Certification as support for resilience? Behind the curtains of a certification body — a qualitative study

Abstract

Background: Certification in healthcare often involves independent private sector bodies performing legally required or voluntary external assurance activities. These certification practices are embedded in international standards founded in traditional beliefs about rational and predictable processes for quality and safety improvement. Certification can affect organizational and cultural changes, support collaboration and encourage improvement that may be conducive to resilient performance. This study explores whether ISO 9001 quality management system certification can support resilience in healthcare, by looking at characteristics in the objectives, methods, and practice of certification from a certification body's perspective. Methods: One of Norway's four certification bodies in healthcare was studied, using an explorative embedded single-case design. The study relies on document analysis of the international standards and associated guidances for the performance of certification bodies and thematic analyses of data from 60 h of observations of auditors in three certification processes and nine qualitative interviews with managers and personnel from the certification body. Results from the analyses were compared to identify discrepancies between the written and perceived certification approach and practice. Results: Standards and guidances for certification embed an elasticity between formal and consistent assessments of nonconformities in organizations and emphasize holistic approaches that brings added value. Auditors were then left with the latitude to navigate their auditing strategy during interaction with the auditees. Members of the certification body perceived and practiced a holistic and flexible auditing approach using opportunities to share knowledge, empower and make guidance for improvement. Conclusions: ISO certification expects structures and systems to ensure consistent and objective certification processes. At the same time, it embodies a latitude to adopt flexible and context-specific certification approaches, as demonstrated by a certification body in this study, to give added value to the certified organizations. Such an ISO 9001 certification approach may support resilient performance in healthcare by nurturing the potential to respond and learn. These results are important for further development of methods that certification bodies use in the auditing encounter.

Innovative approaches in management: a key factor for the quality of health services

“…A very low increase in the overall rating was found in the item -unit change of the quality management (0,132). Although the coefficient is positive, which indicates a certain positive impact, it is very low compared to the findings of other studies, which showed a strong impact of using EFQM models or other best practices of Total Quality Management on organizational performance, even in the longer term (Johannesen et al, 2020;Nabitz et al, 2006;Talib et al, 2011;van Schoten et al, 2016). On the contrary, the negative coefficient has been demonstrated in the comprehensive and systematic management of change (-0.503), which is often underestimated in organizations not only in the health sector but also in other areas.…”

“…Sunol et al (Suñol et al, 2009) demonstrated a positive impact of quality strategies on hospital outputs. Johannesen et al (Johannesen et al, 2020) found that external assessment programs, such as certification, accreditation, may support resilient performance in healthcare by nurturing the potential to respond and learn. Nabitz et al (Nabitz et al, 2006), Van Schoten et al (van Schoten et al, 2016) examined the implementation of the EFQM quality model.…”

Healthcare Regulation and Resilience: a Norwegian Multilevel Case Study

“…Most studies about regulation address deviation and noncompliance, not how regulatory bodies adapt to challenges in the regulated context and contribute to adaptive capacity (or not) in the regulated organizations (Barber, 2002;Johannesen, 2020;Johannesen et al, 2020). Bearing in mind that the literature lacks studies looking at regulation and resilience, concepts often considered as counterparts, this thesis adds value to the absence in previous research Wiig et al, 2020 b).…”

“…External approaches to quality improvement, such as supervision and regulation, often treat healthcare organizations similarly regardless of size, context, competence, skills, resources, and objectives, which implies a naive outlook on organizations . Moreover, the effects of external inspections in healthcare are unclear, with not much existing knowledge about inspectors' approaches and methods Hovlid et al, 2020 a, b;Johannesen et al, 2020). A recent study did however link the promotion of leadership with external inspection, stressing how external inspection may "boost" the way hospitals manage their internal work of improving quality and patient safety (Husabø et al, 2020).…”

Building Organizational Resilience Through Organizational Learning: A Systematic Review

“…Several authors highlight the value of organizations learning from the practices and experiences of other organizations (Gressgard and Hansen, 2015;Johannesen et al, 2020;Bhaskara and Filimonau, 2021;Fasey et al, 2021;Friday et al, 2021;Habiyaremye, 2021 as central to OL (Khan et al, 2017;Herbane, 2019). This may also spread further, to a whole network, as suppliers interact with each other, thereby also facilitating network resilience (Chen K. D. et al, 2021).…”