iran national hospital accreditation was initiated as a government and mandatory program in 2012. The aim of this study was to examine the impact of accreditation on nurses' perceptions of quality of care and to determine those barriers and facilitators needed for effective implementation of accreditation. METHODS A cross-sectional survey conducted in 43 tertiary public hospitals in 5 metropolises, Iran, which successfully passed national accreditation surveys. Participants included nurses with at least 5-year work experience. Overall response rate was 76%, with 1312 of 1706 valid responses included in the data analysis. A questionnaire was applied using a 5-point Likert scale ranging from 1 "strongly disagree" to 5 "strongly agree". In addition, the questionnaire included 2 open-ended questions allowing the respondent to identify barriers and facilitators to the process of for improving accreditation implementation. The relationship between the quality of results and the independent variables was tested using multiple regression analysis. RESULTS The scales measuring benefits of accreditation had the highest mean score followed by strategic quality planning, education and training, and staff involvement. Regression analysis indicated that leadership, commitment, and support; education and training; rewards and recognition; and staff involvement were factors affecting quality results. Barriers encountered included financial and capital resources, staff, institutional, and patients. Hospital accreditation has a positive impact on quality of care. CONCLUSIONS The findings of this study provide valuable information to policymakers and hospital managers on which to base the process of accreditation and its requirements, and to help reap its benefits.
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Affiliation(s)
- Nahid Reisi
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mobin Sokhanvar
- Student Research Committee, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Edris Kakemam
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Desveaux L, Mitchell JI, Shaw J, Ivers NM. Understanding the impact of accreditation on quality in healthcare: A grounded theory approach. Int J Qual Health Care 2018; 29:941-947. [PMID: 29045664 DOI: 10.1093/intqhc/mzx136] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- L Desveaux
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, Ontario, Canada
| | | | - J Shaw
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, Ontario, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada
| | - N M Ivers
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, Ontario, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada
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Alsakkak MA, Alwahabi SA, Alsalhi HM, Shugdar MA. Outcome of the first Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) primary health care accreditation cycle in Saudi Arabia. Saudi Med J 2018; 38:1132-1136. [PMID: 29114702 PMCID: PMC5767617 DOI: 10.15537/smj.2017.11.20760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives: To study and evaluate the first phase of the Saudi Central Board for Accreditation of Health Institutions (CBAHI) in primary health care (PHC) accreditation cycle. Methods: A descriptive analytical study of to evaluate 93 PHC survey visits in 20 regions, over the period October 2016 to May 2017. Results: In the period October 2016 to January 2017, only 28 out of 93 PHC center (30%) targeted PHC in phase-1 were surveyed, 8 PHC got accredited (29%), while 11 PHC received conditional accreditation letters (39%) and 9 PHC were denied the accreditation (32%). During February 2017 to May 2017 visits were shifted to one day site visit, all the health care facilities training’s workshops were completed and the mock survey visits were started to precede the real survey visits, Since then, 65 PHC centers were surveyed (70%). At this time 47 PHC centers were accredited (72%), while 9 PHC were conditionally accredited (14%), and another 9 PHC were denied the accreditation (14%). Overall, 55 out of 93 PHC accredited (59%), 20 PHC got conditional accreditation (22%), and 18 PHC were denied the accreditation (19%). Conclusion: Surveys per month were doubled with the one-day visit site visit. Both the intensive training and mock visits, showed a great impact as the accreditation and conditional accreditation status were increased by twofold due to better understanding of the PHC staff about the standards, as well as early identification of performance gap which allowed the PHC to mitigate these gaps sufficiently enough to avoid zero scores especially in the ESR requirements.
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Affiliation(s)
- Maher A Alsakkak
- Primary Health Care Accreditation Unit, Saudi Central Board for Accreditation of Health Institutions, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Bogh SB, Falstie-Jensen AM, Hollnagel E, Holst R, Braithwaite J, Raben DC, Johnsen SP. Predictors of the effectiveness of accreditation on hospital performance: A nationwide stepped-wedge study. Int J Qual Health Care 2018; 29:477-483. [PMID: 28482059 DOI: 10.1093/intqhc/mzx052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To identify predictors of the effectiveness of hospital accreditation on process performance measures. Design A multi-level, longitudinal, stepped-wedge, nationwide study. Participants All patients admitted for acute stroke, heart failure, ulcers, diabetes, breast cancer and lung cancer at Danish hospitals. Intervention The Danish Healthcare Quality Programme that was designed to create a framework for continuous quality improvement. Main outcome Measure(s) Changes in week-by-week trends of hospitals' process performance measures during the study period of 269 weeks prior to, during and post-accreditations. Process performance measures were based on 43 different processes of care obtained from national clinical quality registries. Analyses were stratified according to condition, type of care (i.e. treatment, diagnostics, secondary prevention and patient monitoring) and hospital characteristics (i.e. university affiliation, location, size, experience with accreditation and accreditation compliance). Results A total of 1 624 518 processes of care were included. The impact of accreditation differed across the conditions. During accreditation, heart failure and breast cancer showed less improvement than other disease areas. Across all conditions, diagnostic processes improved less rapidly than other types of processes. However, after stratifying the data by hospital characteristics, process performance measures improved more uniformly. In respect of the measures that had an unsatisfactory level of quality, the processes related to diabetes, diagnostics and patient monitoring all responded to accreditation and showed an increased improvement during the preparatory work. Conclusion Hospital characteristics were not found to be predictors for the effects of accreditation, whereas conditions and types of care to some extent predicted the effectiveness.
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Affiliation(s)
- Søren Bie Bogh
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, Odense C DK-5000, Denmark.,Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark
| | - Anne Mette Falstie-Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark
| | - Erik Hollnagel
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, Odense C DK-5000, Denmark.,Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark
| | - René Holst
- Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Australia
| | - Ditte Caroline Raben
- Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, Odense C DK-5000, Denmark.,Centre for Quality, Region of Southern Denmark, P.V. Tuxenvej 5, Middelfart DK-5500, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark
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Hijazi HH, Harvey HL, Alyahya MS, Alshraideh HA, Al abdi RM, Parahoo SK. The Impact of Applying Quality Management Practices on Patient Centeredness in Jordanian Public Hospitals: Results of Predictive Modeling. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2018; 55:46958018754739. [PMID: 29482410 PMCID: PMC5833210 DOI: 10.1177/0046958018754739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 12/17/2017] [Accepted: 12/22/2017] [Indexed: 01/22/2023]
Abstract
Targeting the patient's needs and preferences has become an important contributor for improving care delivery, enhancing patient satisfaction, and achieving better clinical outcomes. This study aimed to examine the impact of applying quality management practices on patient centeredness within the context of health care accreditation and to explore the differences in the views of various health care workers regarding the attributes affecting patient-centered care. Our study followed a cross-sectional survey design wherein 4 Jordanian public hospitals were investigated several months after accreditation was obtained. Total 829 clinical/nonclinical hospital staff members consented for study participation. This sample was divided into 3 main occupational categories to represent the administrators, nurses, as well as doctors and other health professionals. Using a structural equation modeling, our results indicated that the predictors of patient-centered care for both administrators and those providing clinical care were participation in the accreditation process, leadership commitment to quality improvement, and measurement of quality improvement outcomes. In particular, perceiving the importance of the hospital's engagement in the accreditation process was shown to be relevant to the administrators (gamma = 0.96), nurses (gamma = 0.80), as well as to doctors and other health professionals (gamma = 0.71). However, the administrator staff (gamma = 0.31) was less likely to perceive the influence of measuring the quality improvement outcomes on the delivery of patient-centered care than nurses (gamma = 0.59) as well as doctors and other health care providers (gamma = 0.55). From the nurses' perspectives only, patient centeredness was found to be driven by building an institutional framework that supports quality assurance in hospital settings (gamma = 0.36). In conclusion, accreditation is a leading factor for delivering patient-centered care and should be on a hospital's agenda as a strategy for continuous quality improvement.
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Affiliation(s)
- Heba H. Hijazi
- Jordan University of Science and Technology, Irbid, Jordan
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YOUSEFINEZHADI T, MOSADEGHRAD AM, ARAB M, RAMEZANI M, SARI AAKBARI. An Analysis of Hospital Accreditation Policy in Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:1347-1358. [PMID: 29308378 PMCID: PMC5750346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/22/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Public policymaking is complex and lacks research evidences, particularly in the Eastern Mediterranean Region (EMR). This policy analysis aims to generate insights about the process of hospital accreditation policy making in Iran, to identify factors influencing policymaking and to evaluate utilization of evidence in policy making process. METHODS The study examined the policymaking process using Walt and Gilson framework. A qualitative research design was employed. Thirty key informant interviews with policymakers and stakeholders were conducted. In addition hundred and five related documents were reviewed. Data was analyzed using framework analysis. RESULTS The accreditation program was a decision made at Ministry of Health and Medical Education in Iran. Many healthcare stakeholders were involved and evidence from leading countries was used to guide policy development. Poor hospital managers' commitment, lack of physicians' involvement and inadequate resources were the main barriers in policy implementation. Furthermore, there were too many accreditations standards and criteria, surveyors were not well-trained, had little motivation for their work and there was low consistency among them. CONCLUSION This study highlighted the complex nature of policymaking cycle and highlighted various factors influencing policy development, implementation and evaluation. An effective accreditation program requires a robust well-governed accreditation body, various stakeholders' involvement, sufficient resources and sustainable funds, enough human resources, hospital managers' commitment, and technical assistance to hospitals.
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Affiliation(s)
- Taraneh YOUSEFINEZHADI
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad MOSADEGHRAD
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad ARAB
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhdeh RAMEZANI
- Dept. of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali AKBARI SARI
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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47
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Hovlid E, Frich JC, Walshe K, Nilsen RM, Flaatten HK, Braut GS, Helgeland J, Teig IL, Harthug S. Effects of external inspection on sepsis detection and treatment: a study protocol for a quasiexperimental study with a stepped-wedge design. BMJ Open 2017; 7:e016213. [PMID: 28877944 PMCID: PMC5589010 DOI: 10.1136/bmjopen-2017-016213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Inspections are widely used in health care as a means to improve the health services delivered to patients. Despite their widespread use, there is little evidence of their effect. The mechanisms for how inspections can promote change are poorly understood. In this study, we use a national inspection campaign of sepsis detection and initial treatment in hospitals as case to: (1) Explore how inspections affect the involved organizations. (2) Evaluate what effect external inspections have on the process of delivering care to patients, measured by change in indicators reflecting how sepsis detection and treatment is carried out. (3) Evaluate whether external inspections affect patient outcomes, measured as change in the 30-day mortality rate and length of hospital stay. METHODS AND ANALYSIS The intervention that we study is inspections of sepsis detection and treatment in hospitals. The intervention will be rolled out sequentially during 12 months to 24 hospitals. Our effect measures are change on indicators related to the detection and treatment of sepsis, the 30-day mortality rate and length of hospital stay. We collect data from patient records at baseline, before the inspections, and at 8 and 14 months after the inspections. We use logistic regression models and linear regression models to compare the various effect measurements between the intervention and control periods. All the models will include time as a covariate to adjust for potential secular changes in the effect measurements during the study period. We collect qualitative data before and after the inspections, and we will conduct a thematic content analysis to explore how inspections affect the involved organisations. ETHICS AND DISSEMINATION The study has obtained ethical approval by the Regional Ethics Committee of Norway Nord and the Norwegian Data Protection Authority. It is registered at www.clinicaltrials.gov (Identifier: NCT02747121). Results will be reported in international peer-reviewed journals. TRIAL REGISTRATION NCT02747121; Pre-results.
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Affiliation(s)
- Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal and Norwegian Board of Health Supervision, Oslo, Norway
| | - Jan C Frich
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kieran Walshe
- Health Management Group, Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Roy M Nilsen
- Department of Health and Social Sciences, Department of Research and Development, Western Norway University of Applied Sciences, Haukeland University Hospital, Bergen, Norway
| | - Hans Kristian Flaatten
- Department of Anaesthesia and Intensive Care, Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Geir Sverre Braut
- Department of research, Stavanger University Hospital, Stavanger; Norwegian Board of Health Supervision, Oslo, Norway
| | - Jon Helgeland
- Quality Measurement Unit, Norwegian Institute of Public Health, Oslo, Norway
| | - Inger Lise Teig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stig Harthug
- Department of Research and Development, Department of Clinical Science, Faculty of Medicine and Dentistry, Haukeland University Hospital, University of Bergen, Bergen, Norway
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Melo S. The impact of accreditation on healthcare quality improvement: a qualitative case study. J Health Organ Manag 2017; 30:1242-1258. [PMID: 27834605 DOI: 10.1108/jhom-01-2016-0021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Research on accreditation has mostly focused on assessing its impact using large scale quantitative studies, yet little is known on how quality is improved in practice through an accreditation process. Using a case study of an acute teaching hospital in Portugal, the purpose of this paper is to explore the dynamics through which accreditation can lead to an improvement in the quality of healthcare services provided. Design/methodology/approach Data for the case study was collected through 46 in-depth semi-structured interviews with 49 clinical and non-clinical members of staff. Data were analyzed using a framework thematic analysis. Findings Interviewees felt that hospital accreditation contributed to the improvement of healthcare quality in general, and more specifically to patient safety, as it fostered staff reflection, a higher standardization of practices, and a greater focus on quality improvement. However, findings also suggest that the positive impact of accreditation resulted from the approach the hospital adopted in its implementation as well as the fact that several of the procedures and practices required by accreditation were already in place at the hospital, albeit often in an informal way. Research limitations/implications The study was conducted in only one hospital. The design of an accreditation implementation plan tailored to the hospital's context can significantly contribute to positive outcomes in terms of quality and patient safety improvements. Originality/value This study provides a better understanding of how accreditation can contribute to healthcare quality improvement. It offers important lessons on the factors and processes that potentiate quality improvements through accreditation.
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Affiliation(s)
- Sara Melo
- Queen's Management School, Queen's University Belfast , Belfast, UK
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49
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dos Santos RA, Snell L, Tenorio Nunes MDP. The link between quality and accreditation of residency programs: the surveyors' perceptions. MEDICAL EDUCATION ONLINE 2017; 22:1270093. [PMID: 28178919 PMCID: PMC5328332 DOI: 10.1080/10872981.2016.1270093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/22/2016] [Accepted: 11/27/2016] [Indexed: 05/29/2023]
Abstract
UNLABELLED Accreditation of medical residency programs has become globally important. Currently it is moving from the goal of attaining minimal standards to a model of continuous improvement. In some countries, the accreditation system engages peers (physicians) to survey residency programs. The surveyors are sometimes volunteers, usually engaged in multiple clinical and education activities. Few studies have investigated the benefits of residency program evaluation and accreditation from the perspective of the surveyors. As peers they both conduct and receive accreditation surveys, which puts them in a privileged position in that it provides the surveyor with an opportunity to share experiences and knowledge and apply what is learned in their own context. The objective of this study is to obtain the perceptions of these surveyors about the impact of an accreditation system on residency programs. Surveyors participated in semi-structured interviews. A thematic analysis was performed on the interview data, and resulting topics were grouped into five themes: Burden (of documentation and of time needed); Efficiency and efficacy of the accreditation process; Training and experience of surveyors; Being a peer; Professional skills and recognition of surveyors. These categories were organized into two major themes: 'Structure and Process' and 'Human Resources'. The study participants proposed ways to improve efficiency including diminish the burden of documentation to the physicians involved in the process and to increase efforts on training programs and payment for surveyors and program directors. Based on the results we propose a conceptual framework to improve accreditation systems. ABBREVIATIONS PD: Program director.
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Affiliation(s)
- Renato Antunes dos Santos
- Department of Education and Health, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil
- Mental Health Unit, University Hospital of Brasília, University of Brasília (UnB), Brasília, Brazil
| | - Linda Snell
- McGill’s Centre for Medical Education, Montreal, QC, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
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Flodgren G, Gonçalves‐Bradley DC, Pomey M. External inspection of compliance with standards for improved healthcare outcomes. Cochrane Database Syst Rev 2016; 12:CD008992. [PMID: 27911487 PMCID: PMC6464009 DOI: 10.1002/14651858.cd008992.pub3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Inspection systems are used in healthcare to promote quality improvements (i.e. to achieve changes in organisational structures or processes, healthcare provider behaviour and patient outcomes). These systems are based on the assumption that externally promoted adherence to evidence-based standards (through inspection/assessment) will result in higher quality of healthcare. However, the benefits of external inspection in terms of organisational-, provider- and patient-level outcomes are not clear. This is the first update of the original Cochrane review, published in 2011. OBJECTIVES To evaluate the effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour and patient outcomes. SEARCH METHODS We searched the following electronic databases for studies up to 1 June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Database of Abstracts of Reviews of Effectiveness, HMIC, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. There was no language restriction and we included studies regardless of publication status. We also searched the reference lists of included studies and contacted authors of relevant papers, accreditation bodies and the International Organization for Standardization (ISO), regarding any further published or unpublished work. We also searched an online database of systematic reviews (PDQ-evidence.org). SELECTION CRITERIA We included randomised controlled trials (RCTs), non-randomised trials (NRCTs), interrupted time series (ITSs) and controlled before-after studies (CBAs) evaluating the effect of external inspection against external standards on healthcare organisation change, healthcare professional behaviour or patient outcomes in hospitals, primary healthcare organisations and other community-based healthcare organisations. DATA COLLECTION AND ANALYSIS Two review authors independently applied eligibility criteria, extracted data and assessed the risk of bias of each included study. Since meta-analysis was not possible, we produced a narrative results summary. We used the GRADE tool to assess the certainty of the evidence. MAIN RESULTS We did not identify any new eligible studies in this update. One cluster RCT involving 20 South African public hospitals and one ITS involving all acute hospital trusts in England, met the inclusion criteria. A trust is a National Health Service hospital which has opted to withdraw from local authority control and be managed by a trust instead.The cluster RCT reported mixed effects of external inspection on compliance with COHSASA (Council for Health Services Accreditation for South Africa) accreditation standards and eight indicators of hospital quality. Improved total compliance score with COHSASA accreditation standards was reported for 21/28 service elements: mean intervention effect was 30% (95% confidence interval (CI) 23% to 37%) (P < 0.001). The score increased from 48% to 78% in intervention hospitals, while remaining the same in control hospitals (43%). The median intervention effect for the indicators of hospital quality of care was 2.4% (range -1.9% to +11.8%).The ITS study evaluated compliance with policies to address healthcare-acquired infections and reported a mean reduction in MRSA (methicillin-resistant Staphylococcus aureus) infection rates of 100 cases per quarter (95% CI -221.0 to 21.5, P = 0.096) at three months' follow-up and an increase of 70 cases per quarter (95% CI -250.5 to 391.0; P = 0.632) at 24 months' follow-up. Regression analysis showed similar MRSA rates before and after the external inspection (difference in slope 24.27, 95% CI -10.4 to 58.9; P = 0.147).Neither included study reported data on unanticipated/adverse consequences or economic outcomes. The cluster RCT reported mainly outcomes related to healthcare organisation change, and no patient reported outcomes other than patient satisfaction.The certainty of the included evidence from both studies was very low. It is uncertain whether external inspection accreditation programmes lead to improved compliance with accreditation standards. It is also uncertain if external inspection infection programmes lead to improved compliance with standards, and if this in turn influences healthcare-acquired MRSA infection rates. AUTHORS' CONCLUSIONS The review highlights the paucity of high-quality controlled evaluations of the effectiveness and the cost-effectiveness of external inspection systems. If policy makers wish to understand the effectiveness of this type of intervention better, there needs to be further studies across a range of settings and contexts and studies reporting outcomes important to patients.
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Affiliation(s)
- Gerd Flodgren
- Norwegian Institute of Public HealthThe Norwegian Knowledge Centre for the Health ServicesPilestredet Park 7OsloNorway0176
| | | | - Marie‐Pascale Pomey
- University of MontrealDepartment of Health Administration, IRSPUM, Faculty of Medicine1420 Boulevard Mont‐RoyalMontrealQCCanadaH2V 4P3
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