Health care accreditation surveyor styles typology

PURPOSE: This paper aims to investigate how health care accreditation surveyors enact their role with a view to identifying a surveyor styles typology. DESIGN/METHODOLOGY/APPROACH: This study was conducted in two phases. First, observational research was used to examine the conduct of a small survey team during the 2005 accreditation survey of a rural health service in Australia. The survey team was from the Australian Council on Healthcare Standards (ACHS), the major health care accreditation agency in Australia. Second, the emerging typology was reviewed by an expert panel of ACHS surveyors. FINDINGS: A typology comprising three unique surveyor styles is identified--interrogator; explorer; and discusser. Additionally, a further style, the questioner, is hypothesised. RESEARCH LIMITATION/IMPLICATIONS: The typology has application for development by accreditation agencies to be used with surveyors as a self-reflection tool to improve learning and development. The knowledge gained about surveyors' styles can be used to match more effectively survey teams to organisations seeking accreditation. Further research is necessary to confirm these styles and examine whether other styles are apparent. ORIGINALITY/VALUE: This study is an important step in examining the conduct of surveyors and opening up health care accreditation surveyor inter-rater reliability for further investigation.     

Comparison of health care professionals' self-assessments of standards of care and patients' opinions on the care they received in hospital: observational study

Objectives: To compare the views of healthcare professionals and patients regarding compliance with standards of care concerning patient information.

Design: Self-rated questionnaire survey.

Setting: Nine wards in short stay French hospitals.

Participants: 939 patients and 359 healthcare professionals (physicians, nurses, assistants and other professionals).

Main outcome measure: Patients' and healthcare professionals' views of compliance with 20 standards of patient care described in the French accreditation manual. Comparison of the rank order of the standards within the two samples.

Results: The response rate was 61.5% in the patient group and 85.8% in the healthcare professionals. The rank orders for the 20 items were similar in both groups (Spearman rank order correlation 0.6, p = 0.004). The two items ranked highest by healthcare professionals ("consent request for a surgical procedure" and "the doctors ask the visitors to leave the room before examining a patient") were also the two ranked highest by the patients. Three items were ranked low by both groups: "consent request for students to be present", "health education given to patients", and "possibility to express satisfaction during discharge". Patients were more satisfied with their pain management than were healthcare providers. Professionals were more satisfied with the social services than the patients.

Conclusion: There are both similarities and differences between patients' and healthcare professionals' views of care. Accurate assessments of quality performed during the accreditation procedure require that both patients' and professionals' views be taken into account.

     

Computer assisted instruction in the continuing education of health professionals.

The rapid increase in new knowledge in health care has resulted in the implementation of continuing education requirements for many health professions. Computer assisted instruction (CAI) is one means by which continuing education opportunities can be provided for health professionals. Three main classes of reasons for using CAI are enumerated and explored. The current status of the use of CAI in the continuing education of health professionals is explored. The four major problems facing the further development and expansion of CAI in the continuing education of health professionals are identified as: (1) developing learning materials, (2) proliferation of software and hardware, (3) cost and (4) accreditation of CAI programs. Possible solutions to these problems are explored.     

The attitude of health care professionals towards accreditation: A systematic review of the literature

Accreditation is usually a voluntary program, in which authorized external peer reviewers evaluate the compliance of a health care organization with pre-established performance standards. The aim of this study was to systematically review the literature of the attitude of health care professionals towards professional accreditation. A systematic search of four databases including Medline, Embase, Healthstar, and Cinhal presented seventeen studies that had evaluated the attitudes of health care professionals towards accreditation. Health care professionals had a skeptical attitude towards accreditation. Owners of hospitals indicated that accreditation had the potential of being used as a marketing tool. Health care professionals viewed accreditation programs as bureaucratic and demanding. There was consistent concern, especially in developing countries, about the cost of accreditation programs and their impact on the quality of health care services.     

Designing education to improve care

BACKGROUND: Educators in all health care disciplines are increasingly aware of the importance and value of teaching improvement as an integral part of health professional development. Although faculty and learners can often identify needed changes in the clinical setting, many educators are not sure how to teach the improvement principles and methods needed to achieve and sustain those changes. DEFINING AND DEVELOPING COMPETENCY IN QI: Five developmental levels apply to physicians, nurses, and other members of an interprofessional quality improvement (QI) team: novice, advanced beginner, competent, proficient, and expert. For example, the expert develops a vast repertoire of skills and a capacity for situational discrimination, performs tasks on a more intuitive level, and recognizes and immediately addresses essential problems. Improvement is an action, and learning about improvement must be action based. Certain skills and knowledge are required at each stage in this learning process so that students in the health professions achieve competence in QI before entering practice. GENERAL PRINCIPLES FOR EDUCATIONAL EXPERIENCES IN HEALTH CARE IMPROVEMENT: Four principles, which apply at any developmental level, can help answer educators' questions about where to start: (1) The Learning Experience Should Be a Combination of Didactic and Project-Based Work; (2) Link with Health System Improvement Efforts; (3) Assess Education Outcomes; and (4) Role Model QI in Educational Processes. CONCLUSION: As educators teach future health professionals about improving care, the dissemination of exemplary models and emerging best practices will be increasingly important. Sustainability of improvements in patient outcomes will be dependent on both the value systems and skills of health professionals entering practice.     

Culturalizing the ethnic patient: educational films and images of interethnic relations in health care

In the wake of an apparent increased utilization of health services by people from ethnic minorities and the perceptions of this as problematic, an educational 'offensive' has been launched in The Netherlands. It is directed at ethnic minority groups and health care professionals, and makes extensive use of educational films. In this article, we discuss results of a qualitative analysis of the ways in which educational films represent interethnic relations in health care, and compare them with the outcomes of an earlier analysis of educational films on discrimination and racism. Instead of a tendency to moralize ethnic attitudes of whites in the latter, we found that films on health care presuppose a professional will to learn and to adapt, but at the same time they emphasize the obstacles posed by ethnic backgrounds. In such films, the traditional culture, rather than institutional constraints, figures as the main reason for the setbacks the ethnic patient experiences and for the problems professionals face in order to accommodate the new situation. Educational films on ethnic minorities and health (care) could be improved by analysing problems rather than focusing on ready-made solutions, and by paying attention to institutional constraints rather than showing a seemingly boundless flexibility of medical professionals in their interaction with ethnic minorities.     

How quality improvement programs can affect general hospital performance

PURPOSE: Given the enormous size of the health care industry, the problem of developing high-quality, cost-effective health care delivery systems is growing in importance. There is general consensus that health care systems require a continuous process of quality improvement (QI). Less agreement, however, surrounds the mechanisms to be implemented so that such a process is effective. This study aims to bring empirical evidence to support the hypothesis that a QI program in a general hospital - a special context of the health care delivery system - does not necessarily lead to better overall organizational performance results. DESIGN/METHODOLOGY/APPROACH: The study was done at the hospital level, and included all acute care hospitals in Israel. Data was collected in 16 of the country's 23 hospitals, a 70 percent response rate. The study compared hospital performance before and after the QI program implementation. FINDINGS: The study shows that QI creates meaningful improvement events. In addition, the research supports the hypothesis that increasing the number of QI activities (items) included in the QI program brings about more improvement events. The results do not support the hypothesis that high, rather than low, intensive implementation of QI activities leads to more improvement events. ORIGINALITY/VALUE: The special context of general hospitals decreases the effects of a QI program on overall hospital performance, whereas QI activities function as triggers in initiating improvement events.     

Environmental health and safety concerns in the health care setting

Increasing attention to the physical, chemical, and biological aspects of the health care environment is evidenced by the actions of consumer groups, as well as state and federal regulatory bodies, and private accreditation and insurance agencies. This paper reviews the major areas of environmental concern within the health care industry and encourages active participation by environmental health professionals in evaluating environmental risk and impacting positive change.     

Domestic violence as a women's health issue--activities of health professionals in Thailand

OBJECTIVES: This paper reports the results of a qualitative study on domestic violence (DV) and interventions against DV in Khon Kaen province in northeastern Thailand. We analyzed the roles of health professionals for identifying, treating and supporting abused women, and examined a network model of DV interventions in developing countries. METHODS: We interviewed abused women, health professionals, staff of the government and legal authorities, community health workers and other relevant people in Khon Kaen city and surrounding areas. We analyzed the health consequences of DV, and the roles of health professionals and other actors regarding care and assistance for abused women. We also visited and observed homes of the victims and health facilities where those women were treated. RESULTS AND DISCUSSION: We interviewed 4 abused women in a slum area. One of the women was identified by a nurse of a nearby health center and a social worker when they visited homes in the area. Another woman was successfully supported by nurses of the health center, a community leader and a Buddhist monk. Health professionals played important roles in identifying, treating and protecting abused women. The Khon Kaen provincial hospital established an One-Stop Crisis Center (OSCC) to provide counseling, care and protection for physically or sexually abused women, with a team consisting of doctors, nurses and social workers who were trained in the care of abused women. The Nampol community hospital in a suburban area also established an OSCC to work together with health centers and communities for effective intervention. OSCC team members pointed out several problems: insufficient mental care, shortage of staff, and the difficulty of caring for women coming to the hospital at night or early in the morning. In Thailand, a legal framework against DV has yet to be established and government agencies are not greatly involved in DV interventions. Health professionals play leading roles in identifying, treating and supporting abused women in Thailand. It is important to provide relevant training for health professionals and to develop cooperation networks with government staff and legal authorities, community health workers, and community leaders. Legal frameworks for protecting and supporting DV victims are often insufficient in developing countries, while health care systems tend to be more reliable. Taking into account the social background, health professionals in developing countries can be expected to continue to play the most important role in looking after abused women.     

Health staff perception regarding quality of delivered information to inpatients.

BACKGROUND: Accreditation usually requires that healthcare staff assess the quality of care delivered to patients in their own hospitals. It is unknown whether this assessment depends on the workplace rather than on the professional category of health personnel. OBJECTIVE: We aimed to identify major determinants of the perception of various categories of healthcare professionals concerning the quality of delivered information to inpatients in their ward, with a perspective to help the development of recommendations on how to compose self-assessment teams for the accreditation process. METHOD: A self-administered questionnaire survey was conducted in nine wards from five short-stay hospitals in Paris, France. Three hundred and fifteen healthcare professionals (physicians, nurses and nursing assistants) were included. The views of various categories of healthcare professionals regarding the compliance with a set of quality standards were compared by nonparametric statistical analyses. Determinants of the self-assessment of quality of care, including ward effect, were identified by fitting the data to a hierarchical model. RESULTS: The participation rate was 86%, with 272 respondents (58 physicians, 149 nurses and 65 nursing assistants). Overall perceptions of various categories of healthcare professionals were not different. The final hierarchical model showed a strong ward effect (intracluster correlation coefficient=0.06, P<0.01) and a significant relationship between age of professionals and their opinion about quality of care. CONCLUSION: We observed a ward cluster effect on healthcare staff perception of quality, but the category of healthcare professional was not a determinant. A satisfactory representativeness on age of professionals selected into the teams in charge of self-assessment during hospital accreditation is recommended.     

Involving consumers in accreditation: the Irish experience.

BACKGROUND: Following the 2004 review of the Acute Care Accreditation Scheme, the Irish Health Services Accreditation Board (IHSAB) decided to increase the level of consumer involvement in the accreditation process by including consumers as members of the review teams assessing healthcare organizations. Such consumers were known as service user (SU) surveyors where SUs were defined as any person who has used the Irish health system, i.e. a patient or relative/carer, etc. OBJECTIVE: Consumer surveyors first participated in surveys in 2005 and a total of seven surveys took place that year. An evaluation of the role and participation of the consumer surveyor was conducted in 2006. METHODS: All stakeholder groups were consulted, i.e. consumer and peer review surveyors, applicant organizations and IHSAB staff, and a combination of qualitative and quantitative techniques was used. RESULTS: Stakeholders considered that consumer involvement introduced greater objectivity and credibility. Characteristics such as good communication and interpersonal skills, excellent powers of observation and objectivity were identified as important traits for consumer surveyors. There were some issues in relation to the clarity and consistency of their role in terms of the rating of criteria and their contribution to the accreditation report. There was support among the stakeholder groups for greater consumer involvement in the process by participating in additional tours and interviews. CONCLUSION: The evaluation highlights that the introduction of consumer surveyors has been successful but illustrates that their role and level of involvement in the process may need to be re-examined.     

A survey on the current status of health care marketing

This article presents the results of a survey, conducted by Market-PULSE Measurement Systems, reflecting the growth of health care marketing and the marketing perspectives of health care professionals. The survey results echo the opinions of two groups of professionals: chief executive officers of hospitals over 100 beds; and administrators as well as directors of marketing, planning, and public relations who attended a recent health services marketing conference. The survey, a telephone interview, was conducted to determine: The degree to which hospitals are market oriented. The degree to which hospitals use survey research. The following is an analysis of what the surveyors found.     

医院评审潜在风险及控制策略

加强医院评审潜在风险识别能力,并制定相应的控制措施,也是保证本轮医院评审工作健康、有序开展的一项重要课题。提出了当前医院评审工作中5种潜在风险：一是虚假信息导致评审误判;二是评审人员人身伤害的风险;三是廉政风险;四是评审后医院发生重大安全生产事故或消防事件,导致评审结果的公信力下降：五是数据外泄的风险。并针对潜在风险提出了6条控制策略：一是宣传评审理念和政策,引导医院正确对待医院评审;二是为评审人员购买相关保险;三是加强评审纪律的督察,建立评审员的考核和退出机制;四是加强评审员评审能力的培训,提高发现问题和隐患的能力;五是规范评审数据的流转工作流程;六是完善数据上报平台,实现数据实时传输与共享等。     

Leveraging quality improvement to achieve equity in health care

INEQUALITY IN QUALITY: Disparities in health care and quality for racial, ethnic, linguistic, and other disadvantaged groups are widespread and persistent. Health care organizations are engaged in efforts to improve quality in general but often make little attempt to address disparities. STANDARD VERSUS CULTURALLY COMPETENT QUALITY IMPROVEMENT (QI): Most QI interventions are broadly targeted to the general population-a "one-size-fits-all" approach. These standard QI efforts may preferentially improve quality for more advantaged patients and maintain or even worsen existing disparities. Culturally competent QI interventions place specific emphasis on addressing the unique needs of minority groups and the root causes of disparities. HOW QI CAN REDUCE DISPARITIES: QI interventions can reduce disparities in at least three ways: (1) In some cases, standard QI interventions can improve quality more for those with the lowest quality, but this is unreliable; (2) group-targeted QI interventions can reduce disparities by preferentially targeting disparity groups; and (3) culturally competent QI interventions, by tailoring care to cultural and linguistic barriers that cause disparities, can improve care for everyone but especially for disparity groups. GUIDELINES FOR CULTURALLY COMPETENT QI: A culturally competent approach to QI should (1) identify disparities and use disparities data to guide and monitor interventions, (2) address barriers unique to specific disparity groups, and (3) address barriers common to many disparity group. CONCLUSIONS: To achieve equity in health care, hospitals and other health care organizations should move toward culturally competent QI and disparities-targeted QI interventions to achieve equity in health care, a key pillar of quality.     

Improving the skills of health professionals in engaging patients in diabetes-related problem solving

INTRODUCTION: Despite instruction, many patients do not employ diabetes-related self-management skills recommended by health professionals. One problem suggested by research is that many health professionals do not often use teaching and counseling skills widely considered to be effective. Among these are specific skills that help health professionals conduct adherence-related assessments, brainstorm workable solutions to obstacles, collaborate during long-term follow-up, and provide effective direct instruction. METHODS: "Effective Patient Teaching and Problem Solving" was developed and taught in a block of 24 hours over 3 days to groups of health professionals. Course content emphasized 13 operationally defined skills in four major categories: (A) assessment, (B) brainstorming, (C) collaboration, and (D) direct instruction skills. To evaluate participants' (n = 33) use of the various skills, a standardized patient teaching exercise was videotaped at both the beginning and end of the course. RESULTS: Total mean scores increased significantly (t = 7.7, p < .001) from 1.8 to 2.5 on a scale that ranged from 1 to 5. Skills improved in all four major categories (p < .003). The length of teaching sessions did not change, lasting 13.2 minutes before the course and 13.6 minutes after the intervention. DISCUSSION: Health professionals play a crucial role in patient education but rarely receive training in effective teaching and counseling techniques. The "Effective Patient Teaching and Problem Solving" course improved several kinds of important skills. As standards of diabetes care for improved glycemic control become more widespread, and as health providers attempt not just to teach but also to help patients overcome considerable obstacles to consistent diabetes self-management, a premium will be placed on the ability of health professionals to counsel efficiently and effectively.     

Investment in quality improvement: how to maximize the return

Today, one of the most pressing concerns of health‐care policymakers in industrialized countries are deficits in the quality of health care. This paper presents a decision program that addresses the question in which disease areas and at what intensity to invest in quality improvement (QI) in order to maximize population health. The decision program considers both a budget constraint as well as time constraints of educators and health professionals to participate in educational activities. The calculations of the model are based on a single assumption which is that more intense quality efforts lead to larger QIs, but with diminishing returns. This assumption has been validated by previous studies. All other relationships described by the model are deduced from this assumption. The model uses data from QI trials published in the literature. Thus, it is able to assess how the vast number of published QI strategies compare in terms of their value. Copyright © 2009 John Wiley & Sons, Ltd.     

Quality improvement implementation and hospital performance on quality indicators

OBJECTIVE: To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality. DATA SOURCES: Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance. STUDY DESIGN: Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. DATA COLLECTION/ABSTRACTION METHODS: Two-stage instrumental variables estimation in which predicted values (instruments) of four QI scope variables and control (exogenous) variables used to estimate hospital-level quality indicators. PRINCIPAL FINDINGS: Involvement by multiple hospital units in QI effort is associated with worse values on hospital-level quality indicators. Percentage of hospital staff and percentage of senior managers participating in formally organized QI teams are associated with better values on quality indicators. Percentage of physicians participating in QI teams is not associated with better values on the hospital-level quality indicators studied. CONCLUSIONS: Results supported the proposition that the scope of QI implementation in hospitals is significantly associated with hospital-level quality indicators. However, the direction of the association varied across different measures of QI implementation scope.     

医院评审员培养模式的探索与实践

探索建立具有我国特色的医院评审员培养模式是新一轮医院评审工作的重点。在借鉴国外评审员培养方式,总结既往评审检查经验的基础上,卫生部医院评审评价项目办逐步摸索出了“1＋1＋2＋E”的医院评审员培养模式,并在医院评审实践中取得了较好的效果。