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While there are set standards set by ACSQHC, how accrediting bodies and assessors interpret these varies. This has been seen with a policy (for example) not fully implemented across the wider organisation, but only one facility had this marked as met with recommendation.
The absence of accountability and incentive for excellence is also concerning. Healthcare facilities must meet the standards, but there's no recognition, change to funding, or significant change if they are exceeded.
The current approach of reviewing evidence is also concerning. While seeing great policies or ways of working, assessment leaves little time to see how this is truly embedded into clinical operations and ultimately to what patients receive outside accreditation.

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auditing conducted by appointment, for the purpose of shining brightly for a brief period is counterproductive to quality and safety in health. This process masks the true problems at the core of AEs. Unplanned visits, targetted at identifying methods for improvement sounds like a much more productive way of increasing safety and quality in health. However, my concern is that in the publishing of audit results, we may very well find ourselves in a scandal quite reminiscent of the 'my schools' saga experienced by NSW dept. Ed.

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auditing conducted by appointment, for the purpose of shining brightly for a brief period is counterproductive to quality and safety in health. This process masks the true problems at the core of AEs. Unplanned visits, targetted at identifying methods for improvement sounds like a much more productive way of increasing safety and quality in health. However, my concern is that in the publishing of audit results, we may very well find ourselves in a scandal quite reminiscent of the 'my schools' saga experienced by NSW dept. Ed.

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Healthcare facilities tend to "look good" for the day and return back to their old self after the accreditaion.

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Healthcare facilities tend to "look good" for the day and return back to their old self after the accreditaion.

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There is no transparency and we do need to move from accreditation being an event to something that resembles continuous improvement

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I believe the audits and accreditation reports and findings should be made public as this adds a level of scrutiny from the public and they can raise their concerns with LHD or the local member of parliament. There should be some financial incentive for higher levels of compliance rather than the current system. The introduction of snap audits from Jun 2023 will assist in gaining a better understanding a view on normal operating standards at the facility. The COVID 19 pandemic and issues with nursing homes in Victoria highlighted some significant failings in our system and how some of the most vulnerable were effected.

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Currently, trainee clinicians are not prevented from training in underperforming units. This means that they may not be learning best practice, and may be replicating substandard approaches into their future practice.

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Currently, trainee clinicians are not prevented from training in underperforming units. This means that they may not be learning best practice, and may be replicating substandard approaches into their future practice.

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One of the key challenges with the current accreditation process is that it focuses on 'work as imagined' rather than the reality of care provided. While it is important to assess that the policies and processes are in place, there needs to be a better way of assessing if these processes are followed, and, more importantly, if they achieve the goal of safer care

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There are no incentives for excellence. As long as the organisation meets the standards, it will be accredited, regardless of whether it has gone above and beyond the standard.

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There are no incentives for excellence. As long as the organisation meets the standards, it will be accredited, regardless of whether it has gone above and beyond the standard.

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Reports for accreditation not available to the public

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Reports for accreditation not available to the public

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Not having results of accreditation available to the public gives the idea that there is something to hide and does not allow consumers to be involved with the process.

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Different accreditors access differently based on their own opinions.
No transparency between the assessments results.

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There is a focus on ‘assurance’ and not ‘improvement’.
Health care facilities who required large safety overhauls, passed accreditation. Therefor, what is the process displaying?
The accreditation process does not exhibit normal day-to-day activities in the clinical space.
Auditors assess using different methods.
Lack on intrinsic drive in healthcare facilities.
Healthcare areas are made of different professionals delivering treatment, diagnosis, support, preventition. The health service is audited on how these areas meet the standards and not the patients goal. As some area may be more relevant than others.

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The idea of changing the perspective to improving safety is very positive.
Getting clinician buy in would make the process much more ongoing and relevant to care provided to patients.
Making accreditation public would change the focus and help to address the public’s concerns.

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'One size fits all' which means no consideration or flexibility for context and organisational needs and functions

Lack of evidence that enforced 'standards' = better quality care and outcomes

The false economy of prioritizing accreditation over the business of caring for patients

No transparency as to outcomes of the process or clear justification as to how recommendations will add benefit to services.

The outcomes can depend on who does the accreditation, that in itself is the opposite of standardisation.

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At present-minimum standards blanket pass for Accreditation, rather than striving for excellence. 

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At present-minimum standards blanket pass for Accreditation, rather than striving for excellence. 

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Currently, the accreditation processes are  centred around staff compliance. Whereas, it should be centred upon outcomes and improvements. That is, assisting hospitals in personal improvement projects as well as analysing complication occurrences individual to each workplace. This will enable specified measures to improve patient outcomes.

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Different people understand things different ways. How one accreditor views things is not necessarily how the next accreditor will. We all view things in our own unique way, which can be a good thing but when pt's safety is the concern it isn't always a great thing.

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The main finding I noticed in the paper is that although hospitals pass accreditation with flying colours we see that some of the greatest patient outcome incidents occurred in those hospitals (the same can also be said for aged care accreditation). One size doesn't fit and the focus on compliance alone is not the long term answer for patient outcomes.

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Accreditation reports are not made public

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Accreditation reports are not made public

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This means that the system cannot be transparent. In addition to reports being made public, they should be presented in a manner that is appropriate for the health literacy of the community that the service serves (David Sutton)

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The accreditation itself results in a period of "abnormal care". 

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The accreditation itself results in a period of "abnormal care". 

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The abnormal care being of improved quality and with notably better outcomes and eventually this reverts back to the pre-accreditation level of cares. The only beneficiary of accreditation might be those patients who happened to receive care during this time. The process is inherently flawed if improved outcomes are not sustained.

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- Accreditation seems to be objective and each facility must fit specific criteria however an aspect of each facility must be subjective due to the differences between each facility
- There is no patient involvement in accreditation from my experience (quality is subjective)
- Accreditation should occur over a longer period of time. I understand it is time consuming and demands the use of resources however to gain a better understanding of the organisation and produce accurate recommendations, this may be more beneficial
- In my experience, each facility would be given a date and time for accreditation and this has recently changed to a more random approach

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Couple of observations that I found interesting:

1. The risk of complications in one specialty is only weakly associated with the risk of complications in another specialty at the same hospital. Should accreditation be specialty specific??

2. Sentinel events in Au hospitals are random - and not linked with accreditation status. I do believe accreditation is a positive thing, but is it really serving it's ultimate purpose? I'm looking forward to seeing how accreditation evolves over the next 10 to 20 years ...

(Marisa Skrzypek)

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Accreditation results are either not made public or are difficult to find.

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Accreditation results are either not made public or are difficult to find.

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Now that the results are made public and the books are out there for all to see, it is in the organisations' best interest to be on their best behaviour at all times in order to keep up their reputation. Shirley

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Hospital accreditation is not looking at the patient's outcome but more looking into the process of care. This may not reflect the quality of care that patients receive in the hospital.
As the accreditation report is not available to the public it is not easy for patients to make their choices of healthcare.

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*"One size fits all" approach is redundant, needs to consider the individual context of the org.
*Looks at the organisation as a "whole"- there are likely variations across the organisation and more should be done to recognise and assess clinical units.
*No consumer engagement or focus on patient centrered care or outcomes

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Auditors use different methods and can have different opinions which means outcomes can vary