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

• Author: Ellakany, Ibrahim Hamed

INTRODUCTION

Saudi German hospital Cairo is in Cairo, Egypt, and provides diverse types of services to the community. Saudi German Hospital in Cairo is in el Nozha district in a very strategic location in front of Cairo International Airport. The hospital has 232 licensed beds providing care in different specialties. In pursuit of providing an excellent quality of care, Saudi German Hospital Cairo has many international accreditations as well as national accreditation.

Hospital accreditation has been defined as "A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance concerning established standards and to implement ways to continuously improve" (Gordana et al., 2016).

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 accrediting bodies in the healthcare sector, including but not limited to Joint Commission International (JCI), Canadian Qmentum International, Australian Council on Healthcare Standards International (ACHSI) and others. In Egypt, General Authority for Healthcare Accreditation and Regulation was established as one commission out of three commissions of the Universal Health Insurance established based on the new law for health insurance in 2018.

The main purpose of the accreditation process is to improve the quality of care as well as patient safety. But unfortunately, some hospital leaders focus on the marketing purpose of the accreditation and only pay attention to improving quality of care and patient safety during the preparation of the survey. Once the accreditation is given, there is no more support for patient care. Such behavior gives staff working in those accredited hospitals the feeling that hospital leaders receive accreditation for marketing purposes and that it has no actual impact on patient quality of care, as well as patient safety.

Many studies all over the world have been conducted to measure the impact of accreditation on quality of care as well as patient safety. Most of those studies focus on the objective outcomes of the accreditation through comparisons of quality and patient safety measures before and after the accreditation to ascertain the actual impact of accreditation on quality of care and patient safety. Some studies also focus on the perception of staff working in hospitals, especially nursing staff to measure the impact.

One of those studies, conducted in Saudi Arabia, reported that 721 registered nurses with diverse cultural backgrounds perceived a good impact of accreditation on patient safety (Alawa et al., 2009).

Unsafe medication practices and errors--such as incorrect dosages or infusions, unclear instructions, use of abbreviations and inappropriate prescriptions--are a leading cause of avoidable harm in health care around the world. Globally, the cost associated with medication errors has been estimated at US$ 42 billion annually, not counting lost wages, productivity, or health care costs. This represents almost 1% of global expenditure on health (Aitken & Gorokhovich, 2012).

Unsafe surgical care procedures cause complications in up to 25% of patients. Almost seven million surgical patients suffer significant complications annually, 1million of whom die during or immediately following surgery (World Health Organization, 2009).

LITERATURE REVIEW

Al Shammari et-al conducted a study in King Khalid Hospital (KKH) in Hail city, Kingdom of Saudi Arabia (Oct 2014), after the hospital had been accredited by JCI (Joint Commission International) to evaluate the nurses' perception toward the impact of hospital accreditation on patient safety and concluded the high positive impact of hospital accreditation on patient safety with overall score 4.17 out of 5 points in a rating scale (Al Shammari et al.,2015).

Karmakar and Sippy (2018) stated that accreditation has a key role in safety measurements like safety awareness, drug safety, and control and incident reporting.

Saut's study in 2017 suggests that accreditation contributed 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 was found that patient involvement and monitoring patient safety goals should be managed by organizations with their respective policies (Saut et al., 2017).

In terms of outcomes, Melo (2016) concluded that the accreditation process was perceived by interviewees as having contributed to significant quality and patient safety improvements in the case study hospital. 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 the year 2004) to 846 (in 2006) and 2015 (in 2008). Several interviewees mentioned that staff became more aware of the importance of reporting incidents even if they were minor incidents. Evidence from the interviews indicates 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 an occurrence variance reporting system (OVR) during and after the accreditation process and the medication error per one hundred beds per month increased 0.1 - 0.33%. Similarly, there was an increase in medication error reporting per one hundred admissions from 0.02 - 0.07% post accreditation.

The blood transfusion reaction reporting in the same study was also closer to the range of other benchmarked hospitals. There was a significant reduction in return to the surgery within 48 hours postoperatively from an average of 2.33 - 0.58 patients/month in 2008 because of the quality and patient safety culture, as well as the creation of pre-anesthesia clinic and establishment of OR review committee. There was an improvement in the 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. Eleven percent with a significant difference across the duration of the study. Pressure ulcers decreased significantly per one thousand 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

One of the accreditation benefits is to increase the market share, especially for private hospitals. Unfortunately, this could be the main reason for hospital leaders not to improve the quality of work, as well as patient safety. One of the challenges facing us for the preparation for any accreditation is the perception of the staff.

Problem Statement

Healthcare professionals in Saudi German Hospital in Cairo believe that accreditation is just for marketing purposes and has no impact on improving the quality of care as well as patient safety.

Hypothesis

There is no significant statistical impact of accreditation standards on improving the quality of care as well as improving patient safety activities inside the hospital.

METHOD

Context

Saudi German Hospital in Cairo is accredited by Joint Commission International, Canadian Qmentum International & General Authority for healthcare accreditation and regulations. There are thousands of applicable standards covering all the functions and activities inside the hospital. There are almost one hundred standards that cover patient safety activities directly; all other standards are indirect.

Questionnaire

The questionnaire consisted of thirty questions including two main parts: the demographic data of the respondents and questions related to different patient safety activities. The different patient safety activities covered in the...