Healthcare accreditation systems: further perspectives on performance measures.
ABSTRACT The purpose of this paper is to identify and suggest a number of performance measures to facilitate the evaluation of accreditation programs in healthcare.
The paper is based on an exploratory research which has used qualitative methods, including snowball sampling technique, email interview and thematic content analysis.
Respondents (experts and professionals) were selected from a diverse spectrum ranging from healthcare organizations, universities and accreditation-associated institutions.
The analysis of the data provided key measures to be considered in the evaluation of accreditation programs' impact at macro and micro levels as well as their nature and operations. The measures can be used to, for example, assess the degree of stakeholders' reliance on accreditation results, measure the cost of accreditation for participating organizations and serve as a formal mechanism for accredited organizations to appeal accreditation decisions.
This paper has brought together a number of generic, yet influential and workable, measures which could be utilized for assessing the overall performance of an accreditation program in healthcare. The application of these measures depends on the features of given accreditation program and the context in which the program operates. Therefore, the next step/steps in the assessment of an accreditation program might be choosing the measures suiting that program.
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ABSTRACT: One contributor to poor health outcomes in developing countries is weak health systems; key to strengthening them are interventions to improve the quality of health services. Though the value of healthcare accreditation is increasingly recognized, there are few case studies exploring its implementation in developing countries. The aim of our study in Pakistan was to identify perceived factors influencing adaptation of international healthcare accreditation within a developing country context. We used qualitative methods including semi-structured interviews, a structured group discussion, focus groups and non-participant observation of management meetings. Data analysis used a grounded theory approach and a conceptual framework adapted from implementation science. Using our conceptual framework categories of inner and outer setting, we found six perceived inner health system factors that could influence the introduction of healthcare accreditation and two outer setting contextual factors, external to the health system but able to influence its introduction. Our research identified that there is no ’one-size fits all’ approach to introducing healthcare accreditation as a means to improve healthcare quality. Those supporting the introduction of healthcare accreditation, such as national and provincial Ministries and international partners, need to understand how the three components of healthcare accreditation fit into the local health system and into the broader political and social environment. In our setting this included moving to supportive and transparent external evaluation mechanisms, with a first step of using locally-developed and agreed healthcare standards. In addition, sustainable implementation of all three components was seen as a major challenge, especially establishment of a well-managed, transparent accreditation agency able to lead processes such as training and support for peer surveyors. Consideration of local change mechanisms and cultural practices are important in designing a local accreditation approach. The results of our study are important for health systems strengthening in Pakistan and in other developing countries.Health Policy and Planning 11/2013; DOI:10.1093/heapol/czt084 · 3.00 Impact Factor
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ABSTRACT: European Foundation for Quality Management (EFQM) model is a widely used quality management system (QMS) worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation (INPHE) based on those of EFQM. This cross-sectional study was conducted in 2012 on a sample of emergency departments (EDs) affiliated with Tehran University of Medical Sciences (TUMS), Iran. The standard questionnaire of EFQM (V-2010) was used to gather appropriate data. The results were compared with those of INPHE. MS Excel was used to classify and display the findings. The average assessment score of the EDs based on the INPHE and EFQM model were largely different (i.e. 86.4% and 31%, respectively). In addition, the variation range among five EDs' scores according to each model was also considerable (22% for EFQM against 7% of INPHE), especially in the EDs with and without prior record of applying QMSs. The INPHE's assessment results were not confirmed by EFQM model. Moreover, the higher variation range among EDs' scores using EFQM model could allude to its more differentiation power in assessing the performance comparing with INPHE. Therefore, a need for improvement in the latter drawing on other QMSs' (such as EFQM) strengths, given the results emanated from its comparison with EFQM seems indispensable.Iranian Journal of Public Health 06/2013; 42(6):610-9. · 0.58 Impact Factor
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ABSTRACT: Objective To evaluate whether accredited hospitals maintain quality and patient safety standards over the accreditation cycle by testing a life cycle explanation of accreditation on quality measures. Four distinct phases of the accreditation life cycle were defined based on the Joint Commission International process. Predictions concerning the time series trend of compliance during each phase were specified and tested. Design Interrupted time series (ITS) regression analysis of 23 quality and accreditation compliance measures. Setting A 150-bed multispecialty hospital in Abu Dhabi, UAE. Participants Each month (over 48 months) a simple random sample of 24% of patient records was audited, resulting in 276 000 observations collected from 12 000 patient records, drawn from a population of 50 000. Intervention(s) The impact of hospital accreditation on the 23 quality measures was observed for 48 months, 1 year preaccreditation (2009) and 3-year postaccreditation (2010–2012). Main outcome measure(s) The Life Cycle Model was evaluated by aggregating the data for 23 quality measures to produce a composite score (YC) and fitting an ITS regression equation to the unweighted monthly mean of the series. Results The four phases of the life cycle are as follows: the initiation phase, the presurvey phase, the postaccreditation slump phase and the stagnation phase. The Life Cycle Model explains 87% of the variation in quality compliance measures (R2=0.87). The ITS model not only contains three significant variables (β1, β2 and β3) (p≤0.001), but also the size of the coefficients indicates that the effects of these variables are substantial (β1=2.19, β2=−3.95 (95% CI −6.39 to −1.51) and β3=−2.16 (95% CI −2.52 to −1.80). Conclusions Although there was a reduction in compliance immediately after the accreditation survey, the lack of subsequent fading in quality performance should be a reassurance to researchers, managers, clinicians and accreditors.BMJ Open 08/2014; 4(8):e005240. DOI:10.1136/bmjopen-2014-005240 · 2.06 Impact Factor