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'Recent Australian research suggests the compliance focus of
current accreditation processes distracts from quality improvement.'

'pass-or-fail approach to the standards, hospitals can be tempted to focus on meeting minimum requirements rather than striving for excellence'

I found this interesting:
Denmark recently introduced accreditation and then discontinued it for public hospitals with claims by doctors and nurses that they were ‘drowning in manuals and paperwork and have no time for patients’.

//Sissa

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they are seen as a tick box, rather then a process that is targeted as health services specifically and that looks at the actual quality and safety within a service.

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There are some great summaries here already but I think it is also worth noting that in theories of change, real gains are made when the motivation is intrinsic rather than extrinsic (required by a regulatory process). I feel like there is an opportunity to explore how to achieve a harness a different kind of motivation.
Bec

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Key problems with hospital accreditation in Australia

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Key problems with hospital accreditation in Australia

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Better and more timely data are needed.

More emphasis on improvement  and safety assurance is required.

Cooperation, rather than compliance, should be encouraged.

Indicators should be re-evaluated regularly, in particular by establishing and reassessing links to important patient outcomes and assessing the experience in the best hospitals, which can be used as benchmarks.

Different auditors use different methods: more agreed measures of quality (e.g. complication rates and other clinical outcome indicators) should be used.

Assessors should assess management of actual high-risk situations.

Current standards do not promote excellence. The current pass or fail system pushes hospitals to meet only the minimum requirements.

The accreditation system should assess each aspect of care individually and not the hospital as a whole. This accreditation system is considered archaic.

Accreditation reports should be made public for all hospitals.

Consumers should be engaged in the assessment process.

The one-size fits all approach should be changed with a new approach based on measurable outcomes tailored to each hospital needs.

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There are many faults with accreditation including the hospital being able to "cram" for an audit. Accreditation without notice would allow the true picture to emerge. Perhaps this is why notice is given.......
Every significant safety failure in Australia over recent decades has occurred at a hospital which passed accreditation with flying colours.

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I agree with the critiques already mentioned.
Lack of transparency to the public (and staff - which can end in the "why bother" attitude), no incentive to improve, time consuming, patient outcomes arent affected.
The last one at our hospital, the accreditation process focused on "passing" accreditation in the now and not how to maintain "the improvements" into the future

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Duckett and Jorn highlight that passing accreditation does not guarantee patient safety citing  “Practically every significant safety failure in Australia in recent decades … has occurred in a hospital which had passed accreditation with flying colours” (pp 26.).

Key problems identified in this article are:

·         Accreditation may not improve patient outcomes

·         The standards hospitals are assessed against lack a strong evidence base

·         Different auditors use different methods

o   I have witnessed this and find it very frustrating

·         Doctors are sceptical

o   Completely agree – it is very difficult to get buy in from the medical officers, as stated in this article – they don’t feel accountable to accreditation bodies.

·         Safety is not tested, and patient outcomes are not systematically measured

·         There are no incentives for excellence

o   I note that the NSQHS have a process now for acknowledging ‘exemplar practice’

·         Accreditation of hospitals overlooks big differences within each hospital

o   This was an issue with our previous accreditation where one department did not demonstrate compliance against one action (I think it was related to sterile stock storage) but the entire facility was required to review practices/processes instead of just focusing on the one department who were in fact non-compliant with the already robust system that was in place

·         Accreditation reports are not made public

o   As the authors have highlighted, transparency of this information is part of the principles of safety and quality

- Ashleigh McHugh

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- Standards lack a strong evidence base
- Auditors have different ways of auditing (inconsistency)
- No incentive to do better than the minimum
- Lack of transparency (results aren't made public)

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Key problems with hospital accreditation 

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Key problems with hospital accreditation 

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1. Costly
2. Time consuming
3. Often limited transparency of findings, outcomes and delay in recommendations passed on from executives to clinicians.

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Lack of transparency in regards to outcomes of accreditation.
Lack of confidence in the value of the accreditation process by doctors.
Failure to effectively assess performance at a granular level within a particular organisation.
Inaccurate assessment due to efforts to improve compliance during the assessment period.
No incentives to perform above the level of minimum standards.