Managing to improve quality: The relationship between accreditation standards, safety practices, and patient outcomes
Given the trend toward eliminating reimbursement for "never events," hospital administrators are challenged to implement practices designed to prevent their occurrence. Little evidence exists, however, that patient safety practices, as evaluated using accreditation criteria, are related to the achievement of patient safety outcomes. The aim of this study was to examine the relationship between patient safety practices, as measured by accreditation standards, and patient safety outcomes as measured by hospital rates of infections, decubitus ulcers, postoperative respiratory failure, and failure to rescue. Secondary data were used to examine relationships between patient-safety-related accreditation standards and patient outcomes in U.S. acute care hospitals. Accreditation performance areas were reduced into subscores to represent patient safety practices. Outcome rates were calculated using the Agency for Healthcare Research and Quality Patient Safety Indicator software. Multivariate regression was performed to determine the significance of the relationships. Three of four multivariate models significantly explained variance in hospital patient safety indicator rates. Accreditation standards reflecting patient safety practices were related to some outcomes but not others. Rates of infections and decubitus ulcers occurred more frequently in hospitals with poorer performance in utilizing patient safety practices, but no differences were noted in rates of postoperative respiratory failure or failure to rescue. Certain adverse events, such as infections and decubiti, may be reduced by preventive protocols that are reflected in accreditation standards, whereas other events, such as failure to rescue and postoperative respiratory failure, may require multifaceted strategies that are less easily translated into protocols. Our approach may have influenced the observed associations yet represents progress toward assessing whether safety practices, as measured by accreditation standards, are related to patient outcomes.
[Show abstract] [Hide abstract] ABSTRACT: Purpose - Accreditation and external peer review play important roles in assessing and improving healthcare quality worldwide. Evidence on the impact on the quality of care remains indecisive because of programme features and methodological research challenges. The purpose of this paper is to create a general methodological research framework to design future studies in this field. Design/methodology/approach - A literature search on effects of external peer review and accreditation was conducted using PubMed/Medline, Embase and Web of Science. Three researchers independently screened the studies. Only original research papers that studied the impact on the quality of care were included. Studies were evaluated by their objectives and outcomes, study size and analysis entity (hospitals vs patients), theoretical framework, focus of the studied programme, heterogeneity of the study population and presence of a control group. Findings - After careful selection 50 articles were included out of an initial 2,025 retrieved references. Analysis showed a wide variation in methodological characteristics. Most studies are performed cross-sectionally and results are not linked to the programme by a theoretical framework. Originality/value - Based on the methodological characteristics of previous studies the authors propose a general research framework. This framework is intended to support the design of future research to evaluate the effects of accreditation and external peer review on the quality of care.0Comments 1Citation
- "come variables. In total, 34 papers concern studies that focus on the accreditation of whole organisations, seven of them use a theoretical framework. Other studies gave arguments for the impact of accreditation programmes such as the standardisation of processes and better guideline adherence but did not explicitly rely on a theoretical framework. Thornlow and Merwin (2009) refer to the Quality Health Outcomes Model to structure the relationships between system, intervention and outcomes (based on Donabedian's structure, process and outcomes model). System variables were hospital characteristics, intervention variables were defined as utilisation of patient safety practices and outcomes were defined by the"
[Show abstract] [Hide abstract] ABSTRACT: Background: Whereas accreditation is widely used as a tool to improve quality of healthcare in the developed world, it is a concept not well adapted in most developing countries for a host of reasons, including insufficient incentives, insufficient training and a shortage of human and material resources. The purpose of this paper is to describe refining use and outcomes of a self-assessment hospital accreditation tool developed for a resource-limited context. Methods: We invited 60 stakeholders to review a set of standards (from which a self-assessment tool was developed), and subsequently refined them to include 485 standards in 7 domains. We then invited 60 hospitals to test them. A study team traveled to each of the 40 hospitals that agreed to participate providing training and debrief the self-assessment. The study was completed in 8 weeks. Results: Hospital self-assessments revealed hospitals were remarkably open to frank rating of their performance and willing to rank all 485 measures. Good performance was measured in outreach programs, availability of some types of equipment and running water, 24-h staff calls systems, clinical guidelines and waste segregation. Poor performance was measured in care for the vulnerable, staff living quarters, physician performance reviews, patient satisfaction surveys and sterilizing equipment. Conclusion: We have demonstrated the feasibility of a self-assessment approach to hospital standards in low-income country setting. This low-cost approach may be used as a good precursor to establishing a national accreditation body, as indicated by the Ministry's efforts to take the next steps. Copyright © 2015 John Wiley & Sons, Ltd.0Comments 3Citations
- "Our project was an attempt to expand an accreditation scheme that followed a small initial pilot (Bateganya et al., 2009). Currently, there is no uniform standard or accreditation process on which to judge hospital performance in Uganda, despite some evidence that accreditation has been associated with the improvement in quality of healthcare in other settings (Whittaker et al., 1994; Whittaker et al., 2000; El-Jardali et al., 2008; Thornlow and Merwin, 2009; Flodgren et al., 2011; Andualem et al., 2012). After developing the standards, we asked key Ugandan stakeholders to refine them and then tested the ability and willingness of 40 hospital administrators to administer them in their hospitals. "
- "A capacidade da acreditação em gerar melhorias na satisfação dos pacientes e conceder reconhecimento público aos hospitais acreditados são argumentos importantes em seu favor (Al Tehewy et al., 2009; Thornlow & Merwin, 2009). Assim, a acreditação deve ser entendida também como uma estratégia de marketing que transmite valor à marca do hospital, diferenciando-o da concorrência. "