Abstract
BackgroundOne 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.MethodsWe 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.ResultsThe 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.ConclusionsWe 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.
Highlights
Today's healthcare organizations (HCOs) struggle with paradoxes of all kinds
This is certainly the case in Canada, where even though accreditation through the United States' Joint Commission of Healthcare Organizations dates from the beginning of the twentieth century, little is known about the real impacts of the accreditation process on Canadian HCOs [14,15,16,17,18,19]
Accreditation Canada follows international accreditation rules regarding HCOs' 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
Summary
A literature review of the impacts of accreditation on HCOs suggests that more research is necessary to determine whether accreditation truly improves healthcare services delivery and health outcomes [13]. This is certainly the case in Canada, where even though accreditation through the United States' Joint Commission of Healthcare Organizations dates from the beginning of the twentieth century, little is known about the real impacts of the accreditation process on Canadian HCOs [14,15,16,17,18,19]. One way to improve quality and safety in healthcare organizations (HCOs) is through accreditation. This study evaluates how the accreditation process helps introduce organizational changes that enhance the quality and safety of care
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