Leveraging the full value and impact of accreditation

Nicklin, Wendy; Fortune, Triona; Ostenberg, Paul Van; O’Connor, Elaine; McCauley, Nicola

doi:10.1093/intqhc/mzx010

Cited by 45 publications

(39 citation statements)

References 5 publications

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“…According to Greenfield and Braithwaite [ 18 ] the fact that the empirical evidence base for accreditation, remains substantially undeveloped, creates a significant validity challenge for accreditation providers, policymakers and researchers. Achieving and maintaining an accreditation status requires a significant investment of resources, and for many organisations, the cost-effectiveness is debatable, including whether or not accreditation demonstrates a quantifiable improvement in healthcare delivery and outcomes [ 14 ]. Many countries are embarking on accreditation programs without any evidence about their effectiveness [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

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The impact of hospital accreditation on quality measures: an interrupted time series analysis

Devkaran¹,

O'Farrell

2015

BMC Health Serv Res

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BackgroundDeveloping countries frequently use hospital accreditation to guarantee quality and patient safety. However, implementation of accreditation standards is demanding on organisations. Furthermore, the empirical literature on the benefits of accreditation is sparse and this is the first empirical interrupted time series analysis designed to examine the impact of healthcare accreditation on hospital quality measures.MethodsThe study was conducted in a 150-bed multispecialty hospital in Abu Dhabi, United Arab Emirates. The quality performance outcomes were observed over a 48 month period. The quality performance differences were compared across monthly intervals between two time segments, 1 year pre- accreditation (2009) and 3 years post-accreditation (2010, 2011 and 2012) for the twenty-seven quality measures. The principal data source was a random sample of 12,000 patient records drawn from a population of 50,000 during the study period (January 2009 to December 2012). Each month (during the study period), a simple random sample of 24 percent of patient records was selected and audited, resulting in 324,000 observations. The measures (structure, process and outcome) are related to important dimensions of quality and patient safety.ResultsThe study findings showed that preparation for the accreditation survey results in significant improvement as 74% of the measures had a significant positive pre-accreditation slope. Accreditation had a larger significant negative effect (48% of measures) than a positive effect (4%) on the post accreditation slope of performance. Similarly, accreditation had a larger significant negative change in level (26%) than a positive change in level (7%) after the accreditation survey. Moreover, accreditation had no significant impact on 11 out of the 27 measures. However, there is residual benefit from accreditation three years later with performance maintained at approximately 90%, which is 20 percentage points higher than the baseline level in 2009.ConclusionsAlthough there is a transient drop in performance immediately after the survey, this study shows that the improvement achieved from accreditation is maintained during the three year accreditation cycle.

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Section: Discussionmentioning

confidence: 99%

“…Previous research on the impact of healthcare accreditation shows inconsistent results [ 13 , 14 ]. Accordingly, there has been an extensive call in the healthcare literature for an assessment of such external accreditation systems to produce rigorous evaluations of their impact [ 9 , 15 - 18 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of hospital accreditation on quality measures: an interrupted time series analysis

Devkaran¹,

O'Farrell

2015

BMC Health Serv Res

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“…The concept of continuous quality improvement (CQI) has inspired the growth of accreditation programs in the healthcare sector (Shortell et al, 1998), which aims to acknowledge healthcare organizations publicly and to encourage them to improve the quality of care provided to patients. 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).…”

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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“…Greenfield and Braithwaite [ 7 ] identified the effects of accreditation on promoting change and professional development, indicating that the effects were probably due to accreditation and certification, but lacking firm evidence. A systematic review by Nicklin et al [ 8 ] found several positive benefits of accreditation, however, the study lacked rigor to support their conclusions. Shaw et al [ 13 ] found evidence for positive effects between accreditation, certification and clinical leadership, systems for patient safety and clinical review, but was fell short of endorsing accreditation, and concluded with recommending further analysis to explore the association of accreditation and certification with clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of hospital accreditation: the challenges of measuring complex intervention effects

Brubakk¹,

Vist

Bukholm

et al. 2015

BMC Health Serv Res

196

185

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BackgroundThe increased international focus on improving patient outcomes, safety and quality of care has led stakeholders, policy makers and healthcare provider organizations to adopt standardized processes for evaluating healthcare organizations. Accreditation and certification have been proposed as interventions to support patient safety and high quality healthcare. Guidelines recommend accreditation but are cautious about the evidence, judged as inconclusive. The push for accreditation continues despite sparse evidence to support its efficiency or effectiveness.MethodsWe searched MEDLINE, EMBASE and The Cochrane Library using Medical Subject Headings (MeSH) indexes and keyword searches in any language. Studies were assessed using the Cochrane Risk of Bias Tool and AMSTAR framework. 915 abstracts were screened and 20 papers were reviewed in full in January 2013. Inclusion criteria included studies addressing the effect of hospital accreditation and certification using systematic reviews, randomized controlled trials, observational studies with a control group, or interrupted time series. Outcomes included both clinical outcomes and process measures. An updated literature search in July 2014 identified no new studies.ResultsThe literature review uncovered three systematic reviews and one randomized controlled trial. The lone study assessed the effects of accreditation on hospital outcomes and reported inconsistent results. Excluded studies were reviewed and their findings summarized.ConclusionAccreditation continues to grow internationally but due to scant evidence, no conclusions could be reached to support its effectiveness. Our review did not find evidence to support accreditation and certification of hospitals being linked to measurable changes in quality of care as measured by quality metrics and standards. Most studies did not report intervention context, implementation, or cost. This might reflect the challenges in assessing complex, heterogeneous interventions such as accreditation and certification. It is also may be magnified by the impact of how accreditation is managed and executed, and the varied financial and organizational healthcare constraints. The strategies hospitals should impelment to improve patient safety and organizational outcomes related to accreditation and certification components remains unclear. Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0933-x) contains supplementary material, which is available to authorized users.

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Leveraging the full value and impact of accreditation

Cited by 45 publications

References 5 publications

The impact of hospital accreditation on quality measures: an interrupted time series analysis

The impact of hospital accreditation on quality measures: an interrupted time series analysis

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

A systematic review of hospital accreditation: the challenges of measuring complex intervention effects

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