Does accreditation stimulate change? A study of the impact of the accreditation process on Canadian healthcare organizations

<p>Abstract</p> <p>Background</p> <p>One way to improve quality and safety in healthcare organizations (HCOs) is through accreditation. Accreditation is a rigorous external evaluation process that comprises self-assessment against a given set of standards, an on-site survey followed by a report with or without recommendations, and the award or refusal of accreditation status. This study evaluates how the accreditation process helps introduce organizational changes that enhance the quality and safety of care.</p> <p>Methods</p> <p>We used an embedded multiple case study design to explore organizational characteristics and identify changes linked to the accreditation process. We employed a theoretical framework to analyze various elements and for each case, we interviewed top managers, conducted focus groups with staff directly involved in the accreditation process, and analyzed self-assessment reports, accreditation reports and other case-related documents.</p> <p>Results</p> <p>The context in which accreditation took place, including the organizational context, influenced the type of change dynamics that occurred in HCOs. Furthermore, while accreditation itself was not necessarily the element that initiated change, the accreditation process was a highly effective tool for (i) accelerating integration and stimulating a spirit of cooperation in newly merged HCOs; (ii) helping to introduce continuous quality improvement programs to newly accredited or not-yet-accredited organizations; (iii) creating new leadership for quality improvement initiatives; (iv) increasing social capital by giving staff the opportunity to develop relationships; and (v) fostering links between HCOs and other stakeholders. The study also found that HCOs' motivation to introduce accreditation-related changes dwindled over time.</p> <p>Conclusions</p> <p>We conclude that the accreditation process is an effective leitmotiv for the introduction of change but is nonetheless subject to a learning cycle and a learning curve. Institutions invest greatly to conform to the first accreditation visit and reap the greatest benefits in the next three accreditation cycles (3 to 10 years after initial accreditation). After 10 years, however, institutions begin to find accreditation less challenging. To maximize the benefits of the accreditation process, HCOs and accrediting bodies must seek ways to take full advantage of each stage of the accreditation process over time.</p

Intercultural Citizenship, Civic Nationalism and Nation Building in Quebec: From Common Public Language to Laicite

This article analyses the current citizenship-nation building nexus in Québec in light of government publications and recent public discourses on ethnocultural pluralism and immigrant integration. First, the article surveys the changing relationship between Québécois nationalism and citizenship according to political circumstances in Québec, suggesting that debates over immigrant integration have played a central role in the creation of a civic Québécois identity, initially based on French as the public language and interculturalism. The article then analyses recent public debates surrounding ‘reasonable accommodation’ in Québec, and identifies a growing emphasis on laïcité – the secularisation of the public space – as identity marker. This article attributes this growing focus on secularism to dissatisfied nationalists seeking to reclaim the cultural prominence of the French Canadian majority in provincial institutions and press for measures aimed at enhancing Québec's distinctiveness and autonomy within the Canadian institutional framework. On a more normative note, the article argues that while language nationalism is reconcilable with ethnocultural pluralism, recent discourses on the secularisation of the public space constrain the emergence of an openly pluralistic stance on national belonging in the province, and undermines the legitimacy of Québec interculturalism