Implementing Hospital Accreditation: Individual Experiences of Process and Impacts

There is a global trend towards the pursuit of healthcare quality, driven forward as countries attempt to engage in the more effective management of resources and services, amidst concerns about increasing costs, competing priorities and patient safety. One approach to managing quality on an organisation-wide basis, and in a hospital context, is through the implementation of accreditation, which involves the assessment of work and organisational practices against predefined standards, conducted by multidisciplinary clinical and support services teams. The level of compliance against these standards is then evaluated by an external team of surveyors, on behalf of an independent body, and on the basis of this, an accreditation rating is arrived at for the organisation. Arising from this, the multidisciplinary teams move forward into the continuous improvement phase of the accreditation cycle, in order to action identified risks and opportunities for the development and enhancement of health services. In terms of the implementation process and impacts associated with organisation-wide quality approaches such as accreditation, the literature highlights that these are not well understood, nor reported on in any depth, from the perspective of those actively involved with, and closest to them (Walshe et al. 2001;Ovretveit & Gustafson 2002;Grol, Baker, & Moss 2002;Ovretveit & Gustafson 2003). Furthermore, with reference to Ireland, accreditation has only relatively recently (2002) been adopted as the key vehicle for improving the quality of healthcare in publicly funded acute-care hospitals. As such, a paucity of literature exists within these particular areas. As a timely response to the recognised gaps in knowledge and understanding, and by positioning the study within the wider body of literature relating to organisational change and specifically, the Weisbord (1976a) change model, the research has posed the following research question: What are the experiences of individual team members in terms of the accreditation implementation process and the individual and organisational impacts associated with this, in a large acute-care hospital context? The research was approached from a philosophical position of anti-positivism and a methodologically pragmatic stance. A descriptive single case study research design was adopted in the context of a large acute-care hospital, where the units of analysis were the individual accreditation team members (population - two hundred and four) who were listed as being involved with the first phase of accreditation. The primary research was supported by the utilisation of non-participant observation, questionnaires and semi-structured interviews and centred on a number of themes integral to the implementation process (leadership; communication; involvement and participation; training; teams; reward) and impacts, in terms of those arising at the individual and organisational levels. Furthermore, the data collection facilitated the exploration of the extent of, and reasons for, differences in the experiences of both the implementation process and impacts, between those in clinical work roles and accreditation teams and those in support services and more administratively orientated functions and teams. The findings from this study indicate that despite the positive assessments of several aspects of the accreditation implementation process, there were also a number of shortcomings associated with this and in particular, respondents identified the areas of leadership, communication, involvement and participation and training as having been problematic. As such, the conclusion arrived at was one of ‘partial implementation’. Despite these issues and somewhat paradoxically, accreditation was identified as contributing to, and impacting positively on, individual learning and development; future career progression; organisational communication; multidisciplinary working; the development of standards; work relationships; morale; hospital reputation and the overall standard and delivery of care at the research site. However, this research also found that accreditation had contributed to individual role conflict and furthermore, was perceived to have potentially impacted on service provision itself. Finally, the majority of results from this study have also demonstrated that those in clinical services roles and accreditation teams were more negative in their assessments of their experiences of the accreditation implementation process and impacts, than their support services counterparts. Importantly, this study has contributed to knowledge and understanding of the under-researched areas of the hospital accreditation implementation process and associated impacts, from the perspective of individual accreditation team members. Furthermore, this has been achieved within an Irish healthcare context. This research may provide a useful framework and additional avenues of enquiry to other researchers in the field and also inform the practice and policy associated with accreditation implementation. Finally, a number of limitations are inherent within the study and relate to generalisability, issues of validity and reliability within the research methods and the potential bias of the author themselves.