Health service accreditation stimulating change in clinical care and human resource management processes: A study of 311 Australian hospitals

Greenfield, David; Lawrence, Steve; Kellner, Ashlea; Townsend, Keith; Wilkinson, Adrian

doi:10.1016/j.healthpol.2019.04.006

Cited by 28 publications

(26 citation statements)

References 25 publications

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“…While the impact and outcome of healthcare accreditation remain debatable, the growth of such programs has accelerated significantly over the past decades (Nicklin et al, 2017). In addition, over 70 countries have employed such accreditation programs in their healthcare organizations, including developing countries such as the United Arab Emirates (Greenfield and Braithwaite, 2008;Devkaran and O'Farrell, 2015;Greenfield et al, 2019). While healthcare accreditation might be appealing to managers and stakeholders, many have argued that accreditation is a demanding activity, which increases workload and stress levels among workers (Touati and Pomey, 2009;Elkins et al, 2010;El-Jardali et al, 2014;Kousgaard et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

What Impact Does Accreditation Have on Workplaces? A Qualitative Study to Explore the Perceptions of Healthcare Professionals About the Process of Accreditation

2020

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This study seeks to explore the emerging psychosocial risks of healthcare accreditation in workplaces and understand healthcare professionals' (HCPs) perceptions of work demands and the unexpected consequences such accreditation has created for them. Methods: Twenty-seven semi-structured interviews and four focus group discussions were conducted with a variety of HCPs, including doctors, nurses, pharmacists, and allied health professionals. The study was conducted in three public hospitals and a network of primary healthcare centers in the United Arab Emirates. Interviews and focus group discussions were transcribed and analyzed using a theoretical thematic analysis approach. Results: The results showed that a number of psychosocial risks were prevalent during the course of accreditation. HCPs faced increased work demands during such a process, including increased working hours, increased working pace, perceived time pressure, and conflicting information. Such demands were perceived to influence not only their health but also their families as well as patients' care. In contrast, teamwork and coworker support were vital to mitigate the effect of such demands. Implications: This study identified emerging risks during the process of accreditation. The findings show that the process of accreditation increases work-related risks before the inspection visit. These findings have significant implications for understanding how accreditation processes increase psychosocial risks; they also consolidate the idea that appropriate systems and support for HCPs should be a priority when planning for accreditation.

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Section: Introductionmentioning

confidence: 99%

What Impact Does Accreditation Have on Workplaces? A Qualitative Study to Explore the Perceptions of Healthcare Professionals About the Process of Accreditation

2020

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“…Benefits from accreditation seems to be linked to the motivation for the activities involved in the process [ 18 ]. Recent research from Australian hospitals has demonstrated that accreditation supports continuous and systematic quality improvement [ 19 ]. However, little is known in healthcare about the approach and methods that external assessment bodies use in their assessment and verification processes, such as auditor’s role repertoire, auditor’s conduct (e.g., inspection or guidance) and assessment practice [ 4 , 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

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

Johannesen

Lindøe

Wiig

2020

BMC Health Serv Res

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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.

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“…90 Performance data from two cohort studies suggest that hospital size and type did not predict effects of accreditation 91 ; however, lower performing hospitals improved at a greater rate than moderate and higher performing hospitals. 92 Two case studies indicate that degree of improvement can depend on improvement capability of the inspected organisation, 43 and that accreditation can be easier to implement in smaller facilities. 76 Creation of networks, and improved communications Qualitative data indicate that inspections can contribute to improved teamwork and communication within existing networks in the sense that these can become more focused around how the organisation delivers clinical care.…”

Section: External Incentivesmentioning

confidence: 99%

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

Hovlid

Braut

Hannisdal³

et al. 2020

BMJ Open

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ObjectivesExternal inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections.MethodsWe performed a literature search (1980–January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change.ResultsWe included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation’s current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance.ConclusionsExternal inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.

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Health service accreditation stimulating change in clinical care and human resource management processes: A study of 311 Australian hospitals

Cited by 28 publications

References 25 publications

What Impact Does Accreditation Have on Workplaces? A Qualitative Study to Explore the Perceptions of Healthcare Professionals About the Process of Accreditation

What Impact Does Accreditation Have on Workplaces? A Qualitative Study to Explore the Perceptions of Healthcare Professionals About the Process of Accreditation

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

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

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