Accreditation of health services: is it money and time well spent?

The research evidence shows that accreditation is a useful tool for stimulating improvements in the quality and safety of health services. Accreditation programs are deployed widely to monitor and promote safety and quality in healthcare. Governments, health service organisations and accreditation agencies have invested considerable resources into accreditation programs, but to date evidence of their effectiveness is limited and varied in some areas. Without more robust evidence – on what aspects of accreditation programs work, in what contexts and why – policymakers will have to continue drawing on expert opinion, small-scale program evaluations and cautious comparative assessments of the literature when reviewing, revising or implementing  accreditation programs

Development of an Evidence-Based Tool to Assess the Relative Vulnerability of Different Communities to Tuberculosis

Identifying specific tuberculosis (TB) vulnerabilities in populations based on their geographical, demographic, and epidemiological characteristics is an essential yet challenging requirement to help reduce and eliminate TB. Assessment tools that can accurately quantify the risks associated with key factors could be used to measure TB vulnerability efficiently and indicate the most appropriate range of interventions. This study aimed to develop TB vulnerability assessment tools based on a TB vulnerability assessment conceptual framework developed with Leximancer. Three steps to produce the tools were facet analysis, interpreting the facet to create a list of questions, and expert judgment to confirm the suitability of the questionnaire. The “everything is data” principle was used to identify the data sources and build the tools. The data came from multiple primary data sources, with a questionnaire survey and observational form, and secondary data from various governmental statistical departments in Indonesia to collect data related to demography, health indicators, climate, temperature, and air quality. These tools will be optimized at scale next year to evaluate their utility for prioritizing and prescribing health system responses to TB in different communities in Central Java Province

"I do what I have to do to survive": An investigation into the perceptions, experiences and economic considerations of women engaged in sex work in Northern Namibia

<p>Abstract</p> <p>Background</p> <p>There is little published research investigating sex work in Namibia, particularly in rural areas. Therefore, the aim of this paper was to determine the views of women engaged in sex work in the Oshakati area of Namibia concerning the main factors influencing their use, or non-use, of male condoms during transactional sexual exchanges.</p> <p>Methods</p> <p>Qualitative interviews were used to better understand the perceptions, experiences and economic considerations of female sex workers in Namibia who were involved in a Behavior Change Communication Program encouraging safer sex practices among high-risk populations in 2006 and 2007.</p> <p>Results</p> <p>While the Behavior Change Communication Program has made significant strides in educating and empowering young women to negotiate more consistent condom use with sexual partners, the gendered economic inequalities and power imbalances within rural and semi-urban Namibian society that favor men hinder further advancement towards positive behavioral change for HIV prevention and also hinder the development of the loving relationships sought by some sex workers.</p> <p>Conclusion</p> <p>This study found that sex workers and transactional sex encounters are heterogeneous entities dependent upon the characteristics of the man (known, stranger, wealthy, attractive to the woman) and the woman (in financial need, desiring love). These features all influence condom use. The 3 E's 'education, empowerment and economic independence' are critical factors needed to encourage and facilitate consistent condom use to prevent HIV transmission. Without financial independence and occupational alternatives building on their health education and empowerment, women who engage in sex work-and transactional sex more generally-will remain largely marginalized from Namibian society, and will continue engaging in risky sexual practices that facilitate HIV acquisition and transmission throughout the community.</p

Strengthening organizational performance through accreditation research - a framework for twelve interrelated studies: the ACCREDIT project study protocol

Background: Service accreditation is a structured process of recognising and promoting performance and adherence to standards. Typically, accreditation agencies either receive standards from an authorized body or develop new and upgrade existing standards through research and expert views. They then apply standards, criteria and performance indicators, testing their effects, and monitoring compliance with them. The accreditation process has been widely adopted. The international investments in accreditation are considerable. However, reliable evidence of its efficiency or effectiveness in achieving organizational improvements is sparse and the value of accreditation in cost-benefit terms has yet to be demonstrated. Although some evidence suggests that accreditation promotes the improvement and standardization of care, there have been calls to strengthen its research base. In response, the ACCREDIT (Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork) project has been established to evaluate the effectiveness of Australian accreditation in achieving its goals. ACCREDIT is a partnership of key researchers, policymakers and agencies.FindingsWe present the framework for our studies in accreditation. Four specific aims of the ACCREDIT project, which will direct our findings, are to: (i) evaluate current accreditation processes; (ii) analyse the costs and benefits of accreditation; (iii) improve future accreditation via evidence; and (iv) develop and apply new standards of consumer involvement in accreditation. These will be addressed through 12 interrelated studies designed to examine specific issues identified as a high priority. Novel techniques, a mix of qualitative and quantitative methods, and randomized designs relevant for health-care research have been developed. These methods allow us to circumvent the fragmented and incommensurate findings that can be generated in small-scale, project-based studies. The overall approach for our research is a multi-level, multi-study design.DiscussionThe ACCREDIT project will examine the utility, reliability, relevance and cost effectiveness of differing forms of accreditation, focused on general practice, aged care and acute care settings in Australia. Empirically, there are potential research gains to be made by understanding accreditation and extending existing knowledge; theoretically, this design will facilitate a systems view of accreditation of benefit to the partnership, international research communities, and future accreditation designers

Advancing the accreditation economy: a critical reflection

n their recent paper, Greenfield et al. [1] outline the substantial and sustained accreditation economy that now exists in many countries. Stakeholders continue to be divided regarding the appropriate design, implementation and reporting mechanisms of programs, as well as their definitive impact on improving the safety and quality of health services [2]. Greenfield et al. [1] cite evidence from previous similar studies in 2000 and 2010 to present these issues as perennial, arguing that work remains to convince stakeholders of the value and sustainability of accreditation. These debates occur in the context of new local programs being introduced annually, supplemented by transnational programs entering new markets—countries, sectors and clinical areas. In some circumstances, governments and donor agencies promote global expansion as a pathway to enabling ‘quality’ universal health coverage [3]. The International Society for Quality in Health Care (ISQua) encourages standardization of accreditation design and processes by facilitating a global community of practice through the ISQua External Evaluation Association. To realize the value and sustainability of programs, the global accreditation economy must resonate with key stakeholders in low- and middle-income countries. Resource constraints and under-developed regulatory environments present clear challenges to effective uptake and diffusion [4], with historical professional and institutional cultures equally influential. For example, staff requirements to ‘speak up for safety’ and consumer engagement in organizational decision-making require new systems and processes to be implemented. The flexibility of transnational accreditation programs to accommodate local adaption of standards is a strength. However, the cross-cultural implementation of the values and goals of accreditation programs requires careful consideration and planning when doing so. A stimulus for the uptake of voluntary programs in low- and middle-income countries has been medical tourism, but the implementation of statutory programs, often based on prominent transnational programs, is also frequently encouraged by donor agencies. This has led some commentators to interrogate the influence of commercial and political drivers on the expanding accreditation economy [5]. The source of funding for accreditation program evaluations is a further area that may require greater consideration and transparency. There is a broad agreement that the accreditation evidence base is diverse and inconsistent [6], analogous to abstract art, which proponents and opponents interpret selectively as validation of their existing perceptions regarding the accreditation economy. However, this variability in the evidence base is hardly surprising, when accreditation is understood as a prototypical complex intervention, designed and implemented variably in complex, dynamic health systems, worldwide [7]. Instead of viewing accreditation as a panacea for low-quality care, and evaluating it accordingly, Greenfield et al. [1] extend the position of Mitchell et al. [8] in arguing that its main function could be the dissemination of sectoral, national and global languages through which to articulate and share system-based approaches for enculturating quality and safety improvement. This distinction may warrant a timely reorientation of the research agenda to better discern the positive impacts arising from the accreditation economy. Furthermore, in addition to pursuing robust evidence of effect, stakeholders may also want to consider the types of evidence that would justify the de-implementation of programs, as occurred in Denmark from 2015 [9]