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Key issues with current hospital accrediation.

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Key issues with current hospital accrediation.

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1.     Compliance focus over quality improvement.

2.     Inconsistencies in auditor methods.

3.     Lack of valid and reliable measures.

4.     The medical profession is sceptical and does not believe that the accreditation process has any meaningful impact on the quality of health care.

5.     Limited assessment of safety and patient outcomes.

6.     Lack of incentives for excellence.

7.     Overlooking differences within clinical units in the same hospital.

8.     Lack of public reporting

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Problems include that the standards that are use lack evidence and patient outcomes may not be improved by the current process of accreditation. 

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Problems include that the standards that are use lack evidence and patient outcomes may not be improved by the current process of accreditation. 

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Accreditation is planned and therefore a facility can push to make last minute positive changes that should have occured earlier.

Different auditors using different methods.

Lack of evidence suggesting benefits of audits

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Problems with current accreditation process:

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Problems with current accreditation process:

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• Accreditation may not improve patient outcomes -- Focus on compliance rather than improvement

• The standards hospitals are assessed against lack a strong evidence base --Standards should be linked to improved patient outcomes -indicators should be regularly re-evaluated. ‘retain, revise, replace, or retire.’

• Different auditors use different methods ---Validity and reliability in question

• Doctors are sceptical-- Cost of bureaucracy

• Safety is not tested and patient outcomes are not systematically measured

• There are no incentives for excellence --Focus on meeting minimum requirements “pass or fail” rather than striving for excellence

• Accreditation overlooks big difference within each hospital-- Each unit is different

• Accreditation reports are not made public--Open disclosure

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Making a 'one box fits all' model - may be different for different facilities

Limited comparisons with other facilities

The 8 standards do not cover all areas of healthcare

Accreditations reports are not public

Facilities can pass accreditation and yet have massive breaches of patient safety

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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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In recent decades, Australian hospitals that experienced the most significant safety failures were found to have easily passed accreditation. There are myriad key problems with hospital accreditation in Australia, to name a few:

Limited evidence suggesting accreditation leads to improved patient outcomes or enhanced quality and safety of patient care

Accreditation standards in place may not be sufficiently proportionate to address the extent of the issues identified in patient care

Doubts re: validity/reliability of surveyor-based assessments, as different surveyors offer varying opinions

Safety & patient outcomes are not systematically measured, accreditors rely on perceived rather than observed aspects of work

Hospitals may prioritise meeting minimum requirements rather than ‘striving for excellence’ as accreditation follows a ‘pass-or-fail approach’

Accrediting hospitals as a whole is outdated and fails to consider the performance variations among individual wards

Accreditation reports are not publicly disclosed

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Hospital accreditation schemes costs money and resources - in terms of direct outlays on fees and preparation time, and time spent by managers and clinicians preparing for accreditation which would be better spent on other quality improvement activities.

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Conflict of interest for the accrediting bodies - they exist because organisations pay them to provide a service. If the organisation does not get what they want/pay for (accreditation) there is potential to take their business elsewhere.

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A fee accreditation critiques that stood out to me was that the accreditation process was scheduled and therefore hospitals can prepare for assessment rather than allowing the inspectors to assess the hospital in an everyday manner. To an extend this is true, but the hospital is a very busy environment, you cannot expect everything to run smoothly and have the support of the team if they are busy with patients providing care.

By also suggesting the accreditation process be customised to each hospital rather than a one size fits all would not work well in the long run since no two days are the same therefore you would need to constantly change the plan for that hospital. Timely and impractical.

Personally, I think if you were to collate a thorough inspection it would need to be over a few days to accurately see the difference in situations and how that hospital handles those situations.

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There were many criticisms of the current accreditation system, all pointing to the current system is focussed on compliance to process and procedure rather than focussed on local or hospital tailored patient outcomes and improvement, evidenced by the fact that major incidents leading to poor patient outcomes have occurred at fully accredited hospitals.

A couple of issues identified:

1.The actual standards were considered not reflective of outcome data - not adaptive to contemporary problems.

2.Whole of hospital accreditation is not able to drill down on individual specialty areas, medical colleges, when sending trainees look at whole hospital accreditation, where there is not guarantee that the specialty within that accredited hospital is performing well.

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-Preparation for accreditation is timely and unable to be completed during patient care. There is no budget for after hours preparation.

-Collecting manual documentation over 2 years proved challenging and in some cases was not reviewed at time of inspection.

-Patient outcomes did not appear to be prioritised.

-The process of Accreditation lacks motivation & doesn't appear to be incentive based.

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The hospital accreditation process in Australia is not linked to high standards of care and outcomes for patients. There are no incentives for excellence and no comparisons with other hospitals

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1.	Identify key problems with hospital accreditation in Australia. - Two that stood out

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1.	Identify key problems with hospital accreditation in Australia. - Two that stood out

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Focus on compliance over continuous improvement: "tick-box" mentality where organisations focus on meeting minimum requirements rather than proactively seeking ways to improve care.

Limited assessment of safety and quality outcomes: relying heavily on document reviews and site visits, which may not always capture the full picture of how safety and quality are actually delivered in practice. This can overlook important aspects like staff attitudes, teamwork, and patient experiences.

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1. Accreditation may not improve patient outcomes

2. The standards hospitals are assessed against lack a strong evidence base

3. Different auditors use different methods

4. Safety is not tested, and patient outcomes are not systematically measured

5. There are no incentives for excellence

6. Reviews consistently demonstrate doctors’ skepticism about accreditation systems

7. Accreditation of hospitals overlooks big differences within each hospital

8. Accreditation reports are not made public

9. Medical staff are not engaged in the process.

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just a couple:

1. current accreditation model alienates staff

2. the model doesn't triangulate evidence - based too much on personal observation and documentation

3. not continuous improvement based

4. doesn't improve patient outcomes