Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis

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The historical development and current landscape of health library standards: A critical review

Background: Since the emergence of the first health library standards, a large body of literature has been published in this field, most often focusing on a particular standard, or set of standards. In the case of literature reviews, they have been usually partial and integrated into a broader study. Objective: Identify and analyse national health library standards developed in different countries worldwide over the past 70 years, tracing their historical development and current status. Method: A comprehensive search of published literature was conducted in Scopus, Web of Science, Medline, LISA, and Google Scholar up to May 2023. The reference lists and citations of retrieved papers were reviewed. After screening and eligibility, a total of 112 papers were included in the final selection. Results: More than 40 national hospital library standards published by a group of Anglo-Saxon and European countries were identified. In a chronological approach, the standards have been arranged by decades, from the 1950s to the present day, and the context of their appearance, their main contributions, and the relationships between them have been analysed. The major trends that have marked their evolution and development over time have also been established. Conclusion: Standards have a key role to play in the important challenge facing health libraries today to demonstrate the high impact and value of their services in the functioning of their organisations and in improving patient care

Safe use of symbols in handover documentation for medical teams

Concern has been reported about the safe use of medical abbreviations in documents such as handover sheets and medical notes, especially when information is being communicated between staff of different specialties (BBC 2008, Sheppard et al. 2008). This article describes a study to investigate whether the use of symbols in handover documentation that is shared within and between multidisciplinary teams (MDTs) has similar safety implications. We asked 19 healthcare professionals from a range of specialties to identify 45 different combinations of 38 individual symbols. The symbols and combinations of symbols were extracted from 102 handover sheets taken from 6 different healthcare contexts in 4 London hospitals. Three symbols proposed in Microsoft's Common User Interface guidelines for alert symbols were also included. Results reveal that while some symbols are well understood, many others are either ambiguous or unknown. These results have implications for the safe use of symbols in medical documents, including paper and electronic handover documents and Electronic Patient Records (EPRs), especially where teams comprise individuals from different professional backgrounds, i.e. MDTs. We offer initial suggestions for standardisation and further research

Assessing the value of accreditation as a strategy for safer healthcare in Uruguay

Introducción La acreditación de servicios de salud desde 1999 fue ganando espacio como una estrategia de regulación, asociado con un interés aumentado en la seguridad del paciente. La acreditación consiste en la evaluación voluntaria y periódica de los servicios, realizada por un agente externo, contra una serie de estándares. Aunque la mayoría de los programas de acreditación tienen similitudes, usualmente se adaptan a las políticas locales. Desde la reforma del Sistema Nacional Integrado de Salud en Uruguay, se ha enfatizado la necesidad de la mejora de la seguridad del paciente, y diferentes partes han propuesto como parte de la solución la implementación de la acreditación. Objetivos y Metodología Para analizar los efectos de la acreditación de hospitales, y entender las perspectivas de diferentes partes interesadas en Uruguay, un estudio observacional fue realizado. Incluye una revisión bibliográfica de revisiones analizando la acreditación, a través de un análisis narrativo, y un análisis temático de nueve entrevistas semiestructuradas, realizadas a tomadores de decisión uruguayos, elegidos mediante un muestreo intencional. Resultados Siete revisiones bibliográficas fueron identificadas e incluidas para el análisis, después de evaluar su metodología. Poca evidencia de una asociación entre la acreditación y los efectos sobre la estructura, procesos y resultados fue encontrada. Algunos de los ejemplos de asociaciones son la re-estructura de las áreas de enfermería, el efecto en la sustentabilidad financiera, y la implementación de buenas prácticas. Sin embargo, no se pudo identificar evidencia consistente sobre la cultura, los resultados o la visión de los usuarios. Mientras la financiación, un cuerpo de dirección comprometido y una organización acreditadora fuerte pueden ser identificados como facilitadores de la implementación, recursos escasos y cultura organizacionales adversas son identificados como posibles barreras. Entre los nueve entrevistados se encuentra un amplio entendimiento del concepto de acreditación. Se espera que, a través de una mejor adherencia de pautas y políticas de seguridad del paciente, evaluaciones periódicas y una aproximación sistémica, la acreditación mejoraría la seguridad del paciente. También se entiende como una manera de mejorar la cultura de seguridad de los médicos y de los cuerpos de dirección. Aunque algunos reparos fueron presentados concerniendo el estilo de gestión y el rol de la política en la gestión, así como con la factibilidad de la implementación de la estrategia, los entrevistados concuerdan en que la acreditación mejoraría la seguridad del paciente en Uruguay, y por lo tanto debería ser contemplada como una solución. Discusión Aunque la evidencia presenta resultados inconsistentes, la formulación de políticas es influenciada por otros elementos. Mientras que diferentes instituciones abogan por la acreditación, algunos de los grupos más poderosos (entre otros los médicos y los cuerpos de dirección) son reactivos y podrían no apoyar la medida. A su vez, intentos pasados por implementar la acreditación han fallado, y los programas actuales de seguridad del paciente no han sido lo efectivos que se esperaba. Sin embargo, se entiende que la acreditación podría mejorar la seguridad en el contexto de la reforma nacional de la salud. Conclusiones y Recomendaciones Aunque la literatura estudiada presenta una pobre metodología, algunas conclusiones pueden ser alcanzadas. Mientras que la actitud de la enfermería es favorable a la acreditación, la de otros grupos es inconsistente. Las investigaciones analizando la asociación con cambios en la estructura, procesos y resultados no fueron concluyentes, excepto por el aumento en la adhesión a pautas y estándares. A pesar de la pobre evidencia, diferentes actores consideran que la implementación de la acreditación, como una estrategia de mejora de la calidad, tendrá un efecto positivo en la cultura sobre la seguridad del paciente y en los resultados. Sin embargo, se expresó preocupación acerca de la viabilidad de su aplicación, sobre todo en cuanto al rol de la política, el estilo de gestión y los limitados recursos humanos y económicos. Teniendo en cuenta el interés de las partes interesadas, el contexto nacional y la evidencia actual algunas recomendaciones pueden ser realizadas: • Recomendación 1: Establecer objetivos de seguridad del paciente y medidas de impacto, y evaluar el desempeño de los servicios de salud. • Recomendación 2: Seleccionar el programa de acreditación apropiada: opciones, la aceptabilidad y la sostenibilidad. • Recomendación 3: Implementar un programa piloto. • Recomendación 4: Coordinar los esfuerzos concurrentes a la seguridad del paciente.Agencia Nacional de Investigación e InnovaciónChevening Scholarship - FC

The impact of health sector accreditation: a literature review

Διπλωματική εργασία--Πανεπιστήμιο Μακεδονίας, Θεσσαλονίκη, 2018.Abstract Background: The necessity for an empirically grounded, comprehensive evidence base for accreditation has long been recognized. Without this, the varying positive and negative views about accreditation will remain anecdotal, influenced by ideology or preferences, and driven by such biases. Purpose: The purpose of this thesis is to identify and analyze research into accreditation processes impact and to find out if there is difference between accredited and nonaccredited health units. Data sources: A review of the accreditation literature was conducted from May to July 2018. The search identified articles researching accreditation of health sector. An analysis of abstracts of the articles was conducted to identify substantial studies relevant to health services accreditation. The full text of these studies was retrieved and reviewed. Inclusion criteria included studies addressing the impact of hospital accreditation using systematic reviews, randomized controlled trials, observational studies with a control group, or interrupted time series. Results: The analysis reveals a complex picture. The results, examining the impact of accreditation, were classified into 2 categories following a chronological order: Proponents – Positive Impact and Opponents – Neutral or Negative Impact. The search identified a number of national health care accreditation organizations engaged in research activities. Accreditation continues to grow internationally but due to scant evidence, no conclusions could be reached to support its effectiveness. Concerns are raised about the cost of accreditation programs by health care professionals especially in developing countries. Conclusion: The health care accreditation industry appears to be purposefully moving towards constructing the evidence to ground our understanding of accreditation, by analyzing both traditional and newly developed measures and measurement systems

International healthcare accreditation : an analysis of clinical quality and patient experience in the UAE

A mixed method research design was used to answer the question; ‘does accreditation have an impact on hospital quality, clinical measures and patient experience?’ The thesis contains three study components: 1) A case study determining the predictors of patient experience; 2) a cross-sectional study examining the relationship of hospital accreditation and patient experience and 3) A four year time series analysis of the impact of accreditation on hospital quality using 27 quality measures. A case study analysis of patient experience, using a piloted, validated and reliable survey tool, was conducted in Al Noor Hospital. The survey was administered via face-to-face interviews to 391 patients. Patient demographic variables, stay characteristics and patient experience constructs were tested against five patient experience outcome measures using regression analysis. The predictors of positive patient experience were the patient demographics (age, nationality, and health status), hospital stay characteristics (length of stay and hospital treatment outcome) and patient experience constructs (care from nurses, care from doctors, cleanliness, pain management and quality of food). Recommendations were made on how hospital managers can improve patient experience using these modifiable factors. The cross-sectional study found that accredited hospitals had significantly higher inpatient experience scores than non-accredited hospitals. The hospital level variables, other than patient volume, had no correlations with patient experience. The interrupted time series analysis demonstrated that although accreditation improved the quality performance of the hospital with a residual benefit of 20 percentage points above the baseline level, this improvement was not sustained over the 3-year accreditation cycle. The accreditation life cycle theory was developed as an explanatory framework for the pattern of performance during the accreditation cycle. This theory was consequently supported by empirical evidence. Recommendations were made for improvement of the accreditation process. The Life Cycle Model and time series analysis were proposed as strategic tools for healthcare managers to recognise and prevent the negative trends of the accreditation life cycle in order to sustain improvements gained from accreditation. The findings of the three research components were triangulated to form a theory on the impact of accreditation on clinical quality measures and patient experience. This thesis is important from a research perspective, as healthcare accreditation, although commonly used to improve quality, is still under researched and under theorised. This is the first investigation of accreditation to use interrupted time series analysis, the first analysis on patient experience and hospital accreditation and also the first study on patient experience in the Middle East. Thus it adds to the evidence base of accreditation and patient experience but also has policy and management implications

The development of hospital accreditation in low- and middle-income countries: a literature review

Hospital accreditation has been transferred from high-income countries (HICs) to many low- and middle-income countries (LMICs), supported by a variety of advocates and donor agencies. This re-view uses a policy transfer theoretical framework to present a structured analysis of the develop-ment of hospital accreditation in LMICs. The framework is used to identify how governments in LMICs adopted accreditation from other settings and what mechanisms facilitated and hindered the transfer of accreditation. The review examines the interaction between national and inter-national actors, and how international organizations influenced accreditation policy transfer. Relevant literature was found by searching databases and selected websites; 78 articles were included in the analysis process. The review concludes that accreditation is increasingly used as a tool to improve the quality of healthcare in LMICs. Many countries have established national hos-pital accreditation programmes and adapted them to fit their national contexts. However, the im-plementation and sustainability of these programmes are major challenges if resources are scarce. International actors have a substantial influence on the development of accreditation in LMICs, as sources of expertise and pump-priming funding. There is a need to provide a roadmap for the suc-cessful development and implementation of accreditation programmes in low-resource settings. Analysing accreditation policy processes could provide contextually sensitive lessons for LMICs seeking to develop and sustain their national accreditation programmes and for international organisations to exploit their role in supporting the development of accreditation in LMICs

Patient Journey and Tracer Methodologies: Literature review

Preface This preface was written by the Australian Commission on Safety and Quality in Health Care (the Commission) to provide context and background to the report which follows, Patient Journey and Tracer Methodologies: Literature review. The Commission contracted the University of Technology Sydney (UTS) to prepare the literature review, as part of the review of the Australian Health Service Safety and Quality Accreditation (AHSSQA) Scheme. Background The Commission’s role is to lead and coordinate national improvements in the safety and quality of health care. The Commission works in partnership with the Australian Government, state and territory governments and the private sector to achieve a safe and high-quality, sustainable health system. In doing so, the Commission also works closely with patients, carers, clinicians, managers, policymakers and healthcare organisations. The Commission developed the National Safety and Quality Health Service (NSQHS) Standards in consultation with the Australian Government, state and territory governments, technical experts and stakeholders. They aim to protect the public from harm and to improve the quality of health service provision. To become accredited, health service organisations must pass assessments to show they have implemented the NSQHS Standards. The assessments are conducted by independent accrediting agencies, approved by the Commission, as part of the AHSSQA Scheme. However, state and territory regulators and chief executives of health service organisations have raised concerns about several aspects of the accreditation process. The Commission is undertaking a review to update and improve the accreditation process. In May 2017, the Commission contracted four literature reviews to provide an evidence base to inform the Commission’s review of the AHSSQA Scheme. The reviews explored the potential use of the following methods to improve the veracity of health service organisations: • Attestation by a governing body • Short-notice and unannounced surveys • Patient journey and tracer methodologies • Safety culture assessment. The report that follows this preface presents the findings of a literature review that explored the potential use of patient journey and tracer methodologies as part of health service organisation accreditation. Key findings The key findings of the report on patient journey and tracer methodologies (hereafter referred to as ‘patient journey methodologies’) are discussed according to the evidence of its effectiveness and considerations for its use in the AHSSQA Scheme

Flying with doctors: Experiences with the application of 6 techniques from aviation industry in the Rotterdam Eye Hospital

Intoduction. Aviation industry is often put forward as an example in creating safer health care. Comparing aviation and health care, there are similarities in using technology, working with highly specialized professional teams and the need for dealing with risk and uncertainties (Sexton 2000; Powell 2006; Kao & Thomas 2008). Rhetorical use of the resemblance however, does not directly contribute to the safety of the health care system. To measure the added value of the experiences in aviation for the health care sector, it is preferable to study in detail the use of aviation based principals in daily practice

Development and pilot of clinical performance indicators for English ambulance services

Introduction: There is a compelling need to develop clinical performance indicators for ambulance services in order to move from indicators based primarily on response times and in light of the changing clinical demands on services. We report on progress on the national pilot of clinical performance indicators for English ambulance services. Method: Clinical performance indicators were developed in five clinical areas: acute myocardial infarction, cardiac arrest, stroke (including transient ischaemic attack), asthma and hypoglycaemia. These were determined on the basis of common acute conditions presenting to ambulance services and in line with a previously published framework. Indicators were piloted by ambulance services in England and results were presented in tables and graphically using funnel (statistical process control) plots. Results: Progress for developing, agreeing and piloting of indicators has been rapid, from initial agreement in May 2007 to completion of the pilot phase by the end of March 2008. The results of benchmarking of indicators are shown. The pilot has informed services in deciding the focus of their improvement programme in 2008 and 2009 and indicators have been adopted for national performance assessment of standards of prehospital care. Conclusion: The pilot will provide the basis for further development of clinical indicators, benchmarking of performance and implementation of specific evidencebased interventions to improve care in areas identified for improvement. A national performance improvement registry will enable evaluation and sharing of effective improvement methods as well as increasing stakeholder and public access to information on the quality of care provided by ambulance services