Contextual factors favouring success in the accreditation process in Colombian hospitals: a nationwide observational study

Abstract

Background: To identify context factors associated with and predicting success in the hospital accreditation process, and to contribute to the understanding of the relative relevance of context factors and their organizational level in the success of QI initiatives. Methods: Analytical study of cases and controls in a sample of hospitals of medium and high complexity in Colombia. Cases (n = 16) are accredited hospitals by the time of preparation of the study (2016) and controls (n = 38) are similar facilities, which have not succeeded to obtain accreditation. Eligibility criteria for both groups included complexity (medium and high), having emergency services, an official quality assurance license, and being in operation for at least 15 years. Besides eligibility criteria, geographical location, and type of ownership (public/ private) are used to select controls to match cases. Context measures are assessed using a survey instrument based on the MUSIQ model ("Model for Understanding Success in Quality") adapted and tested in Colombia. Statistical analysis includes descriptive measures for twentythree context factors, testing for significant statistical differences between accredited and non-accredited hospitals, and assessing the influence and strength of association of context factors on the probability of success in the accreditation process. A multivariate model assesses the predictive probability of achieving accreditation. Results: Eighteen (78.3%) of the twenty-three context factors are significantly different when comparing cases and controls hospitals, particularly at the Microsystem level; all factors are statistically significant in favor of accredited hospitals. Five context factors are strongly associated to the achievement of accreditation but in the logistic multivariable model, only two of them remain with significant OR, one in the Macrosystem, "Availability of economic resources for QI" (OR: 22.1, p: 0,005), and the other in the Microsystem, "Involvement of physicians" (OR: 4.9, p: 0,04). Conclusion: This study has applied an instrument, based on the MUSIQ model, which allows assessing the relevance of different context factors and their organizational level in hospitals, to explain success in the accreditation process in Colombia. Internal macrosystem and microsystem seem to be more relevant than external environment factors.

Análisis comparativo de la acreditación de unidades médicas en Canadá, Chile, la Comunidad Autónoma de Andalucía, Dinamarca y México

“…Las más comunes se refieren a los recursos necesarios, la burocratización del proceso y la resistencia o poca implicación de los profesionales, a pesar de que en el comparativo realizado se aprecia, aunque sea de forma cualitativa, la contribución que ha tenido la acreditación como coadyuvante en la reestructuración y mejora de los procesos que forman parte de la cadena de atención en las diversas instituciones acreditadas. En Colombia, se realizó un estudio en el que se utilizó el modelo de análisis MUSIQ para averiguar qué factores influyeron para que los hospitales lograran la acreditación; el estudio concluyó que los más significativos eran precisamente la existencia de recursos para el proceso y la implicación de los profesionales ( 51 ). Falta, además, cuestionar si las decisiones tomadas en cuanto al diseño del programa son las más acertadas en relación con nuestro contexto, para que el programa contribuya realmente a la mejora.…”

Surveillance and Epidemiology of Dengue in Medellín, Colombia from 2009 to 2017

“…This is plausible because in Colombia, there has been momentum since 2002 to improve accreditation within the hospital system and expand access. 43 Improvements in access to hospitals might encourage dengue patients to seek care, a trend observed in Cali, Colombia. 44,45 In recent years, Colombia has improved its transportation system throughout the country, and crime and violence have gone down, causing Colombia's tourism to increase and potentially the spread of dengue.…”