Factors affecting compliance with national accreditation essential safety standards in the Kingdom of Saudi Arabia

Abstract

Accreditation is a widespread culture internationally and nationally. The effectiveness of compliance with accreditation standards was positively correlated with health care settings’ performance in multiple aspects: leadership, professional performance, patient safety and organizational culture. There is limited knowledge of the national compliance rate with accreditation standards. Therefore, it is important to assess the hospital compliance with accreditation rate in the Kingdom Saudi Arabia (KSA) and its related factors. This paper presents a quantitative cross-sectional study. Data were extracted from the annual Essential Safety Requirement (ESR) survey database from the Central Board for Accreditation of Health care Institutions (CBAHI) research center during the period 2016 to 2018. Hospitals that started their operation after the first ESR survey round in 2016 or shut down during the study period were excluded. The hospital scoring was on a scale of 0 to 100 and classified as follows: score 2 if the hospital satisfactory compliance (Fully Met) was ≥ 80% and score 1 if particular compliance (Partially Met) was ≥ 50% to < 80%. Then, a score of 0 indicated insufficient compliance (Not Met) when < 50% and a score of not applicable (NA) if the standard does not apply to the hospital. A total of 437 hospitals were surveyed in 20 regions in the KSA and had an overall compliance rate on average that was higher among private hospitals than among public hospitals (77% vs. 66%). Overall, private hospitals had a significantly better compliance rate than public hospitals (mean rate = 84% vs. 68%, respectively, P = 0.019). Large hospitals had more compliance with some standards than smaller hospitals. After adjusting for the year of the survey report, the private hospital type was more compliant than the public hospital. This study supports mandatory accreditation programs for both public and private health sectors, with increased monitoring by the concerned parties (i.e., CBAHI and the Ministry of Health). The authors encourage the application of accreditation for specialized and independent health services.

Determinants of regulatory compliance in health and social care services: A systematic review using the Consolidated Framework for Implementation Research

“…For-profit service providers and compliance were negatively associated in 29 studies [ 13 , 16 , 32 , 45 , 48 , 52 , 57 , 60 – 62 , 65 , 72 , 74 , 76 , 80 , 84 – 87 , 90 – 93 , 104 , 113 , 115 , 116 , 119 , 123 ], positively associated in seven [ 50 , 58 , 63 , 81 , 95 , 117 , 121 ], with a null association in 17 studies [ 35 , 36 , 47 , 49 , 51 , 54 , 59 , 64 , 71 , 82 , 83 , 103 , 106 , 108 , 118 , 120 , 122 ]. Aligned to the profit motive, in a qualitative study, staff in poorly-performing NHs (as measured by compliance) were instructed to prioritise the admission of people that attracted higher fees [ 131 ].…”

“…Larger facilities and compliance were negatively associated in 40 studies [ 13 , 14 , 16 , 34 – 37 , 46 , 50 – 52 , 54 , 57 , 58 , 60 – 62 , 64 , 74 , 77 , 80 , 82 , 83 , 86 , 91 – 96 , 106 , 113 , 114 , 116 , 117 , 120 , 122 , 124 , 127 , 128 ]; three reported a positive association [ 59 , 63 , 71 ] and 16 a null association [ 45 , 47 , 49 , 72 , 78 , 80 , 81 , 85 , 87 , 97 , 105 , 108 , 118 , 121 , 123 , 126 ] (one study [ 80 ] reported larger size NHs had a null association whereas larger size assisted-living facilities had a negative associat...…”

Determinants of regulatory compliance in health and social care services: a systematic review using the Consolidated Framework for Implementation Research

“…For-profit service providers and compliance were negatively associated in 29 studies (13, 30, 40, 45, 46, 49–51, 55, 59, 64, 72, 74, 77, 79, 81, 83, 85, 93, 95, 99, 103–105, 109, 117–120) , positively associated in seven (47, 52, 57, 90, 110, 115, 121) , with a null association in 17 studies. (36, 37, 48, 54, 56, 58, 61, 66, 71, 80, 86, 88, 89, 111, 122–124) Aligned to the profit motive, in a qualitative study, staff in poorly-performing NHs (as measured by compliance) were instructed to prioritise the admission of people that attracted higher fees.…”

“…(125) Larger facilities and compliance were negatively associated in 40 studies (13, 15, 35-38, 45-47, 49-51, 53, 57-59, 61, 66, 74, 79, 81, 82, 85, 86, 89, 90, 93, 95, 96, 106, 109, 111, 113, 115, 116, 118, 123, 124, 126, 127) ; three reported a positive association (48,52,71) and 16 a null association. (40,54,56,72,84,88,97,104,105,107,109,110,(120)(121)(122)128) (one study (109) reported larger size NHs had a null association whereas larger size assisted-living facilities had a negative association, thereby represented in both columns). The longer a service was in operation was reported to be associated with poorer compliance in four of five studies.…”

“…serve all populations regardless of insurance status) (negative (84) ); hospitals designated as level-1 trauma centres (negative (84) ); hospitals participating in a clinical surgery registry (negative (84) ); facility certification status (null (37) ); facility proximity to a psychiatric hospital (negative (94) ); nursing home shared ownership status (a form of public-private ownership) (positive (79) ); and more organisational experience with the accreditation process. (121) Networks and communications…”