Exclusive study by Dr. Rana Allam
AAA assessor, International accreditation expert
LinkedIn: https://www.linkedin.com/in/rana-allam-23938219a/

 

Abstract: Background: one of the top concerns for health systems around the world is to enhance healthcare quality. Accreditation is often a voluntary program where qualified external peer

assessors assess a healthcare organization’s compliance & compare it to pre-established performance standards. This research’s objective had been to assess how accrediting initiatives affect the quality of healthcare services. Conclusion: method of care delivered by healthcare services is improved by general accreditation programs, according to consistent data. effectiveness of universal accreditation programs in enhancing therapeutic results for a variety of clinical diseases is supported by a large body of research. There is lots of evidence that subspecialty accreditation programs lead to better clinical results. use of accreditation programs as a strategy to raise the quality of healthcare services must be encouraged, Keywords: accreditation, healthcare quality, services, programs.

One of the top concerns of health systems around the world is the enhancement of healthcare quality (1). Continuous quality improvement in the healthcare industry developed as a result of changes in quality management in the industrial sector, especially since the 1980s (2).

release of studies like To Err is Human in the late 1990s gave this emphasis on quality management—& more specifically, studied case safety—a fresh drive (3) which, in addition to stressing the severity of adverse outcomes, made an argument for how many of them might be prevented (4).

Consequently, several programs are implemented to raise the level of care given, including overall quality management & plan-do-study-act (5), collaboratives, statistical process control (6), & six Sigma (7).

Accreditation is   increasingly seen   as   the   best   way   to   increase   healthcare   quality at organizational & service levels between quality initiatives used in industry (8), given its widespread reputation as a major force behind the enhancement of healthcare quality & studied case safety (9).

Hospitals view accreditation as a worthwhile investment despite the high costs involved (10). creation of required accreditation schemes in nations like Iran is the result of the perception that accreditation improves healthcare quality (11), Italy, Scotland, & France (12).

In Jordan, the hospital certification system had been successful & long-lasting, but it ran into some problems in Egypt & Lebanon. However, ongoing funding & strong political will ensured the implementation & viability of the plan in Jordan despite the premature cessation of external funding & terrible political turmoil following the Arab Spring (13).

Overall, evidence indicates that hospitals that have started accrediting programs do better than those that have not (8). In a sample of twenty-three hospitals chosen at random, it had been discovered that hospitals that had applied for accreditation performed better in terms of management & administration, medical staff organization, nursing service organization,

review systems, physical facilities, & safety, hospital role definition & planning, & physical facilities (14).

Clostridioides difficile & methicillin-resistant staphylococcus aureus bacteremia are two examples of hospital-acquired infections that increase mortality & length of stay while also costing the US economy billions of dollars annually. Despite being avoidable, ongoing incidence shows that infection prevention strategies are still difficult for health system administrators to implement. The Aim of Valenti, (15) purpose of research had been to determine if there had been variation in the frequency of HAIs, specifically CDI & MRSA bacteremia, among facilities with Magnet accreditation & those without. Magnet accreditation status served as an independent variable, whereas CDI & MRSA bacteremia served as dependent variables. Donabedian’s framework of structure, method, & results in enhancing quality care served as the research’s conceptual framework. a total sample size of 4,745 was obtained  in  2021  thanks  to  information  from Centres  for  Medicare & Medicaid. Mann-Whitney  U  test  was  used  to  analyze standardized    infection ratios for dependent variables, which had been divided into groups based on their Magnet status. Outcomes showed variation in the mean rank of SIRs for both research questions among organizations that were Magnet accredited & those that were not (p<.001). Hospital- acquired MRSA bacteremia was treated better by Magnet-accredited hospitals than by non- Magnet accredited hospitals, whereas CDI was treated worse by Magnet-accredited hospitals. By potential application of organizational solutions that could lower healthcare expenditures & HAIs, reduce mortality & inpatient length of stay, & enhance the quality of studied case results, the research contributes to positive social change (15)

Greenfield & Braithwaite used sixty-six studies for a comprehensive review, Greenfield et al., (16) continuous evidence that the promotion of change & professional development was aided by accreditation.

Nevertheless, despite notions that governments often hold, (17) and healthcare professionals

(18) on the advantages of accreditation; currently, available data is either weak (19) or inconclusive (20), especially in terms of how it affects the standard of treatment.

research of 216 state mental hospitals in the United States, for instance, found a weak correlation between accreditation & 7 quality-of-care indicators chosen (average cost of each studied case, each Diem bed cost, total staff hours each studied case, clinical staff hours each studied case, percent of staff hours provided by medical staff bed turnover, & percent of beds occupied) (21).

Information from randomized control experiments including Twenty hospitals in South Africa Salmon et al., (22) demonstrated that while accreditation improved nurses’ perceptions of clinical quality, it had little to no impact on the other 7 quality indicators (patient satisfaction, medication education for patients, accessibility & completeness of medical records, perioperative note quality, hospital cleanliness, & labeling of ward supplies).

Due to a dearth of trustworthy empirical data regarding the effects of applying accreditation standards Greenfield et al., (16) Numerous demands for more research on how certification programs influence structure, procedure, & results of hospital care are made (19), in addition to lack of understanding regarding implementation of accreditation (8; 16; 19).

Particularly, little research has been done on the relationship between accreditation & hospital healthcare quality (23) in addition to procedures through which accreditation “might lead to improved quality of care, strengthen leadership culture and climate, and how these factors, in turn, might mediate accreditation performance” (9).

Why is this an important issue now when accreditation is in existence for decades?

First off, even though hospital certification is a reality for more than a century, patient safety & quality of healthcare services have received lots more attention recently. variety of quality improvement programs in healthcare organizations has increased as a result, & legislative requirements for improving patient safety & quality of clinical services have increased as well (24). Mandatory regulations typically concentrate on fundamental safety measures to safeguard the general population. Clinical staff members & health care leaders have been expected to find & implement programs that will raise standards, lower risks related to clinical variance, & increase process effectiveness. Numerous organizations are unable to handle the implementation, personnel training, & data gathering requirements of a growing number of projects, from Lean management to Six Sigma. It is necessary to make efforts to reduce the burden of audits & duplication of high-quality programs whilst maximizing the advantages that accreditation provides. 1 of those advantages is that accrediting process is a comprehensive framework that may take several various & seemingly unrelated approaches & bring them together (25).

Second, by 2030, we must achieve universal health coverage, which includes financial risk protection, access to high-quality necessary medical services, & availability of safe, reliable, high-quality, & reasonably priced vital drugs & vaccinations for everyone. It will take efficient coordination among governments, payers, providers, & service users to achieve universal health coverage. Accreditation can give direction & structure that makes it easier to deliver high-quality patient care (25).

acute care industry was where accreditation in health care first started, especially at institutions with ties to academics. Governmental accreditation programs are developed in some nations alongside licensing & other regulatory programs; in other nations, academia & private sector have maintained close ties with accreditation; & in still other nations, independent agencies for accrediting health services are established. Accreditation programs have expanded slowly & unevenly over the world, with some of the main obstacles being the absence of professional or stakeholder backing, inflated expectations, & absence of resources or incentives. It is crucial to take action to make sure that the full value of accreditation is realized to guarantee the delivery of health services in a sustainable & consistent way (24).

The Effect of Accreditation on the Level of healthcare quality:

A previous systematic review by Hussein et al., (26) has thoroughly examined the literature on hospital certification over the past 2 decades to determine its impact on the quality of medical services. There have been seventy-six studies altogether, each of which has been given a pertinent effect category.

Although conflicting opinions, over fifty-five percent of included studies, showed favorable accrediting impacts. The findings showed that accreditation consistently had a favorable impact on process-related performance metrics, safety culture, hospital effectiveness, & studied case length of stay. On the other hand, it has been discovered that staff job stress has been regularly impacted negatively. ability to draw conclusive conclusions on mortality & healthcare-associated infections was limited by heterogeneous outcomes. The thirty-day readmission rate studied case experience, & staff job satisfaction had been discovered to be unrelated to accreditation. But the disparity in accreditation models (8), These results could be influenced by a diversity of hospital features & inability to isolate external variables.

Although culture is frequently suggested as a cause of failure, earlier studies by Greenfield et al., (16), and Hussein et al., (26) reviewed discovered that accreditation has a favorable impact on safety culture at the organizational level. Nevertheless, accreditation negatively affects a professional’s stress level on an individual basis (27). This would suggest that there needs to be a balance between the risks & advantages of accreditation to persuade health practitioners to accept & take part in the accreditation process (28). Such a terrible outcome appears inescapable. But there have been important treatments that have to be taken into consideration, including   leadership   support,   better   design   of   accrediting   standards & procedures, & awareness campaigns (29).

Continuing from earlier reviews Almasabi et al., (30), and Hussein et al., (26) association between certification & improved patient satisfaction or experience could not be found. the prior assumption that patient happiness reflects hospital service quality Singh, (31) had not been verified in their examination. Although their results are consistent with the idea that accreditation is a tool that encourages the delivery of better internal procedures (32), the proper threshold for improvement to be tangible is ambiguous. Most likely, the solution depends on how certification criteria & procedures are set up (33).

Hussein et al., (26) According to analysis, hospital accreditation has advantages that manifest before, throughout, & after the process. However, it is important to consider if the influence of accreditation is cyclical & how long it lasts (34). Studies link performance improvement to the positive influence of accreditation on economic consequences. Nevertheless, clear findings were hampered by a small number of research. It is difficult to separate the financial effect of certification from other contextual factors, which can account for a dearth of studies in this area (35).

To complete the picture, additional research on the effects of hospital certification is required. 1 argument could be that accreditation literature’s variability & observational character limit its usefulness in drawing believable conclusions about the efficacy of accreditation (36). Nevertheless, the lack of conclusive proof of consequences does not prove that they did not occur. Observational studies appear to be of undoubted merit although their limitations, given the ethical & practical difficulties of conducting randomized trials on this complex process.

Most efficient ways to achieve accreditation:

Accreditation procedures place a strong emphasis on increasing employee motivation. level of care provided in hospitals is directly impacted by the motivation of doctors & nurses. Based on 3 pillars, certification enhances organizational performance in all hospitals. If an organization focuses on quality assurance, control, & inspection, its performance will increase (13). Hospitals frequently conduct quality control checks by regularly asking studied cases for comments on the level of treatment they received. Building trust through effective communication techniques (37). studied cases may give hospitals their frank opinions. It assists the carer in determining the precise problem with medical services. They can be able to establish trustworthy rapport with studied cases through regular quality checks. Controlling & sustaining the quality of treatment is crucial once hospitals have identified their enhanced areas & raised the standard of care. Because there is fierce competition among hospitals, it is essential to keep up the standard of care (38). implementation of the certification procedure was affected by a variety of variables (13). the certification process would be improved if nurses’ opinions were considered, as this would help with implementation (39). Important checkpoints in accrediting initiatives include requiring patient participation & engagement as well as staff collaboration & communication.

Research by Algunmeeyn & Mrayyan, (40) revealed that the implementation of accreditation in Jordanian public hospitals was influenced by communication. interviewers in both hospitals believed it to be the cornerstone of their institutions’ accrediting cultures. It had been inferred that both hospitals’ top management had worked hard to foster effective communication. participants had been able to point out several areas where things had changed for the better, including thorough feedback & shared understanding between all staff. According to several references, this mutual understanding had a significant impact on how accreditation was implemented at both hospitals. They show how important communication is to hospital management strategy, particularly when it comes to quality initiatives. Similar arguments were made regarding how crucial it is for functions & work units to communicate effectively to meet client demands. As a result, the atmosphere of trust & information exchange develops, leading to common comprehension between functions (41).

The implementation of accreditation must be led by competent hospital managers. This is most likely due to the knowledge that skilled managers may develop precise goals, successful policies, & creative problem-solving methods. Effective managers may also initiate continuous quality initiatives as change agents, which will help the hospital achieve its purpose, vision, & goals. Additionally, competent managers are qualified to create attainable goals & effectively utilize hospital resources.

significance of training initiatives for managing health services was emphasized. These courses improve leadership & management abilities. Studies that demonstrate the importance of hospital management training programs for all personnel, especially managers & decision-makers, support these conclusions (42).

Algunmeeyn & Mrayyan, (40) research, Since successful hospitals continuously innovate change based on studied cases’ growing demands   & feedback, results recommended that engagement of studied cases (studied cases’ feedback system for enhancing quality) as a determinant of accreditation implementation. It ought to be remembered that both hospitals’ performance has been strongly impacted by patient satisfaction & capacity to meet their expectations. These results are consistent with other resources, & it is useful to perform studied case surveys regularly to monitor changes in patient satisfaction. It is debatable whether studied case behavior & how much they participate in the provision of care affect accreditation (43).

responses from participants have been crucial for implementing accreditation. effectiveness of implementing accreditation depends on these responses in Algunmeeyn & Mrayyan, (40) research. According to multiple respondents, participating doctors believed that teamwork had been crucial in overcoming staff resistance to change, consistent with Raut et al.,

1. effectiveness of both hospitals appears to be improved through teamwork, which also affects the hospital’s work atmosphere & patient care. Better results may be achieved through teamwork than through a single person’s efforts. Teamwork will therefore probably result in better & quicker solutions to any current problems.

Collaboration is required to make full use of the opportunity to increase the beneficial effects of service accreditation & reduce the chance that it will become unduly burdensome & unfit for purpose. This relationship is to be led & managed by colleges, in particular RCP, RCPsych, and RCS. Through close collaboration with commissioners, care providers, specialized organizations, & patient groups, the goal would be to guarantee that service accreditation is professionally led & grows in an efficient & effective fashion (Box 1). Service accreditation will be patient-centered & meet everyone’s requirements if this leadership & teamwork are successful. Additionally, it will be a powerful tool for increasing the value of money (45).

strategy for clinical service accreditation must be established in conjunction with all major stakeholders, such as studied cases, CQC, commissioners, & providers, it had been decided at a stakeholder meeting hosted by the Royal College of Physicians, Royal College of Psychiatrists, & Royal College of Surgeons (45).

References:

1. 1. Chassin, M. R. (2013). Improving the quality of health care: what’s taking so long?.

Health Affairs, 32(10), 1761-1765.

1. 1. Boaden, R. (2005). The contribution of quality management to patient safety. Patient Safety: Research into Practice, 41-65.
   2. Donaldson, M. S., Corrigan, J. M., & Kohn, L. T. (Eds.). (2000). To err is human: building a safer health system.
   3. Vincent, C. (2011). Patient safety. John Wiley & Sons.
   4. Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ quality & safety, 23(4), 290-298.
   5. Thor, J., Lundberg, J., Ask, J., Olsson, J., Carli, C., Härenstam, K. P., & Brommels,

M. (2007). Application of statistical process control in healthcare improvement: systematic review. BMJ Quality & Safety, 16(5), 387-399.

1. 1. DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010). Assessing the evidence of Six Sigma and Lean in the health care industry. Quality Management in Healthcare, 19(3), 211-225.
   2. Shaw, C., Groene, O., Mora, N., & Sunol, R. (2010). Accreditation and ISO certification: do they explain differences in quality management in European hospitals?. International Journal for Quality in Health Care, 22(6), 445-451.
   3. Braithwaite, J., Greenfield, D., Westbrook, J., Pawsey, M., Westbrook, M., Gibberd, R., … & Lancaster, J. (2010). Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study. BMJ Quality & Safety, 19(1), 14-21.
   4. Saleh, S. S., Bou Sleiman, J., Dagher, D., Sbeit, H., & Natafgi, N. (2013). Accreditation of hospitals in Lebanon: is it a worthy investment?. International journal for quality in health care, 25(3), 284-290.
   5. Jaafaripooyan, E. (2011). Contextual approach to the performance analysis of Iran’s National Accreditation Programme for healthcare organisations (Doctoral dissertation, University of Southampton).
   6. World Health Organization. (2003). Quality and accreditation in health care services: a global review.
   7. Mansour, W., Boyd, A., & Walshe, K. (2021). National accreditation programmes for hospitals in the Eastern Mediterranean Region: Case studies from Egypt, Jordan, and Lebanon. The International Journal of Health Planning and Management, 36(5), 1500-1520.
   8. Duckett, S. J. (1983). Changing hospitals: the role of hospital accreditation. Social science & medicine, 17(20), 1573-1579.
   9. Valenti, L. (2023). Hospital-acquired Infections and Differences between Magnet and Non-Magnet Hospitals (Doctoral dissertation, Walden University).
   10. Greenfield, D., & Braithwaite, J. (2008). Health sector accreditation research: a systematic review. International journal for quality in health care, 20(3), 172-183.
   11. El-Jardali, F., Jamal, D., Dimassi, H., Ammar, W., & Tchaghchaghian, V. (2008). The impact of hospital accreditation on quality of care: perception of Lebanese nurses. International journal for quality in health care, 20(5), 363-371.
   12. Diab, S. M. (2011). The extent to which Jordanian doctors and nurses perceive the accreditation in private hospitals. International Journal of Marketing Studies, 3(1), 78.

19.Hinchcliff,R.,Greenfield,D.,Moldovan,M.,Westbrook,J.I.,Pawsey,M.,Mumford,V.,&Braithwaite,J.(2012).Narrativesynthesisofhealthserviceaccreditationliterature.BMJ quality & safety, 21(12), 979-991.

• Bogh, S. B., Falstie-Jensen, A. M., Bartels, P., Hollnagel, E., & Johnsen, S. P. (2015). Accreditation and improvement in process quality of care: a nationwide study. International journal for quality in health care, 27(5), 336-343.
• Hadley, T. R., & McGurrin, M. C. (1988). Accreditation, certffication, and the quality of care in state hospitals. Psychiatric Services, 39(7), 739-742.
• Salmon, J. W., Heavens, J., Lombard, C., and Tavrow, (2003). The Impact of Accreditation on the Quality of Hospital Care: KwaZulu-Natal Province, Republic of South Africa.
• Schmaltz, S. P., Williams, S. C., Chassin, M. R., Loeb, J. M., & Wachter, R. M. (2011). Hospital performance trends on national quality measures and the association with Joint Commission accreditation. Journal of hospital medicine, 6(8), 454-461.
• Fortune, T., O’Connor, E., & Donaldson, B. (2015). Guidance on designing healthcare external evaluation programmes including accreditation. Dublin, Ireland: International Society for Quality in Healthcare (ISQua).
• Nicklin, W., Fortune, T., van Ostenberg, P., O’Connor, E., & McCauley, N. (2017). Leveraging the full value and impact of accreditation. International Journal for Quality in Health Care, 29(2), 310-312.
• Hussein, M., Pavlova, M., Ghalwash, M., & Groot, W. (2021). The impact of hospital accreditation on the quality of healthcare: a systematic literature review. BMC health services research, 21(1), 1-12.
• Kim, M. R., & Kim, M. S. (2019). Awareness, job stress, turnover intention, safety management perception change of nurses in a general hospital-before and after medical institution certification system. The Journal of the Korea Contents Association, 19(1), 385-395.
• Alkhenizan, A., & Shaw, C. (2011). Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Annals of Saudi medicine, 31(4), 407-416.
• Park, I. T., Jung, Y. Y., & Suk, S. H. (2017). The perception of healthcare employees and the impact of healthcare accreditation on the quality of healthcare in Korea. Journal of Hospital Administration, 6(6), 20-27.
• Almasabi, M., Yang, H., & Thomas, S. (2014). A systematic review of the association between healthcare accreditation and patient satisfaction. World Appl Sci J, 31(9), 1618-1623.
• Singh, J. (1989). The patient satisfaction concept: a review and reconceptualization.

ACR North American Advances.

1. 1. Hirose, M., Imanaka, Y., Ishizaki, T., & Evans, E. (2003). How can we improve the quality of health care in Japan?: Learning from JCQHC Hospital Accreditation. Health policy, 66(1), 29-49.
   2. Jha, A. K. (2018). Accreditation, quality, and making hospital care better. Jama, 320(23), 2410-2411.
   3. Devkaran, S., & O’Farrell, P. N. (2014). The impact of hospital accreditation on clinical documentation compliance: a life cycle explanation using interrupted time series analysis. BMJ open, 4(8), e005240.
   4. Mumford, V., Forde, K., Greenfield, D., Hinchcliff, R., & Braithwaite, J. (2013). Health services accreditation: what is the evidence that the benefits justify the costs?. International Journal for Quality in Health Care, 25(5), 606-620.

36.Ivers,N.,Tricco,A.C.,Trikalinos,T.A.,Dahabreh,I.J.,Danko,K.J.,Moher,D.,

… & Grimshaw, J. M. (2014). Seeing the forests and the trees—innovative approaches to exploring heterogeneity in systematic reviews of complex interventions to enhance health system decision-making: a protocol. Systematic reviews, 3(1), 1-11.

1. 1. Auer, P., & Maschler, Y. (Eds.). (2016). NU/NÅ: A family of discourse markers across the languages of Europe and beyond (Vol. 58). Walter de Gruyter GmbH & Co KG.
   2. Al-Shdaifat, E. A. (2015). Implementation of total quality management in hospitals.

Journal of Taibah University Medical Sciences, 10(4), 461-466.

1. 1. Atapour, M., & Nayeri, N. D. (2021). Explanation of nursing experiences of hospital accreditation implementation. Research Square, 10.
   2. Algunmeeyn, A., & Mrayyan, M. T. (2022). Understanding the factors influencing the implementation of accreditation in Jordanian Hospitals: the nurses’ view. BMJ Open Quality, 11(3), e001912.
   3. Basu, A., & Dutta, M. J. (2008). The relationship between health information seeking and community participation: The roles of health information orientation and efficacy. Health communication, 23(1), 70-79.
   4. Stephen, S. O., & Bula, H. (2017). Human resource management practices and quality of health care service delivery at Jaramogi Oginga Odinga teaching and referral hospital, Kenya. Human Resource Management, 10(10), 126-140.
   5. Alasmari, H. A. M., & Douglas, C. (2012). Job satisfaction and intention to leave among critical care nurses in Saudi Arabia. Middle East Journal of Nursing, 6(4), 3- 12.
   6. Raut, R. D., Narkhede, B., & Gardas, B. B. (2017). To identify the critical success factors of sustainable supply chain management practices in the context of oil and gas industries: ISM approach. Renewable and Sustainable Energy Reviews, 68, 33- 47.
   7. Valori, R., Rogers, C., Johnston, D., & Ingham, J. (2013). Developing a strategy for accreditation of clinical services. Clinical medicine, 13(6), 538.