The impact of accreditation on health care quality in hospitals
Abstract
Background/Aim. Accreditation is considered to be the oldest and most widespread mechanism of independent external evaluation of health care quality and is implemented in over 70 countries worldwide. Despite numerous studies in this field, there is still no solid evidence about its impact on health care quality and patient safety. The goal of this paper was to investigate if the accreditation process has an effect on the difference in values of health care quality indicators. Methods. The study was conducted in two tertiary level health care hospitals, one accredited, the other non-accredited. Values of seven quality indicators in the period before, during and immediately after the completion of accreditation (from 2007–2015), which measure health care quality, patient safety, the efficiency and productivity of the institution, were compared. Results. Of the seven monitored quality indicators, a positive effect of the accreditation process can be attributed to a shorter length of waiting for the first scheduled health check at the institution, shorter length of waiting for the first scheduled surgical check, lower rate of patients with decubitus as well as a decrease of the rate of hospital days per patient with acute myocardial infarction. No effect of accreditation was found on the mortality rate, mortality rate within the first 48 hours of hospitalization, and the average rate of hospital days per patient at the level of the institution. Conclusion. The process of accreditation undoubtedly intensifies activities that contribute to improving health care quality, which results in better health outcomes. Additional research in this field and new evidence about the relationship between accreditation and quality upgrading in health care institutions are required because this could motivate their managers to decide more easily to enter into this process and implement it, despite the additional efforts and financial investments associated with accreditation.
References
References:
Greenfield D, Braithwaite J. Developing the evidence base for ac-creditation of healthcare organisations: A call for transparency and innovation. Qual Saf Health Care 2009; 18(3): 162‒3.
Training courses for external evaluators. Belgrade: Agency for Accreditation of Health Care Institutions of Serbia; 2010.
Greenfield D, Pawsey M, Braithwaite J. Accreditation: A global regulatory mechanism to promote quality and safety. In: Sol-lecito W, Johnson J, editors. Continuous Quality Improvement in Health Care. 4th ed. New York: Jones and Barlett Learning; 2013. p. 513‒31.
Brubakk K, Vist GE, Bukholm G, Barach P, Tjomsland O. A sys-tematic review of hospital accreditation: The challenges of measuring complex intervention effects. BMC Health Serv Res 2015; 15(1): 280.
Braithwaite J, Westbrook J, Pawsey M, Greenfield D, Naylor J, Iedema R, et al. A prospective, multi-method, multi-disciplinary, multi-level, collaborative, socialorganisational design for researching health sector accreditation. BMC Health Serv Res 2006; 6: 113.
Hinchcliff R, Greenfield D, Moldovan M, Westbrook JI, Pawsey M, Mumford V, et al. Narrative synthesis of health service accredi-tation literature. BMJ Qual Saf 2012; 21(12): 979‒91.
Pomey MP, Francois P, Contandriopoulos AP, Tosh A, Bertrand D. Paradox of French Accreditation. Qual Saf Health Care 2005; 14(1): 51‒5.
Overtveit J. Does Improving Quality Save Money. London, UK: Health Foundation; 2009. Available from: http://www.health.org/
Alkhenizan A, Show C. Impact of Accreditation on the Quality of Health service: A systematic review of the literature. Ann Saudi Med 2011; 31(4): 407‒16.
Mumford V, Forde K, Greenfield D, Hinchcliff R, Braithwaite J. Health services accreditation: What is the evidence that the benefits justify the costs. Int J Qual Health Care 2013; 25(5): 606‒20.
Almoajel A. Relationship Between Accreditation and Quality Indictors in Hospital: A review of the literature. World Appl Sci J 2012; 17(5): 598‒606.
Wagner L, McDonalds SM, Castle NG. Joint Commission Inter-national and Quality Measurement i US Nursing Home. Policy Polit Nurs Pract 2012; 13(1): 8‒16.
Grasso BC, Rothschild JM, Jordan CW, Jayaram G. What is the measure of a safe hospital? Medication errors missed by risk management, clinical staff, and surveyors. J Psychiatr Pract 2005; 11(4): 268‒73.
The Government of the Republic of Serbia. Strategy for con-tinuous quality improvement of health care and patient safety. Official Gazette of RS 15/2009.
Rules on indicators of healthcare quality, Article 2. Official Gazette of RS 49/2010.
Devers KJ, Pham HH, Liu G. What is driving hospitals' patient-safety efforts? Health Aff (Millwood) 2004; 23(2): 103‒15.
Joint Commission. Accreditation, Health Care, Certification. Available from: http://www.jointcommission.org
Salmon J, Heavens J, Lombard C, Tavrow P. The Impact of Ac-creditation on the Quality of Hospital Care: KwaZulu-Natal Province Republic of South Africa. Bethesda: University Re-search Co., LLC; 2003.
Greenfield D, Pawsey M, Braithwaite J. The role and impact of ac-creditation on the healthcare revolution. Acreditação 2012; 1(2): 1‒14. (Portuguese)
International Society for Quality in Health Care (ISQua). Ac-creditation: What is ISQua’s International Accreditation Pro-gramme? Dublin: International Society for Quality in Health Care (ISQua); 2012.
Vuković M, Gvozdenović BS, Ranković M, McCormick BP, Vuković DD, Gvozdenović BD, et al. Can didactic continuing education improve clinical decision making and reduce cost of quality? Evidence from a case study. J Contin Educ Health Prof 2015; 35(2): 109‒18.
Lilly CM, Cody S, Zhao H, Landry K, Baker SP, McIlwaine J, et al. Hospital mortality, length of stay, and preventable complica-tions among critically ill patients before and after tele-ICU re-engineering of critical care processes. JAMA 2011; 305(21): 2175‒83.
Greenfield D, Pawsey M, Naylor J, Braithwaite J. Are accreditation surveys reliable? Int J Health Care Qual Assur 2009; 22(2): 105‒16.