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So much time is spent sugar coating things for accreditation that it undermines the purpose for accreditation. There is no accountability at all other times and the results from the report aren't released to the public, nor are they 'fixed'
Pop up accreditation which focuses on how to make things safer would be far more effective

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One of the problem with the accreditation is that it is not maintained by the participating institutions. Often they become complacent after the accreditation. There is no transparency in some institutions with what is really happening within the organisation and seem to cover up.

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Something that stood out for me in this article was in the conclusion "Spending money on treating complications without the effort to systematically work to reduce their incidence is simply wasteful".

I feel that throughout my career and experience through various health organisations this continues to be an issue.

We are identifying the issues, we are completing IIMS and riskman reports on incidents, "near misses" and serious and harmful events however we never see improvements or actions being taken to prevent these yet money is spent having to correct (if possible) the incident that has occurred.

A elderly but independent patient may be admitted for chest pain, the idea is to stay for 48hrs for monitoring, this patient has a fall overnight and ends up with a fractured neck of femur, requires surgery, analgesia, physio therapy, OT and rehab before discharging home. This 2 day admission becomes a 4-6 week admission and a huge financial burden to the health organisation.

If there was more focus on preventing these commonly see incidents there would be an extraordinary amount of money saved on treating the complications.

In times of accreditation, we find we almost pretend that we are coping in our clinical area by making remarkable improvements in the week of accreditation however they are passing us and not seeing the bigger picture and therefore we get no funding and are left to continually struggle day-to-day.

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I agree that outcomes, particularly when combined as the suggested 3 prong approach of clinical measure, patient and staff feedback would provide a holistic approach. However how do we know what 'systems' have assisted in organisations that perform well against those that are not performing so well? This may well be the way of the future but i cannot see how we can expect organisation's to grow without a descriptive framework on how systems should be structured....at least as a minimum.

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If accreditation would not be announced it would be more effective. If it also involved everyone including patients exclusively organisations would always be striving  to keep the standards at the top. Some organisations tend to relax after accreditation hence the culture of safety is kind of fragmented i.e for show and normal businnes where for show would be safe and quality standards while any other day would be laid back.   

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If accreditation would not be announced it would be more effective. If it also involved everyone including patients exclusively organisations would always be striving  to keep the standards at the top. Some organisations tend to relax after accreditation hence the culture of safety is kind of fragmented i.e for show and normal businnes where for show would be safe and quality standards while any other day would be laid back.   

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The process is intermittent and does not improve patient safety.  It focuses mangers attention on a narrow range of issues which does not have a continuous effect, it gives no incentives for safety and improvement.

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- transparency before, during and after the process. Many staff are unaware of what needs to be done prior and what if they have failed to meet a standard needs to be done. Also transparency for staff to see what upper exec are doing about accreditation rather than feeling like the floor staff will be blamed for "poor performance" during the process.
- medical buy in and a multidisciplinary approach to ongoing QI
- complicated funding situations and financial penalties within hospitals following accreditation
- an attributable improvement in safety for patients

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Hospitals should develop business cases for safety improvement, with government assistance.

States should give hospitals and the public information on the cost of and revenue from complications

Financial incentives should be tailored and hospital specific.

Safety tests performed without notice.

Focus should shift from compliance to outcomes and improvements.

Reports should be published.

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The many issues with the accreditation process

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The many issues with the accreditation process

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- Firstly, it is not implemented throughout the year, rather it is implemented at one point which means it becomes a burden
- The standards that are set out are a one size fits all approach between different hospitals/ units rather than being structures to suit that particular unit
- It focuses on staff improvement at times, rather than patient safety
- There is little focus on quality improvement and mostly on blame culture
- There is little incentive or chance for medical staff to be directly involved in the process, which I feel may potentially reduce the level of accountability for the individuals contributing in overall improvement in the hospital performance
- The public (and medical staff) have little to no insight into the outcomes from the accreditation process and as such, leaves little idea about how the hospital is performing and how better to improve it

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The problem is there is no accountability to the clinical setting once the recommendations have been made. There is no follow up to make sure that clinical improvement recommendations have been followed through.

It would make sense if accreditation was undertaken randomly and not on a set date well in advance, this gives the clinic plenty of time to put procedures into place that may not have already been there because they are scared of failing accreditation, whereas the fear of a 'surprise visit' ensures the clinical setting is always of a high standard.
The accreditation process focuses more on failures than achievements, it points the finger at what is wrong and does not give credit where it is due. In this instance, clinicians are scared to answer questions truthfully because they think they might be getting their workplace into trouble, they should be made to feel supported.

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Accreditation treats the hospital system as a whole. Regional, rural and tertiary metro systems are often different in infrastructure but are accredited in the same manner. This doesn't take into account the differences, and should be tailored according to hospital type. The narrow approach can be extended to include the cost of adverse advents instead of concentrating solely on sentinel events, thus encouraging overall patient safety.
Results are not publicised other than a hospital proudly displaying its' status as Accredited. This needs to include transparency of WHAT accreditation means for public information.

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Critiques of accreditation-	Lack of transparent disclosure of the accreditation outcome.-	One size fitting all-	Doesn’t look at Patient as an individual.-	Lack of incentive for the outstanding performance-	More focus in compliance out come than continuous improvement.

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Critiques of accreditation-	Lack of transparent disclosure of the accreditation outcome.-	One size fitting all-	Doesn’t look at Patient as an individual.-	Lack of incentive for the outstanding performance-	More focus in compliance out come than continuous improvement.

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-as opposed to spontaneous accreditation, planned accreditation can result in periods of abnormal care.
- variances in auditors, methods, hospitals and wards.
-  there is no incentives to strive for excellence with a pass or fail model
- healthcare is continuously changing and therefore clinical indicators assessed should continuously change as well
- no public accreditation reports available for providers or consumers

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Team members are not actively involved as they do not understand how the accreditation process works, what  are the standards, what is the focus of the organisation.

Many organisation just perform well during accreditation/review period of time

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If the safety of a hospital or their accreditation report is made public, will this result in hospital shopping by consumers? Particularly for services such as obstetrics, orthopedics etc. Will we find patients looking to go somewhere safer for the assumed better care? And what is the flow on effect of this? Do the rich get richer?

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Problems with accreditation in Australia

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Problems with accreditation in Australia

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It has shown that it does not improve patient outcomes (many SAC1 events occurring in hospitals that have passed accreditation with flying colours), No transparency for public- often results are kept secret, No incentive for excellence, A one size fits all approach which doesnt take into account operational methods and designs of each hospital, Drs find it irrelevant, Based on compliance not improvement.

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passing accreditation does not equal improved patient outcomes
lack of transparency-  reports from accreditation sometimes not made available to staff and consumers
the infrequent planned visits by accreditors- facilities are made aware the dates that they will be getting assessed which doesn't give accreditors an accurate picture of what happens on a day to day basis

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Accreditation can be negative, when it should be embraced.

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Accreditation can be negative, when it should be embraced.

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AS mentioned in the Gratton 2018 report errors cost money. Publishing each hospital's accreditation status and report is actually a brilliant idea.

Financial punishment does not hurt those who might commit errors and cause harms. However, can further harm morale and patient safety.
As it notes, hospitals that rushed around to meet accreditation then slacked off and stopped their safety and quality improvements. They caused serious harm. It is still happening in hospitals recently.

I believe the cause is the anxious build up to the event instead of an attitude of continual improvement, personal responsibility and ownership of one's own actions; Top down accreditation flurry reeks of daily laissez-faire leadership where staff are unsupported, not heard, complaints fall on deaf ears.

Incentives on safer, innovative ways to care for patients is more likely to move healthcare forward. Clinicians should be supported, and encouraged. Team strategy meetings and statistics of patient waiting lists can encourage brainstorming.

I am not opposed to the idea of spontaneous accreditation because we should be fostering a culture of continual improvement, striving to maintain good standards, review unsafe practices, hear our critics and appraisers of our safety measures, seeking to improve the quality of our systems, improve the staff with education, (not just to meet mandatory requirements but for their careers, interests, visions and scope).

If we build up our staff and listen to what they see, if we listen to our patients and their families and communicate out intentions, we will be patient-centred anyway.

This idea of no-blame is a very good way of getting people to truthfully report errors. Blame and financial punishments make hospitals less likely to report safety issues, creating a culture of ‘sweeping under the table’

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- The current system does not focus on patient outcomes.
- Clinicians have a negative view towards accreditation because it is generally problems-based rather than improvement-based, with no incentives for well performing services.
- Hospitals are informed of when the accreditation is happening, and therefore "prepare" for it, instead of the standard being encouraged and enforced all the time.
– accreditation results are not published
- trainees may be training in underperforming services, therefore learning poor delivery of care

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*The system is not transparent enough and confusing for hospital management .

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*The system is not transparent enough and confusing for hospital management .

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*Accreditation does not improve patient outcomes.
* The focus should shift from compliance to outcomes and improvement  which engages with hospitals to help them with their own improvement measures.
* The accreditation report should be published as the data should be used to improve safety and quality

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The major problem I can see is that we are not an all "one size fits all" (hospitals). We would benefit from improving safe quality care according to the facility you work in, instead of meeting the recommended standards. There is not public access to the results. It is costly to have accreditation performed and accessed. It causes stress  and false information as the staff try to gather and correct documentation, cleaning standards, storage standards, audits.
Staff are also disengaged in the process due to the stress it causes.
Organisations vary immensely within NSW health in particular.

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Problems with accreditation in Australia

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Problems with accreditation in Australia

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In the article by Duckett & Jorm the key issues identified with accreditation in Australia were
Hospital accreditation does not improve patient outcomes
Doctors dismiss it as irrelevant or a waste of time
It provides no incentives for excellent safety performance
Accreditation reports are kept secret

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-        Hospitals can improve or raise standards prior to accreditation assessment.
-        Should be outcomes and improvement focused based on complications rather than compliance.
- Do not focus on assessing management of real life high risk situations, more how would you handle this situation approach
-  Validity and reliability of assessors can vary, can be reduced with standard outcome measures eg complication rates
-  Currently focus is on assessing the organisation as a whole not each individual area- Performance can vary between units or specific areas and limits the validity of results.

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There are no incentives for excellence. Accreditation is based on a pass/fail mark and there is no clear indication of what is considered and excellent pass mark and hospitals are not being rewarded for excellent work and are punished if they fail.

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Identify key problems with hospital accreditation in Australia. Duckett & Jorm (2018) concluded that the hospital accreditation does not improve patient health outcomes; doctors dismiss it as irrelevant, or worse, a waste of their time; it provides no incentives for excellent safety performance; and accreditation reports have not been published for public to review. The authors also demonstrated that big incident happened in specific hospital however still able to pass the accreditation.  

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Identify key problems with hospital accreditation in Australia. Duckett & Jorm (2018) concluded that the hospital accreditation does not improve patient health outcomes; doctors dismiss it as irrelevant, or worse, a waste of their time; it provides no incentives for excellent safety performance; and accreditation reports have not been published for public to review. The authors also demonstrated that big incident happened in specific hospital however still able to pass the accreditation.  

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Problems with hospital accreditation in Australia

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Problems with hospital accreditation in Australia

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- not all hospitals make their accreditation reports public, this should be available to the public so they are able to make informed care about the health services they choose to use
-one size does not fit all - the accreditation procedure should be tailored to fit each hospital and what areas they need to focus on mostly