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

Bogh, Søren Bie; Falstie-Jensen, Anne Mette; Bartels, Paul; Hollnagel, Erik; Johnsen, Søren Paaske

doi:10.1093/intqhc/mzv053

Cited by 44 publications

(36 citation statements)

References 21 publications

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“…However, notwithstanding the commonly accepted perceptions by governments (El-Jardali et al, 2008) and healthcare professionals (Diab, 2011;El-Jardali et al, 2008) on the benefits of accreditation; existing evidence is either modest Lutfiyya et al, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 r n a l o f H e a l t h O r g a n i z a t i o n a n d M a n a g e m e 3 2009) or inconclusive (Bogh et al, 2015;Braithwaite et al, 2010;Dean Beaulieu and Epstein, 2002;Greenfield and Braithwaite, 2008;Miller et al, 2005;Shaw et al, 2010;Thornlow and Merwin, 2009), particularly regarding its impact on the quality of care. For example, findings from a study of 216 state psychiatric hospitals in the U.S. revealed a weak association between accreditation and the seven indicators of quality of care selected (average cost per patient, per diem bed cost, total staff hours per patient, clinical staff hours per patient, percent of staff hours provided by medical staff bed turnover, and percent of beds occupied) (Hadley and McGurrin, 1988).…”

Section: Introductionmentioning

confidence: 99%

The impact of accreditation on healthcare quality improvement: a qualitative case study

Melo

2016

JHOM

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Journal of Health Organization and Management r n a l o f H e a l t h O r g a n i z a t i o n a n d M a n a g e m e1 The impact of accreditation on healthcare quality improvement: a qualitative case study Abstract PurposeResearch 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 article aims at exploring the dynamics through which accreditation can lead to an improvement in the quality of healthcare services provided. Design/methodology/approachData for the case study was collected through 46 in-depth semi-structured interviews with 49 clinical and non-clinical members of staff. Data were analysed using a framework thematic analysis. FindingsInterviewees 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/implicationsThe 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/valueThis 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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Section: Introductionmentioning

confidence: 99%

The impact of accreditation on healthcare quality improvement: a qualitative case study

Melo

2016

JHOM

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“…Several studies have employed multilevel analyses for evaluating hospital accreditation both in Denmark60–62 and in other countries 63 64. However, those studies consider variance and clustering of patient outcomes within hospitals as a sort of noise that should only be accounted for in the statistical analysis to obtain correct estimations of the SE around the regression coefficients 25.…”

Section: Discussionmentioning

confidence: 99%

Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance

2019

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BackgroundStudies 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.MethodsFrom 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.ResultsIn 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.ConclusionsParallel 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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“…It has been a growing practice internationally for the last few decades [1]. Yet, the evidence to support its clinical and organizational value is inconsistent [2][3][4][5][6]. Although a systematic review of health sector accreditation suggested that it was able to promote change and professional development, the review also found evidence for substantial financial costs, and demands on staff time and other resources [7].…”

Section: Introductionmentioning

confidence: 99%

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

Ellis

Nicolaisen

Bogh

et al. 2020

BMC Health Serv Res

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Background: This study aimed to examine managers' attitudes towards and use of a mandatory accreditation program in Denmark, the Danish Healthcare Quality Program (Den Danske Kvalitetsmodel [DDKM]) after it was terminated in 2015.Methods: We designed a nationwide cross-sectional online survey of all senior and middle managers in the 31 somatic and psychiatric public hospitals in Denmark. We elicited managers' attitudes towards and use of DDKM as a management using 5-point Likert scales. Regression analysis examined differences in responses by age, years in current position, and management level. Results: The response rate was 49% with 533 of 1095 managers participating. Overall, managers' perceptions of accreditation were favorable, highlighting key findings about some of the strengths of accreditation. DDKM was found most useful for standardizing processes, improving patient safety, and clarifying responsibility in the organization. Managers were most negative about DDKM's ability to improve their hospitals' financial performance, reshape the work environment, and support the function of clinical teams. Results were generally consistent across age and management level; however, managers with greater years of experience in their position had more favorable attitudes, and there was some variation in attitudes towards and use of DDKM between regions. Conclusion: Future attention should be paid to attitudes towards accreditation. Positive attitudes and the effective use of accreditation as a management tool can support the implementation of accreditation, the development of standards, overcoming disagreements and boundaries and improving future quality programs.

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

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

Cited by 44 publications

References 21 publications

The impact of accreditation on healthcare quality improvement: a qualitative case study

The impact of accreditation on healthcare quality improvement: a qualitative case study

Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance

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

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