IMPACT OF ACCREDITATION STANDARDS ON PATIENT SAFETY ACTIVITIES: A CASE STUDY IN SAUDI GERMAN HOSPITAL-CAIRO.

• Author: Ellakany, Ibrahim Hamed

INTRODUCTION

Hospital accreditation has been defined as "A self-assessment and external peer assessment process used by healthcare organizations to accurately assess their level of performance concerning established standards and to implement ways to continuously improve" (Gordana et al., 2016). Accreditation is not just about standard-setting: there are analytical, counseling and self-improvement dimensions to the process. There are parallel issues around evidence-based medicine, quality assurance and medical ethics, and the reduction of medical error is a key role of the accreditation process. Healthcare accreditation is therefore one component in the maintenance of patient safety.

The accreditation process is a voluntary process by which the organization assesses its performance against a set of standards created by accrediting bodies. There are many international accrediting bodies in the healthcare sector like Joint Commission International (JCI) for healthcare organizations out of the USA, Accreditation Canada (AC) in Canada, Australian Council on Healthcare Standards International (ACHSI) in Australia and General Authority for Healthcare Accreditation and Regulation (GAHAR) in Egypt.

Accredited hospitals are supposed to offer higher quality of care to their patients; moreover, accreditation provides a competitive advantage for the accredited hospitals and strengthens community confidence in the quality and safety of care, treatment and services.

Accreditation is an approach for improving the quality of health services like unsafe medication practices and errors--such as incorrect dosages or infusions, unclear instructions, use of abbreviations and inappropriate prescriptions-which are leading causes of avoidable harm in healthcare services around the world. Globally, the cost associated with medication errors has been estimated at $42 USD billion annually, not counting lost wages, productivity or health care costs. This represents almost 1% of global expenditure on health (Aitken & Gorokhovich, 2012). Also, unsafe surgical care procedures cause complications in up to 25% of patients. Almost seven million surgical patients suffer significant complications annually, 1 million of whom die during or immediately following surgery (World Health Organization, 2009).

Healthcare workers hold an important role in preparing and receiving accreditation, as well as maintaining sustainable quality performance. Therefore, their perception regarding the impact of implementing quality standards is critical to building long-term commitment towards quality, regardless of being examined to receive accreditation or managing the routine workflow.

LITERATURE REVIEW

Many studies have been conducted to measure the impact of accreditation on the quality of care, as well as patient safety / Most of them focus on the objective outcomes of the accreditation by comparing quality and patient safety measures before and after the accreditation. Others focus on the accreditation's perception among healthcare workers especially the nursing staff to measure the impact of accreditation.

A study conducted in the Kingdom of Saudi Arabia reported that 721 registered nurses with different cultural backgrounds perceived a good impact of accreditation on patient safety (Alawa et al., 2009). Another study was conducted in King Khalid Hospital (KKH) in Hail city, Kingdom of Saudi Arabia, after the hospital had been accredited by JCI (Joint Commission International) to evaluate the nurses' perception toward the impact of the hospital's accreditation on patient safety. The results revealed high positive impact of the hospital's accreditation on patient safety with an overall score 4.17 out of 5 points in a rating scale (Al Shammari et al., 2015).

Karmakar and Sippy stated that accreditation plays an important role in safety measurements like safety awareness, drug safety and control and incident reporting (Karmakar & Sippy, 2018).

According to Saut et al. (2017), accreditation contributes to implementing and performing patient safety activities, quality management activities, quality-related policy and strategy planning and involvement of professionals in quality programs. These measures are perceived to contribute to better outcomes. Additionally, it has been found that patient involvement and monitoring patient safety goals should be managed by organizations with their respective policies.

In terms of outcomes, Melo (2016) concluded that the accreditation process was perceived to contribute to significant quality and patient safety improvements. Several respondents pointed out that accreditation played a key role in the establishment of a patient safety culture within the hospital. Respondents also felt that accreditation led to a shared feeling that everyone inside the hospital could play an active role in improving the quality of care across the hospital: there was a generalization of this patient safety culture. Staff felt that it was important that everyone is involved in patient safety. One visible result of this strengthening of patient safety culture was the rise in the number of notifications of patient safety incidents from 254 notifications (in 2004) to 846 (in 2006) and 2015 (in 2008). Several interviewees mentioned that the staff became more aware of the importance of reporting incidents even if they were minor incidents. Evidence from the interviews indicated that several factors contributed to the quality and patient safety improvements resultant from the accreditation process. Whereas some of these were intrinsic to the accreditation process itself, others were related to the way the hospital implemented accreditation and/or to the specific characteristics of the hospital (Melo, 2016).

In 2011, Al-Awa et al. concluded that the indicators under study related to the accreditation standards were significantly improved, including marked improvement in the reporting mechanism through the occurrence variance reporting system (OVR) during and after the accreditation process. The medication error reports per 100 beds per month also increased from 0.1 to 0.33%. Similarly, there was an increase in medication error reporting per 100 admissions from 0.02 to 0.07% post accreditation. Also, the blood transfusion reaction reporting in the same study was closer to the range of other benchmarked hospitals. There was a significant reduction in return to surgery with 48 hours post-operatively from an average of 2.33-0.58 patients/month in 2008 as a consequence of the quality and patient safety culture, as well as the creation of pre-anesthesia clinic and establishment of the OR review committee. There was an improvement in overall CPR management from all aspects due to the implementation of mandatory certification, as well as continuous drills that are done with CPR critique and analysis. The survival rate improved from 54.97-61.11% with a significant difference across the duration of the study. Pressure ulcers decreased significantly per 1000 admissions, as compared with the other international benchmarks of 5-6%. Also, accreditation improved OVR reporting with a significant increase in the reporting. The increase was significant from the monthly average of 3.17-4.67 per month (Al-Awa et al., 2011).

STUDY PROBLEM AND HYPOTHESIS

Brief

As healthcare workers play a main role in preparing accreditation, their perception regarding the impact and...