Health Technology Assessment in Action

Editorial for the Special Issue on “The Role of Accreditation in Improving Healthcare Systems Performance”

2024-09-14T10:24:38+0430

The World Health Organization’s annual report in 2000 sparked a global trend of assessing and improving healthcare performance indicators. These performance indicators provide tangible measures of the performance of health systems and healthcare institutions. Ranking countries based on these indicators has been a smart and strategic decision to focus the attention of health managers and policymakers on improving them. These performance indicators include quality, safety, equity, public health coverage, service continuity, comprehensiveness, accessibility, and etc. These indicators’ positive trajectory demonstrates the gradual attainment of the health system’s mission and objectives. An often-seen strategic error in health system administration, particularly in developing nations, is the excessive allocation of funds to physical infrastructure and the acquisition of costly equipment. This expense diminishes the resources that could be allocated to performance indicators improvement.

Patient Safety Culture in a Tertiary Referral Hospital: Evidence from a Main Criterion in Accreditation

2024-09-10T07:26:21+0430

Objectives: In Iran’s accreditation program, the patient safety dimension is one of the main dimensions, holding the highest weight among the accreditation criteria. The purpose of this study was to identify the patient safety culture (PSC) in a tertiary referral hospital.
Methods: The current study was conducted between March and April 2021 in a tertiary hospital in Iran. The sample size was 628 participants, selected through simple random sampling. The hospital survey on patient safety culture (HSOPSC) was used to assess provider and staff perceptions about patient safety issues, medical errors, and event reporting. The survey included 32 items that measure 10 dimensions of PSC. Normality tests, along with non-parametric Mann-Whitney and Kruskal-Wallis tests, were used to examine the relationship between PSC and demographic variables using SPSS 22 software.
Results: Based on current findings, among the 10 dimensions of PSC, teamwork and organizational learning-continuous improvement received the highest scores (83% positive response), which were higher than these variables in the Agency for Healthcare Research and Quality (AHRQ) data. Conversely, staffing and work pace, as well as hospital management support for patient safety, received the lowest positive scores (43% and 55% positive response, respectively), which were lower than these variables in the AHRQ data. There was a significant positive relationship between dimensions of PSC and older age, female gender, staff with longer working experience, and longer work hours per week (P < 0.05).
Conclusions: The majority of our participants felt that patient safety needs to be enhanced. Based on the findings of this study, it is recommended to emphasize the dimensions of “staffing and work pace” and “hospital management support for patient safety” more in the accreditation criteria to strengthen these dimensions in hospitals. Additionally, we have introduced a comprehensive guide for using an international tool to measure PSC, which hospitals can use to succeed in annual accreditation.

Stakeholder Perspectives and Experiences of Implementation of Accreditation and the ISO 9001 Programs in Hospitals of Iran: A Qualitative Study

2024-09-10T07:26:23+0430

Background: Accreditation and ISO 9001 programs in hospitals are widely adopted for quality control and quality improvement in healthcare.
Objectives: The objective of this study is to identify stakeholders’ perspectives and experiences regarding the implementation of accreditation and ISO 9001 programs in hospitals affiliated with the Social Security Organization in Alborz Province, Iran.
Methods: In this qualitative study, participants were selected based on purposive sampling. For data collection, semi-structured one-to-one interviews were conducted with hospital staff in different positions (n = 30). All interviews were digitally recorded, transcribed verbatim, and analyzed using thematic analysis.
Results:Based on the analysis, 10 primary themes and 88 subthemes were identified. The 10 primary themes were categorized as experiences, strengths, weaknesses, effective factors, and recommendations for the implementation of accreditation and ISO 9001 programs in hospitals. Proper planning, benchmarking, physician involvement, increased resources, and more training are suggested for the successful implementation of accreditation in hospitals. Additionally, fostering a positive culture, focusing on the executive dimension, changing managerial attitudes, training, and supporting and motivating staff are the most important recommendations for the implementation of the ISO 9001 program.
Conclusions: The results provide important insights into the dimensions of implementing accreditation and ISO programs in hospitals, which can be used by health policymakers and managers to improve the implementation of these programs in Iranian hospitals.

Effect of Feedback Provision on Improving Patient Safety Indices Based on Hospital Accreditation Model: A Study in Shahid Rahnemoon Hospital, Yazd

2024-09-14T10:25:10+0430

Background: Accreditation means systematic evaluation of health service centers with specific standards. One of the most important goals of the accreditation process is to improve patient safety. Patient safety visits are one of the most important standards for improving safety. One of the ways to increase the effectiveness of visits is holding feedback sessions.
Objectives: The present study was conducted with the aim of assessing the effect of feedback provision on improving patient safety indices based on the hospital accreditation model in Shahid Rahnemoon Hospital, Yazd.
Methods: The present study is a semi-experimental study with a before-and-after design that was conducted in Shahid Rahnemoon Hospital, Yazd, from September to December 2021 and January to August 2022. After each visit, formal feedback sessions were held with the attendance of patient safety team members and officials of the visited wards/units. Evaluation indicators included patient safety indicators in accreditation standards, such as error reporting, rate of unwanted events, and patient safety culture score. These were measured before and after feedback. The tools used were the patient safety standards evaluation checklist based on the accreditation model, the patient safety culture questionnaire, and other indicators extracted using documentation. The Patient Safety Culture Evaluation Questionnaire was completed by 360 nurses working in the hospital in the form of a census. Analysis was done using descriptive statistical tests and paired t-tests with STATA 14.2 software.
Results: Based on the results of the study, safety feedback was provided to increase patient safety indicators in different departments and units of hospitals [t = - 4.8652, w/df = 10, P = 0.0007, (P = 0.05)]. A significant difference was observed in the amount of error reporting (P = 0.031) and patient safety (P < 0.001) before and after the intervention. The degree of compliance with the dimensions of the patient safety culture had a statistically significant difference before and after the intervention (P < 0.001). Conclusions: Providing a safety feedback program had a significant positive effect on the cons umption and consequences of the patient’s safety culture. Therefore, conducting regular safety visits and setting up a direct feedback program to each department/unit after the visit, and the follow-up of corrective measures, will lead to an increase in patient safety standards.

How Iran’s Hospital Accreditation Program Meets the International Society for Quality in Health Care(ISQua)

2024-09-10T07:26:24+0430

Background: Hospital health service quality is a fundamental component of the health system. Hospital accreditation is a key approach to enhancing this quality, necessitating the correct implementation of processes.
Objectives: This study aims to investigate the compliance of the executive processes of Iran’s hospital accreditation program with the requirements of the International Society for Quality in Health Care and to provide corrective solutions.
Methods: This qualitative study uses an inductive content analysis technique. A checklist with seven axes was established by extracting and interpreting the requirements of the executive processes from the International Society for Quality in Health Care. By examining existing documents at the Ministry of Health’s Accreditation Office and conducting interviews with managers and experts in the field, challenges in the domain of the executive processes of Iran’s hospital accreditation program were identified using the relevant checklist. Corrective solutions were then gathered through semi-structured interviews with 19 experts, managers, and accreditation field specialists, categorized inductively, and presented using MAXQDA software.
Results: Challenges in seven areas were identified, including governance; strategic, operational and financial management; risk management; human resources management; information management; survey and client management; and the granting of accreditation approval. Subsequently, solutions were categorized into five groups encompassing 26 concepts, focusing on reforming macro policies, addressing implementation challenges, fostering appropriate interactions, improving human resource management, and promoting evidence-based decision-making.
Conclusions: The Iran hospital accreditation program’s adherence to International Society for Quality in Health Care standards is inadequate. Establishing a semi-autonomous, non-profit accreditation body that operates under government control and ensuring the independence of the accreditation office is essential for achieving higher compliance and receiving certification from International Society for Quality in Health Care.

Advocating for Equity Inclusion in the Health Accreditation Plan of the Iranian Health System

2024-09-10T07:26:21+0430

Over the past three decades, healthcare organizations have prioritized enhancing patient care quality (1). The Institute of Medicine (IoM) has highlighted that most medical errors stem from flawed systems and processes rather than individual actions (2). Consequently, initiatives to improve processes and safety in healthcare have explored various quality improvement (QI) methodologies, including healthcare accreditation programs (1). Accreditation is a systematic process that evaluates a healthcare organization’s compliance against pre-defined peer review standards, which are structural, procedural, and outcomeoriented (3). Assessments are undertaken by various governmental or non-governmental entities, using different modalities in voluntary or mandatory approaches. The scope of accreditation may encompass the entire health organization, individual hospitals, health facilities, only a specialty, or even a sub-specialty (4). Accreditation standards cover diverse domains including clinical governance and patient-centeredness, with the consequences of failing to meet these standards variable across different health system contexts (5). First proposed and implemented by the American College of Surgeons in 1917, accreditation has since undergone numerous transformations and adaptations.