The effect of certification and accreditation on quality management in 4 clinical services in 73 European hospitals

Abstract

ObjectiveTo investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals.DesignA mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathways.Setting and ParticipantsSeventy-three acute care hospitals with a total of 291 services managing acute myocardial infarction (AMI), hip fracture, stroke and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey.Main Outcome MeasureFour composite measures of quality and safety [specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies (PSS) and clinical review (CR)] applied to four pathways.ResultsAccreditation in isolation showed benefits in AMI and stroke more than in deliveries and hip fracture; the greatest significant association was with CR in stroke. Certification in isolation showed little benefit in AMI but had more positive association with the other conditions; greatest significant association was in PSS with stroke. The combination of accreditation and certification showed least benefit in EBOP, but significant benefits in SER (AMI), in PSS (AMI, hip fracture and stroke) and in CR (AMI and stroke).ConclusionsAccreditation and certification are positively associated with clinical leadership, systems for patient safety and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care. Further analysis of DUQuE data will explore the association of certification and accreditation with clinical outcomes.

The perception of healthcare employees and the impact of healthcare accreditation on the quality of healthcare in Korea

“…[23,30,31] In other systematic reviews, accreditation programs are consistently found to facilitate improvements in medical institutions and healthcare quality. [32][33][34] The standards included in this study are intended to determine whether the goals and purpose of the accreditation system are being achieved well. In the future, it will be necessary to carry out additional research to determine how accreditation affects patients' well-being as well as research to evaluate outcome indicators, and cost-effectiveness studies.…”

“…Some empirical studies found that accreditation improves patient safety, including mortality, morbidity, and the incidence of infection, [32,[36][37][38][39] and this needs to be applied to domestic research. However, the ability to generalize from the results of this study is limited because the history of Korea's accreditation system is short and few relevant studies exist.…”

Benefits and difficulties in the implementation of hospital accreditation: The voice of quality managers

“…The complexity of services provided in hospital institutions, the fast pace of work and the possible lack of resources, together with an increased technological progress, may represent barriers that go beyond this and other strategies that aim at quality of care by means of accreditation 11,12 . Even if hospital accreditation has its limitations, this quality management system results in improvements related to patient safety, from the interviewed managers' point of view, and in benefits to quality of care:…”

“…Statements made by QM1H2 and QMH3 show that accreditation is an element that brings safety to users cared for at the hospital, and consequently, it is something that supports quality of care as a result. This is important, as patient/user safety has been one of the most discussed topics in the health care sphere, both in practice and in scientific fields, including in the establishment of international targets, which include prevention and management of adverse outcomes related to care services, among others 12 . It is worth remembering that safety in care is a diktat already provided at the first certification level of national accreditation 4 .…”

Acreditação hospitalar e seus impactos nas boas práticas em serviços da saúde

“…A eficácia dos processos pode ser alcançada a partir de indicadores e de treinamentos para os trabalhadores, fazendo com que os processos sejam desenvolvidos com base na sua real necessidade 20 . Shaw et al 18 afirmam que a acreditação está associada com os sistemas utilizados pelos hospitais para a segurança do paciente. Seu aprimoramento se relaciona com a implantação bem-sucedida de iniciativas de melhoria da qualidade 6 .…”