Understanding accreditation standards in general practice – a qualitative study

Abstract

BackgroundAccreditation is a widely adopted tool for quality control and quality improvement in health care, which has increasingly been employed for general practice. However, there is lack of knowledge of how accreditation is received and experienced by health professionals in general practice. This study explores how general practitioners (GPs) and their staff experienced the comprehensibility of accreditation standards and how they worked to increase their understanding of the standards. The study was conducted in Denmark where accreditation was mandatory in general practice from 2016 to 2018.MethodsThe study consists of qualitative interviews with general practitioners and staff from 11 general practices that were strategically sampled among practices set to receive their survey visit in 2017. Participants were interviewed twice; once during the preparation phase and once after the survey visit. GPs and staff were interviewed separately. The interviews were analysed inductively using thematic analysis.ResultsUnderstanding the requirements of the accreditation standards was a major challenge for the professionals when preparing for the accreditation survey visit. The participants attempted to increase their understanding of the standards in several ways including the use of regional support options and seeking out experts and colleagues. However, participants had mixed experiences with the various support options and many found the sense making work frustrating and time consuming.ConclusionThe results point to the importance of considering the level of specificity in accreditation standards and how to ensure an organisational set-up that can offer appropriate support to primary care clinics in terms of understanding what is required to meet the standards.Electronic supplementary materialThe online version of this article (10.1186/s12875-019-0910-2) contains supplementary material, which is available to authorized users.

Experiences of accreditation impact in general practice – a qualitative study among general practitioners and their staff

“…- Reading, understanding and discussing the standards and their implications for the clinic and describing practice procedures in formal documents. This work could include participation in regional information meetings and workshops (see also [16]);…”

“…Having received notification of the date of their survey visit, the clinics had 1 year to prepare for the visit. During this period of accreditation various agencies offered some kind of support to clinics preparing for the survey visit [16]. Approximately 1 year after the notification date, the clinics received a survey visit by two surveyors who questioned the GPs and the staff to determine whether the clinic adhered to the accreditation standards.…”

“…This study is part of a larger research project on the implementation and impact of accreditation in general practice in Denmark. The project involves both quantitative and qualitative approaches [15, 16]. While quantitative methods can produce more generalizable results on the effects of new interventions, qualitative investigations can, among other things, contribute with more detailed knowledge on the nature of intervention impact from the perspective of the professionals.…”

Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis

“…Survey and interview data suggest that the standards used for inspections must be valid, focused on clinical practice and benefits for the patients, and should be translated into something perceived as relevant and useful for the services in their improvement work. 36 44–50 To be perceived as relevant, the standards should be adapted to the local context. 51 52 Development and revision of standards require a collaborative approach and the expertise of a range of stakeholders including the patients.…”

“…[30][31][32][33][34] Four other studies reported that the self-assessment tool was confusing and time consuming and was concerned with finding and producing documentation rather than reviewing practice. [35][36][37][38] Four case studies, three using interview data and one using time series analysis of performance indicators Open access found that most substantial changes were made during the self-assessment phase, 36 39-41 where as one study using interview data found that the organisation did not make improvements during the self-assessment phase because it was considered sufficient just to identify improvement needs. 42 Another case study found that changes made before the site visit were superficial and sought to achieve ritual compliance, focusing more on getting through the inspection process than on really improving the quality of care.…”