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

20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years

The administration of endocrine therapy for 5 years substantially reduces recurrence rates during and after treatment in women with early-stage, estrogen-receptor (ER)-positive breast cancer. Extending such therapy beyond 5 years offers further protection but has additional side effects. Obtaining data on the absolute risk of subsequent distant recurrence if therapy stops at 5 years could help determine whether to extend treatment

Measurement of the B0^0 and B+^+ meson lifetimes with fully reconstructed hadronic final states

The B0 and B+ meson lifetimes have been measured in e+e- annihilation data collected in 1999 and 2000 with the BABAR detector at center-of-mass energies near the Upsilon(4S) resonance. Events are selected in which one B meson is fully reconstructed in a hadronic final state while the second B meson is reconstructed inclusively. A combined fit to the B0 and the B+ decay time difference distributions yields tau_{B0} = 1.546 +/- 0.032 (stat) +/- 0.022(syst) ps, tau_{B+} = 1.673 +/- 0.032 (stat) +/- 0.023 (syst) ps and tau_{B+} / tau_{B0} = 1.082 +/- 0.026 (stat) +/- 0.012 (syst

Manikin measurements versus wear trials of cold protective clothing (Subzero project)

The thermal insulation properties of clothing systems can be defined through physical measurements using thermal manikins or through wear trials using human test subjects. One objective of the European Subzero project was to define the relationship between physically measured thermal insulation values of cold-protective clothing and the corresponding physiological reactions on human test subjects. Four cold-protective clothing ensembles, intended for use in temperatures between 0 and -50degreesC, were measured with manikins in eight European laboratories and on human test subjects in four of these laboratories. The results showed that reasonably good reproducible values from the manikin tests can be achieved (CV <8%); however, the fit of the clothing on the manikin is a critical factor. There were greater individual differences in the wear trial results. Comparing the results from the manikin and the wear trials, good agreement in the thermal insulation values was shown if the amount of accumulated sweat was low. In these situations, which are normal when using cold protective clothing, the thermal comfort can also be determined with good accuracy by means of mathematical models based on manikin results. Special situations, e.g. for highly perspiring wearers, strong wind, or high friction between garment layers, need specific modelling; some suggestions have been made as a result of the Subzero project, but further research is required