Hospital Accreditation Research Articles

La Qualité dans les hôpitaux publics marocains : Enjeux et pistes d’amélioration

Public hospitals in Morocco suffer from a lot of dysfunctions and shortcomings, which have in their turn perverse effects on the quality of their practices, their activities and services (shortage and lack of management of resources, governance problems, staff demotivation, accessibility difficulties, user dissatisfaction, etc.). Several efforts have been made by the ministry of health through the implementation of a set of reforms, strategies and action plans, in order to control and reduce the impact of those dysfunctions in the public hospital world. From the 1990s, the ministry of health have focused mainly on quality procedures (Competition for quality, certifications, hospital accreditation, etc.), to ensure both the correction of certain dysfunctions and the improvement of the quality of services offered to public hospital services users. However, all these efforts could not succeed. As a matter of fact, they were not able to make the change in the Moroccan public hospital world work. In this article, we try to dissect the main quality initiatives that have been established in the public hospitals of the kingdom, to shed some light on the main obstacles that hinder their success, and therefore, suggest ways of improvement to allow their sustainability. We implicitly target, through this work, the identification and the contribution to the fixing of the major dysfunctions of the Moroccan public hospitals that strive to improve their services, performances and ability to cope with various challenges, issues and risks such as the serious repercussions and the devastating consequences of the current covid-19 pandemic.

Evaluasi Penerapan Early Warning Score di Ruang Rawat Inap Dewasa

Early Warning Score (EWS) is one of the instruments used to assess the patient's physiological deterioration and is one of the assessments in hospital accreditation. The application of the EWS can predict patient outcomes in the form of mortality, length of stay, and re-hospitalization. The purpose of this study was to evaluate the application of EWS in the inpatient room. This study was a prospective observational cohort study of patients in adult wards (≥16 years) over a while (1 month). The number of samples was 256 patients. The instruments used in this study were a demographic data questionnaire and an EWS observation sheet. Descriptive statistics were used for patient characteristics, and EWS monitoring documents. The results showed that 100% of the EWS sheet documentation was incomplete, if this examination sheet was not carried out correctly it would affect the subsequent patient handling and patient outcomes both related to illness and death. Monitoring and evaluation related to the implementation of the EWS are very much needed in the future for the improvement of hospital services as a whole. Keywords: Early Warning Score, Evaluation

Association of social vulnerability with the use of high-volume and Magnet recognition hospitals for hepatopancreatic cancer surgery

BackgroundIn an effort to improve perioperative and oncologic outcomes, there have been multiple quality improvement initiatives, including regionalization of high-risk procedures and hospital accreditation designations from independent organizations. These initiatives may, however, hinder access to high-quality surgical care for certain patients living in areas with high social vulnerability who may be disproportionally affected, leading to disparities in access and worse postoperative outcomes. MethodsMedicare beneficiaries who underwent liver or pancreas resection for cancer were identified using the 100% Medicare Inpatient Standard Analytic Files. Hospitals were designated as high-volume based on Leapfrog criteria. The Centers for Disease Control and Prevention’s social vulnerability index database was used to abstract social vulnerability index information based on each beneficiary’s county of residence at the time of operation. The probability that a patient received care at a high-volume hospital stratified by the social vulnerability of the patient’s county of residence was examined. Risk-adjusted postoperative outcomes were compared across low, average, and high levels of vulnerability at both low- and high-volume hospitals. ResultsAmong 16,978 Medicare beneficiaries who underwent a pancreatectomy (n = 13,393, 78%) or a liver resection (n = 3,594, 21.2%) for cancer, the mean age was 73.3 years (standard deviation: 5.8), nearly half the cohort was female (n = 7,819, 46%), and the overwhelming majority were White (n = 15,034, 88.5%). Mean social vulnerability index was 49.8 (standard deviation 24.8) and mean Charlson comorbidity index was 4.8 (standard deviation: 3). Overall, 8,251 (48.6%) of patients had their operations at a high-volume hospital, and 3,802 patients had their operations at a hospital with Magnet recognition. Age and sex were similar within the low-, average-, and high-social vulnerability index cohorts (P > .05); however, race differed across social vulnerability index groups. White patients made up 93% (n = 3,241) of the low social vulnerability index compared with 83.9% (n = 2,706) of the high-social vulnerability index group, whereas non-Whites made up 7% (n = 244) of the low-social vulnerability index group compared with 16.1% (n = 556) of the high-social vulnerability index group (P < .001). The risk-adjusted overall probability of having surgery at a high-volume hospital decreased as social vulnerability increased (odds ratio: 0.98, 95% confidence interval: 0.97–0.99). Risk-adjusted probability of postoperative complications increased with social vulnerability index; however, among patients with high social vulnerability, risk of postoperative complications was lower at high-volume hospitals compared with low-volume hospitals. In contrast, there was no difference in postoperative complications between hospitals with and without Magnet recognition across social vulnerability index. ConclusionPatients residing in communities characterized by a high social vulnerability index were less likely to undergo high-risk cancer surgery at a high-volume hospital. Although postoperative complications and mortality increased as social vulnerability index increased, some of the risk appeared to be mitigated by having surgery at a high-volume hospital. These data highlight the importance of access to high-quality surgical care, especially among patients who may already be more vulnerable.

Consecutive cycles of accreditation and quality of in-hospital care: a Danish population-based study.

Little is known about whether repeated cycles of hospital accreditation are a robust method to improve quality of care continuously. We aimed to examine the association between compliance with consecutive cycles of accreditation and quality of in-hospital care. We conducted a Danish nationwide population-based study including patients aged 18 years treated for acute stroke, chronic obstructive pulmonary disease, diabetes, heart failure or hip fracture at public, non-psychiatric hospitals. From 2012 to 2015, two cycles of national hospital accreditation were completed, resulting in 12 high and 14 low compliant hospitals (Low = partially accredited in both cycles). Our outcome measure was quality of in-hospital care measured by 39 process performance measures (PPMs), reflecting recommendations from the national clinical guidelines by adherence to (i) individual PPMs and (ii) the full bundle of PPMs (all-or-none). We computed adjusted odds ratios (ORs) using logistic regression based on robust standard error estimation for cluster sampling of data at hospital level. In total, 78 387 patient pathways covering 508 816 processes were included, of which 47% had been delivered at high compliant hospitals and 53% at low compliant hospitals, respectively. Compliance with consecutive cycles was not associated with improved quality of in-hospital care (individual: OR = 0.92, 95% confidence interval (CI): 0.77-1.10; All-or-none: OR = 0.87, 95% CI: 0.66-1.15). However, in the second cycle alone, patients treated at partially accredited hospitals had a lower adherence than patients treated at fully accredited hospitals (Individual: OR = 0.84, 95% CI: 0.71-0.99; All-or-none: OR = 0.78, 95% CI: 0.59-1.03). The association was particularly strong among patients treated at partially accredited hospitals required to submit additional documentation. Compliance with consecutive cycles of hospital accreditation in Denmark was not associated with improved quality of in-hospital care. However, compliance with the second cycle alone was associated with improved quality of in-hospital care.

Comparison of Major Clinical Outcomes between Accredited and Nonaccredited Hospitals for Inpatient Care of Acute Myocardial Infarction.

Hospital accreditation programs are used worldwide to improve the quality of care and improve patient safety. It is of great help in improving the structure of hospitals, but there are mixed research results on improving the clinical outcome of patients. The purpose of this study was to compare the levels of core clinical outcome indicators after receiving inpatient services from accredited and nonaccredited hospitals in patients with acute myocardial infarction (AMI). For all patients with AMI admitted to general hospitals in Korea from 2010 to 2017, their 30-day mortality and readmissions and length of stay were compared according to accreditation status. In addition, through a multivariate model that controls various patients’ and hospitals’ factors, the differences in those indicators were analyzed more accurately. The 30-day mortality of patients admitted to accredited hospitals was statistically significantly lower than that of patients admitted to nonaccredited hospitals. However, for 30-day readmission and length of stay, accreditation did not appear to yield more desirable results. This study shows that when evaluating the clinical impact of hospital accreditation programs, not only the mortality but also various clinical indicators need to be included, and a more comprehensive review is needed.

Iran hospital accreditation standards: challenges and solutions.

The purpose of this study was to identify the challenges of Iranian hospital accreditation standards and provide solutions. A qualitative research design was used in this study. Open and semi-structured interviews were conducted in 2018. Thematic analysis was used to analyse qualitative data. Public, private, semi-public, charity and military hospitals in Tehran, Iran. A pluralistic evaluation approach was employed and 151 participants including policy makers, hospital management and staff, accreditation surveyors and university professors participated in this study. Challenges of hospital accreditation standards were grouped into two groups: standards development process and standards content. Lack of an independent standards development committee, insufficient expertise of committee members, inconsistencies among the standards' constructs, inappropriate standard classification, ambiguity of standards, unmeasurable standards, vague and inflexible scoring system, and inability to use some standards were the main challenges of Iran hospital accreditation standards. Establishing a scientific committee consisting of representative from hospitals, health insurance companies, professional and scientific associations and universities for standard development, training the committee members, and utilizing hospital's feedback will help address these problems. Iran's hospital accreditation standards face challenges that prevent them from achieving their goals, that is, improving the quality, safety, effectiveness and efficiency of hospital services. Necessary measures should be taken to solve these problems.

Divide and conquer: Feasibility and Impact of antimicrobial stewardship in a safety‐net community hospital after a syndrome‐based education initiative for pharmacists

AbstractIntroductionAntimicrobial stewardship programs (ASP) have been shown to reduce antimicrobial utilization (AU) and cost. ASP has been required by the Joint Commission for hospital accreditation since 2017. Community hospitals with limited pharmacy staffing and infectious diseases (ID)‐trained pharmacists may have barriers for implementing and sustaining comprehensive ASP.ObjectivesOur objective was to assess the feasibility and impact of syndrome‐based ASP training on pharmacist knowledge, perceptions, and AU in a community hospital with limited pharmacy staff.MethodsA quasi‐experimental study at a 151‐bed hospital was conducted. Pharmacist training on syndrome‐based guidelines was developed by an ID physician. A qualitative cross‐sectional survey to assess pharmacist knowledge and perceptions of ASP was administered before and 3 months after ASP training. Prospective audit and feedback (PAF) were deployed with responsibilities divided between shifts. The Centers for Disease Control and Prevention (CDC) checklist of core elements was done quarterly for 12 months. AU, Clostridium difficile rates, and cost were compared for 12 months before and after implementation.ResultsMost pharmacists did not feel comfortable managing infections before ASP training. All pharmacists found the guidelines helpful and felt more comfortable managing infections at 3 months. ASP was successfully deployed by dividing tasks between shifts. Days of therapy per 1000 patient days increased from 355.5 to 376. The proportion of parenteral antimicrobials decreased from 71% to 65%.Total antimicrobial expenditures decreased by 23%. C. difficile rates decreased by 21% (3.27 vs 2.56) per 10 000 patient days.ConclusionASP was successfully implemented in a safety‐net community hospital without ID‐trained pharmacists using a syndrome‐based education initiative. This strategy improved pharmacist knowledge and perceptions of ID syndromes and ASP. Dividing tasks between shifts can leverage existing resources to fulfill all core elements. Clear guidelines and access to an ID physician are necessary to develop materials and provide support for pharmacists without ID‐specific training and can help curb costs and optimize AU.

Hospital Accreditation: A Solution for Iranian Challenges or a Challenge for the Hospitals?

As accreditation is of great significance for hospitals, this study aimed to explain the accreditation challenges of Iranian hospitals through a content analysis approach. A qualitative and thematic analysis study was conducted through the content analysis method in 2018. Nineteen semi‐structured interviews were conducted with experts and the data were saturated. To increase the accuracy and precision of the study, Guba and Lincoln's four criteria including credibility, dependability, conformability, and transferability were used. MAX QDA10 was used for data analysis via the five‐step framework analysis approach. The findings identified 5 main themes and 29 subthemes. The main themes included macro and policymaking issues, evaluators' issues, structures, and processes, executive issues, and accreditation measures. All of them contain related subthemes that indicate the national challenges of implementing hospital accreditation in the country. Iranian hospitals need to implement major changes in applying accreditation as a quality assurance mechanism. In other words, it seems necessary for policymakers affiliated with the Ministry of Health and Medical Education to revise accreditation measures according to hospital needs and try to clarify the structure and executive process of the accreditation. Moreover, improving and standardizing the evaluators' skills is recommended.

Advanced Medication Alert System Decreased Hospital-Based Outpatient Duplicated Medications: A Longitudinal Hospital Cohort Study.

This study aimed to examine the associations between adoption of an advanced medication alert system and decreases in hospital-based outpatient duplicated medication rates in Taiwan. The unit of analysis was the hospital. We merged the hospital medication alert system adoption survey data and Taiwan National Health Insurance outpatient claims data. The observation time was 1998 to 2011, divided into 5 periods (T1-T5). The analysis included 216 hospitals, and outcome variable was hospital-based outpatient duplicated medication rates. The system adoption time frame, hospital accreditation level, and number of drugs per prescription were defined as predicted variables. A generalized estimating equation regression model was used. Adoption of the advanced medication alert system gradually increased, such that 100% of medical centers and 84% of regional hospitals, but less than 50% of district hospitals, had systems by T5. The hospital-based outpatient duplicated medication rate continually decreased, from 29.8% to 11.2%. The generalized estimating equation model showed rates of duplicated medications of b = -8.44 at T2 and b = -17.88 at T5 (P < 0.001) compared with T1. Medical centers and regional hospitals demonstrated much lower duplication rates (b = -13.71, b = -6.82; P < 0.001) compared with district hospitals. Hospitals with more medications per prescription had higher duplication rates than did hospitals with fewer items. Hospitals accredited at higher levels tended to have advanced medication alert systems. Hospitals that implemented advanced systems decreased hospital-based outpatient duplicated medications, avoiding a potential risk due to inappropriate medication use.

Postoperative Outcomes of Lung Separation With Double-Lumen Tubes and Bronchial Blockers.

Background The choice between a double-lumen tube (DLT) and a bronchial blocker (BB) for lung isolation remains controversial. The aim of this study was to determine if the features of these lung isolation devices affect postoperative pulmonary outcomes. Methods We retrospectively identified claims by patients who underwent surgery under lung isolation in 2000-2012 in the Taiwan National Health Insurance Research Database. After matching for age, sex, and year of surgery, 1,898 patients were enrolled in a BB group and 5,694 in a DLT group. The risks of readmission in the first postoperative year with pulmonary complications, in-hospital death, and one-year mortality were estimated using conditional logistic regression analysis. Results Patients in the BB group had higher risks of readmission with pulmonary infection (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.22-1.74) or respiratory failure (aOR, 1.38; 95% CI, 1.09-1.76) in the first postoperative year as well as in-hospital death (aOR, 2.03; 95% CI, 1.40-2.94) and one-year mortality (aOR, 1.94; 95% CI, 1.60-2.35) than those in the DLT group after adjustment for the types of the surgeries, hospital accreditation level, underlying comorbidity, and a potentially difficult airway. Patients in the BB group had longer median (interquartile range) stays in the intensive care unit (1 [0-4] vs. 1 [0-3] days, P ＜ 0.001) and in hospital (16 [10-26] vs. 13 [8-22] days, P ＜ 0.001). Conclusion Patients undergoing thoracic surgery are more likely to experience postoperative pulmonary complications if a BB than a DLT is used.

I don't even want to go to the doctor when I get sick now: Healthcare experiences and discrimination reported by people who use drugs, Arizona 2019.

People who use drugs experience severe health inequities created by structural and social barriers related to healthcare access. This includes stigma. To characterize the experience of healthcare access among people who use drugs in Maricopa County, Arizona USA. A 20-item guided survey with quantitative and qualitative items was fielded between October 23-November 5, 2019 among people who use drugs in community locations (public spaces, trap houses, drug copping areas). Surveys were administered face-to-face by community researchers with lived experiences. Survey recruitment included convenience sampling and social referral among respondents. Quantitative items were described and qualitative data were independently coded using an a priori coding scheme including reasons for healthcare seeking and healthcare-related stigma (anticipated, experienced, enacted). Over one-third (39.5%) of the185 person sample did not seek medical care in the past year. Of this group, 34.2% reported that they did not seek needed healthcare because they were afraid of being treated badly by medical providers for using drugs. The three major experiences reported by those seeking healthcare in the past year included 1) medical mistreatment (not addressing the primary medical complaint, providing wrong or inadequate treatment), 2) social mistreatment (disapproval, embarrassment, shaming) and 3) abusive behavior (verbal and physical) by healthcare providers. Efforts should create healthcare social and practice environments that assure appropriate and competent medical care and prohibit healthcare provider mistreatment of people who use drugs. Structural incentives such as healthcare finance, hospital accreditation and medical complaint registration should be considered.

Does implementation of a tailored intervention increase adherence to a National Safety and Quality Standard? A study to improve delirium care.

Delirium is commonly detected in older people after hip fracture. Delirium is considered to be a multifactorial disorder that is often seen post-operatively (incidence ranging from 35% to 65%). Hospitals in Australia are required to meet eight standards including the comprehensive care standard to be able to maintain their accreditation. The standard includes actions related to falls, pressure injuries, nutrition, mental health, cognitive impairment and end-of-life care. Delirium prevention was identified as an area for improvement in our Orthopaedic unit in a Level 1 University Trauma Centre in Australia. This implementation research project aimed to understand the efficacy of a delirium prevention intervention within an existing orthopaedic speciality care system. Implementation of the tailored intervention will increase adherence to National Safety and Quality Health Service Standards, thereby reducing rate of delirium. In this study, we used an interrupted time series design to examine changes in practice over time in people admitted to hospital with a hip fracture. Clinical staff caring for patients with hip fracture in an acute care setting in Adelaide, South Australia, participated in the project. In brief, intervention included education, environmental restructuring, change champions, infographics and audit feedback reports. The primary outcome of interest was rate of delirium. The secondary outcome was compliance with the use of delirium 4AT screening tool, duration of delirium and hospital length of stay. The rate of change per month in patients with delirium decreased significantly by 19.2%. There was no significant change observed in trend for duration of delirium and length of hospital stay between pre-intervention and post-intervention phases. A significant increase in the use of screening tool was observed from 4.7% in the pre-intervention phase to 33.6% in the post-intervention phase. Translation of evidence-based intervention model incorporating well-considered implementation strategies had a mixed impact on decreasing the rate of delirium. The scheduled hospital accreditation enhanced the use of validated screening tool to recognize delirium. This project highlights the importance of aligning implementation goals with the wider goals of the organization as well as making clinicians accountable by consistent auditing.

Exploring the challenges of educational accreditation of teaching hospitals and providing the solutions.

BACKGROUND:In the recent years, the accreditation of educational institutions and hospitals has attracted a lot of attention in different countries to ensure the quality of medical education. In this regard, examining the experiences of different countries will help to improve the world and local standards. This study was an attempt to explore the lived experiences of senior managers about the educational accreditation challenges and appropriate strategies to overcome these challenges.MATERIALS AND METHODS:The authors used a phenomenological approach to explore the lived experiences of the senior managers about educational accreditation of teaching hospitals affiliated to Iran University of Medical Sciences. Semi-structured interviews were conducted to reach data saturation. For this purpose, three semi-structured face-to-face interviews and six electronic interviews were conducted. Data were analyzed using the Colaizzi method.RESULTS:Data analysis showed that the most important challenges of educational accreditation of teaching hospitals were related to standards and criteria, executive policies of accreditation, and educational, attitudinal, and financial infrastructures. The strategies expressed by the participants were categorized into four themes including reviewing and revising standards and criteria, planning for education, providing human and financial resources, and modifying the executive structure of accreditation.CONCLUSIONS:In order to improve the quality of educational accreditation programs, it is necessary to identify and find a solution for the existing challenges by experiential support of the senior managers of teaching hospitals and the other stakeholders (e.g., faculty members and students). It also provides an opportunity for educational policy-makers to improve the hospital's educational accreditation program.

Authentic leadership, nurse satisfaction at work and hospital accreditation: study in a private hospital network.

to identify the dominant dimensions of the authentic leadership of nurses in a private hospital network and to verify the association with job satisfaction and accreditation. cross-sectional, analytical study carried out in 11 hospitals with 282 nurses, of which 94 were leaders and 188 were led. Participants answered the Authentic Leardership Questionnaire and the Job Satisfaction Survey. there was a significant difference between the assessment of leaders and followers in all dimensions of the Authentic Leardership Questionnaire. Regarding the association of authentic leadership and job satisfaction, a significant positive moderate correlation was found among the employees. In hospitals accredited by the Joint Commission International, leaders were perceived as more transparent by their subordinates. there was correlation between authentic leadership and job satisfaction and authentic leadership and the accreditation model among the subordinates.

The relationship between service quality perceptions and the level of hospital accreditation

BackgroundThe quality of health services has long received global attention. Consequently, safe and quality health services in hospitals have become the main hopes and goals of the community, health workers, managers, owners, and regulators. A common external strategy used globally involves recognizing the applied quality management system, specifically certification and accreditation. ObjectiveTherefore, the purpose of this study is to determine the relationship between levels of quality perception and accreditation in hospitals based on several variables. MethodsA total of 13 hospitals were examined in this cross-sectional study, while a questionnaire consisting of 24 validated items was used for data collection. Subsequently, the analysis was performed by utilizing descriptive statistics and chi-square techniques. ResultsFrom the results obtained, the patient assessment, drug use management, patient and family education, infection prevention and control, alongside facility management and safety variables, had a relationship with the level of hospital accreditation, while patient service did not. ConclusionsTherefore, each hospital is expected to improve its service quality and accreditation.

Medical record documentation quality in the hospital accreditation.

BACKGROUND:Medical records constitute a legal and professional document regarding the activities of medical staff in hospitals. This study was conducted with the aim of identifying the factors that affect the quality of medical records by implementing the accreditation models in hospitals.MATERIALS AND METHODS:This was a qualitative study. The data were collected via 28 semi-structured interviews. The research population included administrators and supervisors of nursing, medical records and accreditation in educational hospitals in Ahvaz, southwest Iran. Content analysis method was used to analyze the data. Descriptive statistics were used to present demographic characteristics of interviewees.RESULTS:Facilitators and barriers to improve the quality of documentation were categorized into three levels: organizational, environmental, and personal, all achieved after the implementation of accreditation model in hospitals. Six facilitating factors were identified including organizational structure, organizational culture, management support, individual characteristics, and perceived benefits science and technology. The barriers included five factors including program structure, organizational structure, beliefs, justice, and individual characteristics.CONCLUSIONS:The identification of factors affects the quality of medical record documentation and it seems that health managers and policymakers should take measures to improve the quality of medical recording documentation through strengthening the facilitators and overcoming the barriers in the program since the purpose of accreditation is to improve the quality in hospitals.

Quality improvement programs and the professional nursing practice environment: an integrative review.

to analyze the knowledge produced regarding the practice environment in hospitals with quality improvement programs. integrative literature review performed in the Latin American and Caribbean Literature in Health Sciences databases, US National Library of Medicine/National Institutes of Health, Web of Science, Scopus and CINAHL, consisting in 10 articles. data were presented and discussed using categories: Measures for the professional nursing practice environment; Hospital accreditation as an improvement program; Nursing autonomy, interpersonal relationship between nurse and doctor and the nurse as a manager and leader. it was possible to analyze that the influence of quality improvement programs can be considered as favorable in the professional nursing practice environment. The survey also brings contributions to administration in implementing strategies aiming at continuous improvement in the environment characteristics.

Association and correlation between stress, musculoskeletal pain and resilience in nurses before hospital accreditation maintenance assessment.

Objective:to associate and correlate musculoskeletal pain, stress and resilience of nurses in the maintenance of Hospital Accreditation Certification.Method:longitudinal study in two moments, before and after the Accreditation maintenance visit, March and June 2019, with 53 nurses from a hospital institution. The data collected was: sociodemographic, clinical and occupational variables, stress, osteomuscular pain and resilience. Descriptive variables, Chi-square test, t test, Fisher’s exact test, Pearson’s correlation and Spearman’s correlation coefficient were used.Results:most of the study participants had average stress levels before and after the evaluation. Most of those who reported pain were at medium stress levels at both times. The resilience capacity increased after the evaluation, which demonstrates that the experienced stressors were adequately addressed. There was no significant association between the cortisol levels and the perceived stress.Conclusion:occupational stress and musculoskeletal pain were experienced by nurses during the Accreditation processes. It was evident that individuality permeated the perception of stress and resilience allowed to overcome the tensions experienced. The study identified that there is a need for planning and implementation of actions to collaborate with the nurses in the best confrontation, aiming to promote resilience.

National Accreditation Board for Hospitals and Healthcare Accreditation System for healthcare sector in India

Quality and standards of services in healthcare have become essential for the current generation of healthcare providers and beneficiaries, that is, patients. Healthcare accreditation has become the most important tool for improving the standard of the hospitals and thereafter benchmarking. Most hospitals and healthcare providers are differentiated and evaluated according to their organizational performance and quality. National Accreditation Board for Hospitals and Healthcare Providers (NABH) is an integral board of the Quality Council of India (QCI), which has been established to operate an accreditation program for healthcare organizations/institutions globally. Accreditation is a public recognition awarded to healthcare organizations that fulfill the standards laid by NABH through an independent external assessment, conducted by a qualified team of assessors. In India, healthcare organizations face a lot of burden on the number of patients. However, it is important to have a keen quality and standards of services to such a huge number of patients without compromise. NABH helps with its standards controlling the standard of care and services by the health industry in different areas. There is a constant need that many such organizations are motivated to undergo an accreditation process to have uniformity in the standard of services worldwide as it is a voluntary act in India.

A Mixed-Methods Study to Explore the Impact of Hospital Accreditation.

There are several hospital accreditors globally but there is limited understanding of how accreditation impacts on hospital performance and the health system objectives. The objective of the study were to explore the impact of hospital accreditation and inform policy decision-making. We adopted a mixed-methods approach to include an online survey and 3 focus groups. We report 27 of 36 private hospitals who responded to the survey. Key reasons for accreditation were to improve quality (n = 23), implement evidence-based practice (n = 17), continuity of accreditation (n = 15), and popularity (n = 11). Reported improvements include quality of care (27), patient care (26), organizational processes (21), and patient satisfaction (19) among others. Average stakeholder satisfaction rate was 74%. Participants from the 3 focus group discussions felt that staff hours and stress levels were high during the accreditation process, and some standards were useful while others were deemed non-essential. There was support for a local accreditation body with an emphasis on best practice. The findings from the study suggest accreditation to have an impact on structure and process measures, but the gains in key areas were short-lived. There is a need to strengthen governance and develop performance measures to evidence outcome improvement, assure alignment with regulation and the health system objectives.