Managers’ perceptions of the effects of a national mandatory accreditation program in Danish hospitals. A cross-sectional survey

Abstract

Objective This study aimed to examine and compare middle and senior hospital managers’ perceptions of the effects of a mandatory accreditation program in Denmark, the Danish Healthcare Quality Program (Den Danske Kvalitetsmodel [DDKM]) after it was terminated in 2015. Design A cross-sectional online questionnaire survey. Setting All 26 somatic and psychiatric public hospitals in Denmark. Participants All senior and middle managers. Methods A questionnaire with open and closed response (five-point Likert scale) questions. Quantitative data were analyzed descriptively and through ordered logistic regression by management level. Qualitative data were subjected to a software-assisted content analysis. Results The response rate was 49% (533/1059). In both the qualitative and quantitative data sets, participants perceived the DDKM as having: led to an increased focus on registration, documentation and additional and unnecessary procedures. While the DDKM was perceived as increasing a focus on quality, the time required for accreditation was at the expense of patient care. There were significant differences by management level, with middle managers having more negative perceptions of the DDKM related to time spent on documentation and registration. Conclusion While the DDKM had some perceived benefits for quality improvement, it was ultimately considered time-consuming and outdated or having served its purpose. Including managers, particularly middle managers, in refinements to the new quality improvement model could capitalize on the benefits while redressing the problems with the terminated accreditation program.

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

“…Of the included papers, 61 focussed on clinical audits, 17 on accreditation/certification and 7 on peer reviews. In terms of the evidence levels established by EPOC review group [30], one randomised trial was found [35], two controlled studies [36,37], 66 case studies , and 16 descriptive studies [104][105][106][107][108][109][110][111][112][113][114][115][116][117][118][119]. Using the QI-MQCS, the completeness of reporting scores ranged from 4 to 16 (16 being the highest possible score) (S1 Table ).…”

“…Other QI initiatives, which they perceived as more relevant to patient care, were sometimes paused or stopped during the external audit [ 83 , 117 ]. It was also noted that at times issues might arise during an external audit that were not in line with healthcare professionals’ priorities for QI [ 102 , 107 ].…”

“…In contrast, if healthcare professionals perceive an audit as a 'side-line' or 'mandatory exercise', rather than a process to contribute to improved quality of care, they will not feel engaged and not put significant effort into the change [77,118]. This is especially true when audits are externally initiated and have a strong organisational focus, sometimes without links to clinical care [102,104,[106][107][108]117]. Additionally, some studies showed that healthcare professionals reported reduced time for patient care when preparing for an external audit [38,62,93,117].…”

“…Other QI initiatives, which they perceived as more relevant to patient care, were sometimes paused or stopped during the external audit [83,117]. It was also noted that at times issues might arise during an external audit that were not in line with healthcare professionals' priorities for QI [102,107]. Champions are those healthcare professionals who are committed to implementing change, act as a role model for the intended change and are enthusiastic in convincing others in the organisation of the necessity of change [69,82,86,89,101,103,109].…”

Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study

“…6,20,22,23 In other words, the current number, efficacy and efficiency of quality measurements potentially threatens the quality of care by diminishing the joy in work of healthcare professionals. [24][25][26] Despite these concerns, the nature and consequences of this registration burden as perceived by healthcare professionals has received little empirical attention. 27,28 To support the recent discussion on this registration burden, we set up a study to identify and explore the types and consequences of burden due to registrations for quality monitoring and improvement as perceived by healthcare professionals in hospitals and the effect of this burden on their joy in work.…”