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

Abstract

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.

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

“…Of the 17 studies that addressed externally mandated audits, eight reported on the ongoing improvement process after the initial audit had taken place. Although externally initiated audits do stimulate hospitals to improve their quality of healthcare [ 39 , 44 , 51 , 68 , 83 , 93 , 104 ], there seems to be a tendency towards “complacency with past improvements” and a diminishing urgency for continued QI [ 68 , 73 , 83 , 104 , 117 ]. Similarly, it seems that the rate of improvement levels off once the external pressure diminishes [ 51 ].…”

“…When a hospital started with audit activities, the process was perceived as a QI endeavour and as a challenge as the organisation attempted to align its care activities with best practices. However, after a few years, the extent of improvement reached a plateau and healthcare professionals and organisational members no longer considered the audit as a driver of change [ 83 , 93 , 104 ]. Notwithstanding these observations, the fact that organisational members had to comply with the audit requirements, had to participate in the audit process and had to collect data for the audit, fuelled the awareness and interest of healthcare professionals and organisational members in QI [ 73 , 83 ].…”

“…considered the audit as a driver of change [83,93,104]. Notwithstanding these observations, the fact that organisational members had to comply with the audit requirements, had to participate in the audit process and had to collect data for the audit, fuelled the awareness and interest of healthcare professionals and organisational members in QI [73,83].…”

The Contribution of Healthcare Middle Managers as Change Agents in the Era of Covid-19: Critical Review

“…Organizational development is also considered one of the forms of change aimed at the growth of the organization and the improvement of its performance (Khodaparasti et al 2020 ; Galy 2020 ). In general, change is the transformation from one state to another and a change in organizations or organizational change means a transformation, movement or modification from one state to another (Ellis et al 2020 ; King et al 2020 ).…”

“…Ellis et al ( 2020 ) this study aimed to examine Middle Managers’ attitudes in the direction of an obligatory accreditation program in Danish Healthcare Quality Program. The researchers used a nationwide cross-sectional online survey for all Middle Managers and other managers in the 31 public hospitals in Denmark.…”