Accreditation

Citation

Hurst, K. (2010), "Accreditation", International Journal of Health Care Quality Assurance, Vol. 23 No. 1. https://doi.org/10.1108/ijhcqa.2010.06223aaa.001

Accreditation

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 23, Issue 1

Health service quality management, accreditation and related matters feature strongly in this issue. For example, gate keeping and commissioning hospital care are among the most important roles that primary care staff perform. Consequently, primary care service evaluation is gaining ground on inpatient services owing to commissioning and budgetary implications. Adrian Edwards and colleagues, therefore, report an interesting and impressive primary care accreditation study – the Maturity Matrix project, which involves external facilitators and organisational standards-based self-assessment. There are useful outcomes and spin-offs – not least international primary care benchmarking opportunities. The authors raise interesting and important points. First, travel and migration mean that European patients moving around Europe are likely to expect the same care standards in every European Community (EC) country; indeed EC accession may demand it. Second, the authors briefly examine top-down vs bottom-up service improvement in an accreditation context. Their literature review is helpful and their arguments for adopting a bottom-up approach are strong. Their European project, 153 general practices in five countries, is a collaboration lesson for all managers and practitioners thinking about embarking on similar journeys. They show how language subtleties, organisation structures and processes influence a quality management project’s success. Nevertheless, they conclude that the Maturity Matrix is a feasible, robust and an informative quality improvement approach.

Accreditation also features strongly in Sangom Kanitvittaya and colleagues’ article. Laboratory services and accreditation, which have a significant effect on health service quality, is interesting and relatively straightforward owing to the services’ tangible and self-contained nature (compared to say the more diffuse medical or nursing services). The authors describe a region-wide, voluntary, laboratory QA project and they provide clear and logical laboratory QA frameworks and specifications that readers can adopt. Their large-scale, region-wide project involves establishing network, education and training, peer review and benchmarking systems. The project team were fortunate to obtain funding, allowing them to plan and implement a substantial and successful programme. Although recruiting laboratory staff to the accreditation project was not hard, motivating them to persevere was challenging. The project had mixed results but there were spin-offs, on which other laboratory staff can capitalise.

We recently published a patient safety special issue (IJHCQA, 20, 7) owing to the manager and practitioner interest and the topic’s importance. Understandably, this prompted several follow-up articles, which add new insights. In this issue, Stephen Walston and colleagues follow-up their earlier article (20, 7) by publishing results from an extensive middle-east hospital patient safety survey. They explore public and private Saudi Arabian hospital safety cultures by exposing their survey findings to higher-level statistical analysis. Saudi Arabian ministers are investing heavily in the country’s health service – especially quality assurance policy and practice, so their article is important groundwork and is valuable for many reasons. First, it explores patient safety theory and practice in detail. The authors define patient safety climates (not the easiest notion to digest) and the components likely to drive it. Second, they surveyed a unique workforce – the Saudi health system relies heavily on expatriate workers, who tend to be transient and bring unusual issues to quality assurance research and development. Third, their factor and regression analyses condense numerous data into three manageable patient safety climate variables. Interesting and important differences between Saudi private and public hospitals emerge; notably and interestingly that the private sector seems to perform less well.

Anastasius Moumtzoglou also undertook a large-scale patient safety-related study by surveying hospital doctor perceptions. As we see from Stephen Walston et al’s work in this issue, clinical incidents are relatively common. Dr Moumtzoglou explains that clinical error underreporting may be more significant than we realise, which is a pity because learning from clinical mistakes is a powerful quality improvement technique. Although anecdotal, the literature is clear on what causes underreporting: reprisal fears, potential law suits, damaged reputations and blame cultures. Solutions are more complex, so what better way to clarify policy and practice than by surveying coalface workers? Consequently, the author surveyed 350 medical practitioners, but response rates were poor (the underlying reasons are worth reading). Data were exposed to high-level statistics including factor analysis, which confirm that blame cultures remain at the heart of failure-to-report clinical problems, which double-underlines an urgency to strengthen clinical error reporting policy and practice.

Medical records are such a commonplace, everyday hospital feature that they may be taken for granted. However, their compilation, storage and access have many financial and patient safety implications that deserve quality assurance managers’ attention. Cem Canel and colleagues, therefore, take a look at an organisation where medical record structures and processes were inefficient and ineffective, which threatened the hospital’s financial and accreditation status. They studied medical record processes using flow charting and statistical process control. Even though their analysis clarified problems at specific medical record process stages, staff – notably hospital hierarchies and employee resistance - hindered improvement strategies. Nevertheless, important inefficiencies were removed.

The old and very old populations are growing and reasonably well understood worldwide. The Lebanese elderly population is expected to reach 10 percent by 2025. Unsurprisingly, therefore, articles focussing on care home resident quality of life (QoL) are growing. In this issue, Ramzi Nasser and Jacqueline Doumit describe a thorough and comprehensive elderly QoL study. They remind us that Lebanese families are increasingly less nuclear and care home demand is rising. Lebanon offers comprehensive elderly care services consisting of private, public and charity providers, and there are countrywide efforts to monitor and improve elderly care services including elderly wellbeing and QoL. Almost everyone agrees what constitutes elderly resident wellbeing but there is little consensus on what needs to be measured. Consequently, they employ an impressive range of mental, physical and social indicators and measures – the latter are well described and their psychometric properties are carefully explained. Findings show that the Lebanese elderly are well served but there are welfare system anomalies that seem to penalise the elderly. There are moderate levels of able elderly who are well cared for in Lebanese care homes but service improvements are needed. Service quality ranges widely and the authors noted that worrying proportions of elderly care home residents were depressed. Dementia also is an issue. These are important points but the novel issues arising from the study include the somewhat bizarre relationships between “custodial care”, staffing and elderly residents’ independence and freedom. That is, larger, well-staffed units seem to constrain the elderly by curtailing their independence and freedom.

Finally, in this issue, Sameer Kumar, a regular IJHCQA contributor, introduces us to a relatively new and what seems an important health service topic – focused factories. In essence, he looks at general versus specialist hospital efficiency and effectiveness. He reminds us about rising hospital costs, which are eye wateringly high and how inefficient general hospitals can be – a 68 percent occupancy rate, for example. Unsurprisingly, therefore, there are sustained efforts in the US to reduce healthcare costs by improving hospital efficiency and effectiveness. Focused factories or to give them a more meaningful healthcare phrase – specialist hospitals – concentrate on fewer procedures but high volumes. The argument is that expert, specialised practitioners lead to fewer complications. The downside is that specialist hospital staff cherry pick, avoid emergency care patients unlikely to have health insurance, chronic disease management and risk lowering staff job satisfaction owing to repetitive and unchallenging work. Such competition may unfairly disadvantage general hospitals. Nevertheless, evidence consistently favours specialist hospitals from a cost and mortality standpoint. Sameer’s analytical techniques are thorough, well described and his recommendations, aimed at hospital managers, have merit. As the advertisers say, this’s one to watch.

Healthcare workforce planning and development (WP&D) does not get the research, development and publishing attention it deserves especially considering that staffing is any health service’s greatest expensive and that staff number and mix significantly influence health service outputs and outcomes. In practice, however, most WP&D articles are published in health and social care management journals, which means that quality issues are opaque or absent although there’s been several article linking staffing with service processes and outcomes such as “failure to rescue”. It may be that more WP&D-oriented publications need to go in quality management journals not least because recent UK healthcare inquiries such as the Healthcare Commission England’s Mid-Staffordshire hospitals’ damning service quality review linked understaffing with poor patient care. In this issue, therefore, we are pleased to publish an article by Judy Curson and colleagues, which provides who-does-workforce-planning-well overviews. Although the commonly used WP&D definition is twee – getting the right people in the right place at the right time at the right price – it works. An alternative representation is the ‘WP&D scales’ that represent balancing workforce demand (top-down and bottom-up methods) and supply (recruitment and retention). The scales also provide a framework for implementing healthcare WP&D policies and procedures. However, in England there are 1.3 million NHS employees so it’s not hard to imagine what time, effort and money are needed for successful WP&D including balancing the scales and integrating WP&D structures, processes, outputs and outcomes into health and social care, education, etc., which require knowledge and skills. The authors’ systematic review clearly underlines healthcare WP&D theoretical and practical gaps, and what additional work is needed to support healthcare managers and practitioners wanting to explore health service efficiency, effectiveness in a workforce planning development context.

Keith HurstLeeds University, Leeds, UK