Summary - What is the impact of accreditation recommendations on healthcare organisations A pilot study of accreditation data - march 2013

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• Publié par: haute-autorite-sante
• Publié le: 01 mars 2013
• Nombre de lectures: 9
• Licence : En savoir +
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• Langue: English
• Poids de l'ouvrage: 1 Mo

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Division for the improvement of quality and safety of care
What is the impact of accreditation
recommendations on healthcare
organisations?
A pilot study of accreditation data
Summaryor several years, the Haute Autorité de Santé has under- these systems. This study highlights the role of HAS reserva-
taken to strengthen the evaluation of the impact of its tions and recommendations as a lever for improvement. The Fprograms, in order to meet two objectives that are also study shows that the majority of changes needed are only
implemented progressively because they concern the prac-two commitments to HAS stakeholders:
tices of all professionals. These changes may be delayed by ● Give a fully transparent account of the results obtained;
problems involving barriers to adaptation within the health-
● Inform the debate on the development of systems
care system. Through the continuity provided by its follow-up
implemented by HAS and enable these systems to system and its gradual increases in requirements, accredita-
become more effective in improving patient care. tion helps healthcare organisations to engage in and maintain
improvement initiatives.
The accreditation of healthcare organisations, which has been
an established part of the healthcare landscape for more than This impact study has led to the following actions by HAS:
12 years, is particularly concerned by these requirements. ● Continuity of approach will be one of the features of the
next version of accreditation. The aim is to ensure that The study presented here plays an important role in the quest
systems are in place to prevent or correct any steps
to understand the effects of accreditation and its limitations,
backward in key areas of risk management.which requires a diverse range of approaches and a combi-
nation of different types of study. ● Provisions will be made for monitoring the impact of
accreditation recommendations. This monitoring will
HAS set out to analyse the data gathered at national level
enable HAS, healthcare organisations and users to note
during accreditation procedures. By processing these data in
the positive developments related to accreditation, and
a pilot study, questions can be asked about the effectiveness
also to more easily identify barriers to improvement in
of accreditation recommendations, and the progress made healthcare organisations.
by healthcare organisations between cycles of accreditation
can be analysed.
Accreditation has had the great merit of encouraging health-
Jean-Luc HAROUSSEAU Jean-Paul GUÉRINcare organisations to implement systems for managing the
President of the HAS Pr esident of the Committee
quality and safety of care. As a result of accreditation, organi- Board for the Accreditation of
sations have taken it to the next level in terms of developing Healthcare Organisations
Summary
Since its implementation in France 12 years ago, accreditation has resulted in several thousand recommenda-
tions and reservations for healthcare organisations. Almost 18,000 recommendations (guidelines or reservations)
were issued during the second cycle of accreditation (2005-2010).
What is the outcome of these recommendations and reservations once they have been issued? Do healthcare
organisations take them on board? Are they implemented and do they lead to improvements in organisational mana-
gement and patient care?
The study presented here in summary form tackles the issue of the effects of accreditation recommendations, using
data from accreditation visits.
This study aims to follow up the outcome of 4,109 reservations and recommendations issued during the “V2” cycle of
accreditation to the frst 612 organisations to have undergone “V2010”.
Quantitative and qualitative analysis of these decisions, from their formulation until their follow-up evaluation four years
later at recent V2010 accreditation visits, demonstrates that:
● Reservations and recommendations create a positive pressure on healthcare organisations, and act as a lever for
improvement;
● From one version to the next, changes in the accreditation standard and assessment methods have made accredi-
tation increasingly demanding;
● In some felds (such as medication management), the improvements sought by recommendations and reserva -
tions imply a substantial overhaul of the organisation. Examination of organisations’ fles shows how the follow-up
process and the progressive increase in the level required for accreditation can support this lengthy undertaking;
● Certain barriers may limit the impact of reservations and recommendations such as structural issues, limited
resources, and the slow nature of changes in professional practice and organisational culture.
2 | What is the impact of accreditation recommendations on healthcare organisations? • Summary Î Introduction
To meet the challenges of regulating the quality and safety of
care in healthcare organisations, many countries have set up In recent years, many countries accreditation and external evaluation systems for healthcare
organisations, inspired by Canadian or American models. In have started to ask legitimate recent years, healthcare providers in many countries have
started to ask legitimate questions about the effectiveness of
questions about the efectiveness the mechanisms of external evaluation, and a feld of applied
research has gradually developed in response to these ques-
of the mechanisms of external tions, despite the methodological challenges of evaluating
this type of intervention.
evaluation.
An investigation of the impact of accreditation/certifcation
concerns the entire accreditation system, and includes the
question of how effectively the recommendations made
during the process are implemented: are these decisions
acted upon within the organisation? Are improvement initia- of recommendations and reservations issued during accredi-
tives put into place and do they have the desired results? tation between the V2 cycle of accreditation, now completed,
and the V2010 cycle that is currently under way, and thus to The study presented here in summary form tackles the issue
of the effects of accreditation recommendations, using data answer the question: what are the outcomes of recommen-
from French accreditation. It aims to follow up the outcomes dations made during the accreditation procedure?
What is the accreditation of healthcare organisations?
The accre organisations, implemented by HAS, aims to ensure continuous improve-
ment in the quality and safety of care in healthcare organisations.
The accreditation of healthcare organisations was established in France by the decree of 24 April 1996
(article L. 6113-3 of the Code of Public Health). It is compulsory for all public and private healthcare organi-
sations. It engages each healthcare organisation in a process of improvement, including internal assessment
and an independent external evaluation of quality in the organisation.
Transparency is intrinsic to the process, with accreditation reports published so that the public and stake-
holders can be informed.
1. http://www.jointcommission.org/accreditation/accreditation_main.aspx, http://www.accreditation.ca/en/default.aspx.
2. Braithwaite et al.: Strengthening organizational performance through accreditation research-a framework for twelve interrelated studies: the ACCREDIT project study
protocol. BMC Research Notes 2011 4:390; Analysis of the literature on the impact of accreditation procedures on healthcare organisations. http://www.has-sante.fr/portail/
jcms/c_1021625/rapport-matrix-analyse-de-la-litterature-sur-l-impact-des-demarches-de-certifcation-des-etablissements-de-sante .
3. Berwick D. The science of improvement. JAMA 2008; 299(10): 1182-4.Ovretveit J, Gustafson D. Evaluation of quality improvement programmes. Qual Saf Health Care
2002; 11(3): 270-5. http://www.has-sante.fr/portail/upload/docs/application/pdf/2011-02/impact_synthese_es.pdf.
4. Paradoxically, despite its importance, this more specifc question about the impact of recommendations is rarely tackled in studies of the impact of accreditation/certifca -
tion. Abdelmoumène N, Burnel P. Second cycle of accreditation of healthcare organisations. Impact of V1 recommendations. Gestions Hosp 2006; (460): 6.
What is the impact of accreditation recommendations on healthcare organisations? • Summary | 3The accreditation procedure involves the following steps:
■ a self-assessment phase, during which professionals and patient representatives are invited to evaluate
the functioning of the organisation with reference to the Accreditation Manual;
■ an on-site visit, called the initial visit, conducted by healthcare professionals who have been appointed
and trained by HAS, known as surveyors;
■ the production of a report including observations and any recommendations or reservations. These indi-
cate improvements that need to be made, and are classifed according to their severity: recommendations,
reservations or major reservations;
■ validation and publication of the report, any recommendations or reservations, and the corresponding level
of decision made by the HAS Board;
■ in the case of reservations or major reservations, the implementation of follow-up measures: the organ