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As Nurses we are all familiar with some form of accreditation that is relevant to our healthcare workplace. Many discussions have been held over time regarding the true effectiveness of the accreditation system. ”Accreditation in healthcare has existed for over 100 years (Brubakk et al, 2015) and has been widely adopted as an essential part of healthcare systems in more than 70 countries,including Australia (Greenfield et al, 2013).The core function of healthcare accreditation is assurance that a level of compliance to minimum standards is achieved . Accreditation is an assessment of performance against standards at a given point in time. It provides a snapshot of performance against standards.” We understand that the maintenance and ongoing continuous improvement rests with the individual organisation/ facility/ service and its staff.
“In Australia, hospital accreditation costs around 0.1% of the acute public hospital budget (Mumford et al, 2015) and whilst there are limited comparators, a study in Ireland suggests accreditation costs 0.29% of a hospital’s budget (Doyle et al, 2008). The cost for hospitals is greater in those years when inspections take place and in relative terms is more expensive for smaller facilities. This compares with an estimated 1.1% of total administration costs for general practice in Australia (Mumford et al, 2013).”
Many discussions have been held with Nurses who express concern that additional resources are allocated in the lead up to a successful accreditation review and then post review, a range of resources are withdrawn or reduced. The Deeble Institute for Health Policy Research has produced a thought provoking report, that I’m confident will spark additional discussion amongst staff who work in healthcare in Australia and who, to date, have had varying opinions in regards to the real sustained effectiveness of the current accreditation systems in achieving the core objectives.,
The following content is taken form the report and the report is enclosed below for your additional interest.
- “Current literature is unable to consistently assess the effectiveness of accreditation (Brubakk et al, 2015), with some commentators arguing that inconsistent and unconvincing evidence fails to demonstrate the value of accreditation to the Australian health system (Duckett et al, 2018).
- The role of accreditation may well not be easily related to patient satisfaction as it impacts on healthcare in a way which is not clear for consumers to recognise (Hinchcliff et al, 2012).Variation in public and indeed staff perception also varies by region
- Despite a lack of clarity around the costs and benefits associated with accreditation (WHO,2003) and with some researchers questioning if the investment in accreditation delivers sufficient outcomes (Øvretveit, 2000), the uptake of accreditation continues globally. Ambiguity in the value accreditation brings to healthcare (Brubakk et al, 2015) and escalating costs across Australian healthcare (AIHW, 2018) mean that understanding the value accreditation adds to healthcare remains important for policy makers given the scale and cost involved (Scmaltz et al, 2011).
- Studies in Australia and the USA demonstrate a positive association between accredited facilities and several indicators of quality such as adherence to guidelines and protocols (Braithwaite et al, 2010; Schmaltz, 2011). Infection control performance is also positively associated with accredited facilities (Sekimoto et al, 2008; Mumford et al, 2015). Other indicators of quality such as good leadership and organisational culture also show a positive association with accredited facilities in Australia (Braithwaite et al, 2010).
- Further challenges exist for healthcare accreditation with commentary suggesting that the process has ‘failed’ (Duckett et al, 2018). This is attributed to variation in complication rates in Australian hospitals and high profile examples of safety failures in healthcare resulting in multiple patient deaths at accredited hospitals such as those seen at Bundaberg (Queensland Health, 2005), Campbelltown (NSW Department of Health, 2004),Bacchus Marsh (Victorian Department of Health, 2016) and Bankstown-Lidcombe (NSW Health, 2016).
- In Australia, as with many countries covered by the existing literature, all health care facilities are required to be accredited. This prevents appropriate control comparisons between accredited and non-accredited facilities and as such the literature relies heavily on observational studies; typically cross-sectional in nature. This limits conclusive statements regarding the effectiveness of accreditation.
- Overall staff were supportive of the accreditation process and feel it supports patient safety although there were consistent concerns across professional groups in relation to the perceived
additional work and costs involved”
“It has been suggested that measuring value in healthcare should incorporate the following: NSW Health has adopted the ‘Healthcare Triple Aim’ framework to measure value in healthcare.
The three components of the healthcare triple aim are:
•Improving the patient experience of care (including quality and satisfaction)
•Improving the health of populations
•Reducing the per capita cost of health care
In recognition of the role workforce can play in enhancing or impeding the triple aim, it has been suggested that to truly deliver the best value a ‘Quadruple Healthcare Aim’ should be embraced.”
You can access the report below. What do you think? In your experience have accreditation programs improved the quality of care and service delivered to our healthcare recipients?
The Nursing CPD Institute provides great information and CPD on an array of nursing topics in a range of easy learning ways including webinars and quizzes on the latest information that Nurses need to know – remember it was created by Australian Nurses for Nurses! https://www.ncpdi.com.au