ShortNotice and Unannounced Survey Methods: Literature review

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 -qu ality, sustainable health system. In doing so, the Commission also works closely with patients, carers, clinicians, managers, policymakers and healthcare organisations. The Commission is responsible under the National Health Reform Act 2011 for the formul ation of standards relating to health care safety and quality matters and for formulating and coordinating national models of accreditation for health service 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 other 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

Attestation by Governing Bodies: 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, Attestation by Governing Bodies: 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 is responsible under the National Health Reform Act 2011 for the formulation of standards relating to healthcare safety and quality matters and for formulating and coordinating national models of accreditation for health service 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 attestation by governing bodies during accreditation of health service organisations. Key findings The report on attestation by governing bodies includes a definition of attestation, a review of the evidence of the effectiveness of attestation by governing bodies as part of accreditation in healthcare, and examples of the use of attestation in practice

Stakeholder perspectives on implementing accreditation programs: A qualitative study of enabling factors

Background: Accreditation programs are complex, system-wide quality and safety interventions. Despite their international popularity, evidence of their effectiveness is weak and contradictory. This may be due to variable implementation in different contexts. However, there is limited research that informs implementation strategies. We aimed to advance knowledge in this area by identifying factors that enable effective implementation of accreditation programs across different healthcare settings. Methods. We conducted 39 focus groups and eight interviews between 2011 and 2012, involving 258 diverse healthcare stakeholders from every Australian State and Territory. Interviews were semi-structured and focused on the aims, implementation and consequences of three prominent accreditation programs in the aged, primary and acute care sectors. Data were thematically analysed to distil and categorise facilitators of effective implementation. Results: Four factors were identified as critical enablers of effective implementation: the accreditation program is collaborative, valid and uses relevant standards; accreditation is favourably received by health professionals; healthcare organisations are capable of embracing accreditation; and accreditation is appropriately aligned with other regulatory initiatives and supported by relevant incentives. Conclusions: Strategic implementation of accreditation programs should target the four factors emerging from this study, which may increase the likelihood of accreditation being implemented successfully. © 2013 Hinchcliff et al.; licensee BioMed Central Ltd

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

Evaluation of current Australian health service accreditation processes (ACCREDIT-CAP): Protocol for a mixed-method research project

Introduction: Accreditation programmes aim to improve the quality and safety of health services, and have been widely implemented. However, there is conflicting evidence regarding the outcomes of existing programmes. The Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork-Current Accreditation Processes (ACCREDIT-CAP) project is designed to address key gaps in the literature by evaluating the current processes of three accreditation programmes used across Australian acute, primary and aged care services. Methods and design: The project comprises three mixed-method studies involving documentary analyses, surveys, focus groups and individual interviews. Study samples will comprise stakeholders from across the Australian healthcare system: accreditation agencies; federal and state government departments; consumer advocates; professional colleges and associations; and staff of acute, primary and aged care services. Sample sizes have been determined to ensure results allow robust conclusions. Qualitative information will be thematically analysed, supported by the use of textual grouping software. Quantitative data will be subjected to a variety of analytical procedures, including descriptive and comparative statistics. The results are designed to inform health system policy and planning decisions in Australia and internationally. Ethics and dissemination: The project has been approved by the University of New South Wales Human Research Ethics Committee (approval number HREC 10274). Results will be reported to partner organisations, healthcare consumers and other stakeholders via peer-reviewed publications, conference and seminar presentations, and a publicly accessible website

A multimethod research investigation of consumer involvement in Australian health service accreditation programmes: The ACCREDIT-SCI study protocol

Introduction: Health service accreditation programmes are a regulatory mechanism adopted to drive improvements inpatient safety and quality. Research investigating the benefits or limitations, of consumer involvement in accreditation programmes is negligible. To develop our knowledge in this area the ACCREDIT collaboration (Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork) has developed a research plan, known as the ACCREDIT-SCI (Standards of Consumer Involvement) study protocol. Two complementary studies have been designed: one, to examine the effectiveness of a standard for consumer participation and two, to explore how patient experiences vary across a range of settings with differing accreditation results. Methods and design: The research setting is the Australian healthcare system, and the two studies focus on three accreditation programmes in the primary, acute and aged care domains. The studies will use multimethods: document analysis; interviews and surveys. Participants will be stakeholders across the three domains including: policy officers; frontline healthcare professionals; accreditation agency personnel, including surveyors and healthcare consumers. Drawing on previous experience, the research team has developed purpose-designed tools. Data will be analysed using thematic, narrative and statistical (descriptive and inferential) procedures. Ethics and dissemination: The University of New South Wales Human Research Ethics Committee has approved the two studies (HREC 10274). Findings will be disseminated through seminars, conference presentations, academic publications and research partner websites. The findings will be formulated to facilitate uptake by policy and accreditation agency professionals, researchers and academics, and consumers, nationally and internationally

Comparison of wound strength, histologic, and aesthetic outcomes after microsurgical versus conventional skin closure in a rat model.

The purpose of this study was to compare the healing, strength, and cosmetic outcome of linear incisions after repair with the naked eye, surgical loupes, or a surgical microscope. Two parallel incisions were made on the dorsal skin of Sprague-Dawley rats (n = 36) and the rats randomized into four groups. A single surgeon repaired the incisions using 5-0 poliglecaprone in a running subcuticular pattern using the naked eye (Group I), surgical loupes with 2.5× magnification (Group II), surgical microscope with 5-10× magnification (Group III), and 6-0 poliglecaprone with a surgical microscope (Group IV). Rats were sacrificed at 1, 3, and 6 weeks. At each time point, the tensile strength of each closure was assessed. Macroscopic outcomes were evaluated using the Vancouver Scar Scale (VSS) and histology assessed by a blinded observer. Microscope closure took significantly longer than closure with the naked eye (p < 0.05). There was no significant difference in tensile strength or VSS ratings between the closure methods at any of the time points. On histopathologic analysis, there were a greater number of inflammatory cells and fibroblasts in the 6-0 microscope closure group versus the naked eye closure group at week 3 (p ≤ 0.05). In conclusion, wound repair under magnification did not yield a significant difference in cosmesis or wound tensile strength, but did increase operative time. Moreover, there was a trend toward increased inflammation with microscope-assisted closures, perhaps due to the increased suture burden

Economic evaluation of Australian acute care accreditation (ACCREDIT-CBA (Acute)): Study protocol for a mixedmethod research project

Introduction: The Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork-Cost-Benefit Analysis (ACCREDIT-CBA (Acute)) study is designed to determine and make explicit the costs and benefits of Australian acute care accreditation and to determine the effectiveness of acute care accreditation in improving patient safety and quality of care. The cost-benefit analysis framework will be provided in the form of an interactive model for industry partners, health regulators and policy makers, accreditation agencies and acute care service providers. Methods and design: The study will use a mixedmethod approach to identify, quantify and monetise the costs and benefits of accreditation. Surveys, expert panels, focus groups, interviews and primary and secondary data analysis will be used in cross-sectional and case study designs. Ethics and dissemination: The University of New South Wales Human Research Ethics Committee has approved this project (approval number HREC 10274). The results of the study will be reported via peer-reviewed publications, conferences and seminar resentations and will form part of a doctoral thesis

Comparison of two cadaveric acellular dermal matrices for immediate breast reconstruction: A prospective randomized trial.

AlloDerm RTU® and AlloMaxTM are two acellular dermal matrices (ADMs) used in implant-based breast reconstruction. In this study, we examined whether different processing methods for the ADMs lead to a disparity in histologic, clinical, and financial outcomes after breast reconstruction. Thirty patients undergoing implant-based breast reconstruction were randomized into AlloMax or AlloDerm arms (n = 15, each). ADM was placed at the time of immediate reconstruction. Patients were evaluated for complications on postoperative days 7, 14, and 30. During implant exchange, ADM biopsies were taken and compared histologically for vascular and cellular infiltration. Patient satisfaction was evaluated using the BRECON-31 questionnaire 1 year after implant exchange. A cost analysis was performed comparing the two ADMs. Patient demographics and complication rates were similar between the two groups (p > 0.05). Histologically, vessel density and fibroblast/inflammatory cell infiltrate were greater on the dermal side than on the implant side (p < 0.01) in both ADMs, suggesting greater vascular and cellular in-growth from the dermal side. Vessel density in the middle portion of the Allomax biopsies was significantly higher than the same site in the Alloderm biopsies (p < 0.05). The extent of fibroblast/inflammatory cell infiltration was similar in both arms (p > 0.05). The BRECON-31 satisfaction questionnaire yielded similar responses across all metrics between the two study arms. The negotiated price was slightly different when comparing the two ADMs, with no significant difference in ADM reimbursement. In this study, AlloDerm RTU and AlloMax were successfully used for implant-based breast reconstruction with comparable outcomes