Abstract
BackgroundTo identify context factors associated with and predicting success in the hospital accreditation process, and to contribute to the understanding of the relative relevance of context factors and their organizational level in the success of QI initiatives.MethodsAnalytical study of cases and controls in a sample of hospitals of medium and high complexity in Colombia. Cases (n = 16) are accredited hospitals by the time of preparation of the study (2016) and controls (n = 38) are similar facilities, which have not succeeded to obtain accreditation. Eligibility criteria for both groups included complexity (medium and high), having emergency services, an official quality assurance license, and being in operation for at least 15 years. Besides eligibility criteria, geographical location, and type of ownership (public/private) are used to select controls to match cases.Context measures are assessed using a survey instrument based on the MUSIQ model (“Model for Understanding Success in Quality”) adapted and tested in Colombia. Statistical analysis includes descriptive measures for twenty-three context factors, testing for significant statistical differences between accredited and non-accredited hospitals, and assessing the influence and strength of association of context factors on the probability of success in the accreditation process. A multivariate model assesses the predictive probability of achieving accreditation.ResultsEighteen (78.3%) of the twenty-three context factors are significantly different when comparing cases and controls hospitals, particularly at the Microsystem level; all factors are statistically significant in favor of accredited hospitals. Five context factors are strongly associated to the achievement of accreditation but in the logistic multivariable model, only two of them remain with significant OR, one in the Macrosystem, “Availability of economic resources for QI” (OR: 22.1, p: 0,005), and the other in the Microsystem, “Involvement of physicians” (OR: 4.9, p: 0,04).ConclusionThis study has applied an instrument, based on the MUSIQ model, which allows assessing the relevance of different context factors and their organizational level in hospitals, to explain success in the accreditation process in Colombia. Internal macrosystem and microsystem seem to be more relevant than external environment factors.
Highlights
To identify context factors associated with and predicting success in the hospital accreditation process, and to contribute to the understanding of the relative relevance of context factors and their organizational level in the success of quality improvement (QI) initiatives
Differences in context factors between accredited and non-accredited hospitals Because of the matching design of the sample, there were no significant differences in level of complexity, size and type of ownership between cases and controls
Assessment of eighteen (78.3%) of the twenty-three context factors are significantly different when comparing cases and controls hospitals. These differences occur in all the levels, but at the Microsystem, where all its five factors are statistically significant in favor of accredited hospitals (Table 2)
Summary
To identify context factors associated with and predicting success in the hospital accreditation process, and to contribute to the understanding of the relative relevance of context factors and their organizational level in the success of QI initiatives. A noteworthy contribution in this search is the MUSIQ model [11] (The Model for Understanding Success in Quality) proposed by Kaplan and colleagues [12] after a systematic review They concluded that research and knowledge on the subject is in an early stage of development and observed more than sixty-six elements and factors that may be relevant to QI, but without a definitive conclusion about the weight that each one of them may have for success. This review gave foundation to the proposed model, which in its original form identified twenty-five factors that may influence success in the implementation of QI projects These factors are grouped by organizational level according to the place of interaction. The MUSIQ model has been used in a number of countries [6], but to our knowledge it has not been adapted and applied neither in the Latin-american environment nor having accreditation as the objective of a quality improvement initiative
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