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These findings support the hypothesis that hospital accreditation leads to improvements in patient care.

The work in patient safety is often centred on adverse events and errors. Typical methods to improve patient safety are reactive and focus on understanding past failures. This article presents the development of a proactive method towards improving patient safety and understanding why processes function as intended on a daily basis. The paper presents the steps of how the method was

Purpose The purpose of this paper is to understand how staff at various levels perceive and understand hospital accreditation generally and in relation to quality improvement (QI) specifically. Design/methodology/approach In a newly accredited Danish hospital, the authors conducted semi-structured interviews to capture broad ranging experiences. Medical doctors, nurses, a quality coordinator and a quality department employee participated. Interviews were audio recorded and subjected to framework analysis. Findings Staff reported that The Danish Healthcare Quality Programme affected management priorities: office time and working on documentation, which reduced time with patients and on improvement activities. Organisational structures were improved during preparation for accreditation. Staff perceived that the hospital was better prepared for new QI initiatives after accreditation; staff found disease specific requirements unnecessary. Other areas benefited from accreditation. Interviewees expected that organisational changes, owing to accreditation, would be sustained and that the QI focus would continue. Practical implications Accreditation is a critical and complete hospital review, including areas that often are neglected. Accreditation dominates hospital agendas during preparation and surveyor visits, potentially reducing patient care and other QI initiatives. Improvements are less likely to occur in areas that other QI initiatives addressed. Yet, accreditation creates organisational foundations for future QI initiatives. Originality/value The authors study contributes new insights into how hospital staff at different organisational levels perceive and understand accreditation.

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

Background Failure to keep medical appointments results in inefficiencies and, potentially, in poor outcomes for patients. The aim of this study is to describe non-attendance rate and to investigate predictors of non-attendance among patients receiving hospital outpatient treatment for chronic diseases. Methods We conducted a historic, register-based cohort study using data from a regional hospital and included patients aged 18 years or over who were registered in ongoing outpatient treatment courses for seven selected chronic diseases on July 1, 2013. A total of 5895 patients were included and information about their appointments was extracted from the period between July 1, 2013 and June 30, 2015. The outcome measure was occurrence of non-attendance. The associations between non-attendance and covariates (age, gender, marital status, education level, occupational status, specific chronic disease and number of outpatient treatment courses) were investigated using multivariate logistic regression models, including mixed effect. Results During the two-year period, 35% of all patients (2057 of 5895 patients) had one or more occurrences of non-attendance and 5% of all appointments (4393 of 82,989 appointments) resulted in non-attendance. Significant predictors for non-attendance were younger age (OR 4.17 for 18 ≤ 29 years as opposed to 80+ years), male gender (OR 1.35), unmarried status (OR 1.39), low educational level (OR 1.18) and receipt of long-term welfare payments (OR 1.48). Neither specific diseases nor number of treatment courses were associated with a higher non-attendance rate. Conclusions Patients undergoing hospital outpatient treatments for chronic diseases had a non-attendance rate of 5%. We found several predictors for non-attendance but undergoing treatment for several chronic diseases simultaneously was not a predictor. To reduce non-attendance, initiatives could target the groups at risk. Trial registration This study was approved by the Danish Data Protection Agency (Project ID 18/35695 ). Electronic supplementary material The online version of this article (10.1186/s12913-019-4208-9) contains supplementary material, which is available to authorized users.

ObjectiveThe study aim was to test the intra-assessor and interassessor reliability of the Healthcare Complaints Analysis Tool (HCAT) for categorising the information in the claim letters in a sample of Danish patient compensation claims.Design, setting and participantsWe used a random sample of 140 compensation cases completed by the Danish Patient Compensation Association that were filed in the field of acute medicine at Danish hospitals from 2007 to 2018. Four assessors were trained in using the HCAT manual before assessing the claim letters independently.Main outcome measuresIntra-assessor and interassessor reliability was tested at domain, problem category and subcategory levels of the HCAT. We also investigated the reliability of ratings on the level of harm and of the descriptive details contained in the claim letters.ResultsThe HCAT was reliable for identifying problem categories, with reliability scores ranging from 0.55 to 0.99. Reliability was lower when coding the ‘severity’ of the problem. Interassessor reliability was generally lower than intra-assessor reliability. The categories of ‘quality’ and ‘safety’ were the least reliable of the seven HCAT problem categories. Reliability at the subcategory level was generally satisfactory, with only a few subcategories having poor reliability. Reliability was at least moderate when coding the stage of care, the complainant and the staff group involved. However, the coding of ‘level of harm’ was found to be unreliable (intrareliability 0.06; inter-reliability 0.29).ConclusionOverall, HCAT was found to be a reliable tool for categorising problem types in patient compensation claims.