Healthcare accreditation as trigger of organisational change: The view of professionals.

BACKGROUND: Healthcare accreditation seeks to promote the organisational change in healthcare organisations from an approach that values the level of progress achieved through a validated reference framework. The aim of this paper is to analyse the role played by accreditation through the experience perceived by health professionals during the process of self-assessment and external evaluation, taking into account three dimensions of analysis: focus on the patient, internal organisation and leadership, and impact on the clinical aspects of healthcare. MATERIAL AND METHODS: Design: Semi-structured interviews with key informants from clinical management units (CMU) within the Andalusian Health System (Spain). PARTICIPANTS: The key informants in each CMU were the clinical leader, the head of nursing and two health professionals (doctors and nurses). A qualitative research protocol was employed to conduct the semi-structured interviews (n=52 interviews) with physicians and nurses, in order to analyse their experience with the accreditation process. RESULTS: The analysis identified four main outcomes related to the accreditation process perceived by professionals: (1) A benchmarking conceptualisation of the process; (2) Improvements in patient-centred care, quality of clinical records, and organisational culture of the units; (3) Improvement of patient safety culture; (4) As negative outcomes, a slight perception of bureaucratisation and standardisation of the clinical practice. CONCLUSIONS: The described initiative of accreditation process in Andalusia (Spain) is widely perceived as positive by health professionals since it fosters the organisational change, although it also has a slightly negative bureaucratisation effect on clinical practice.

[Patient safety risks in Primary Health Care: identification and prevention of adverse events]. / Soluciones aportadas por Atención Primaria para abordar los riesgos relacionados con la seguridad del paciente.

OBJECTIVE: To determine whether there are pro-active strategies for identifying risks to patient safety, the potential risks identified by the professionals, and the solutions to prevent their occurrence. MATERIALS AND METHODS: A descriptive-retrospective study was conducted on Primary Health Care units in the process of accreditation. This work was performed at the Andalusian Agency for Health Care Quality through the analysis of primary healthcare units assessed. A total of 61 Primary healthcare units were assessed between June 2010 to June 2011. The main measurements were methods for identifying and prioritising risks, prioritised risks, and solutions provided by the Primary Health Care units. The risks and solutions were classified into 8 categories (medication, infection, diagnosis, management, patient accidents, communication, care, medical devices/equipment). The data were obtained in our computer application for the accreditation process (Me_joraC). RESULTS: Just under half (47.5%) of the healthcare units used tools for proactive analysis of patient safety risks. The risks identified most often were related to medication (100%), and infection (89.6%). The main solutions identified were related to protocols for medication review, hand hygiene training, alcohol-based hand-wash solutions, and interventions on patients on polypharmacy. CONCLUSIONS: A large proportion of adverse events that occur in health care are preventable, thus it is necessary to establish preventive strategies. This study shows the solutions for Primary Health Care units to prevent adverse events, and other patient safety risks not found in other studies (related to the use of medical devices/equipment).

[Measures to ensure data confidentiality in Clinical Units in order to achieve quality accreditation in Andalusia]. / Medidas para garantizar la confidencialidad de los datos en unidades clínicas en el marco de la acreditación de calidad en Andalucía.

OBJECTIVE: To analyse the measures introduced by Health Care Units to ensure the confidentiality of health information on patients that been validated as adequate by an assessment team of the Agency for Healthcare Quality in Andalusia (Spain). MATERIAL AND METHODS: A retrospective study was conducted on Health Care Units accredited by the Agency for Healthcare Quality in Andalusia. A total of 272 Health Care Units were evaluated between January 2003 and December 2010. We analysed the measures that were assessed as adequate to ensure the confidentiality of data by this team, establishing categories after analysing records of the application that supports the certification process (ME_joraC). RESULTS: Using on- site surveys, areas of improvement were found in the safeguarding of medical records (64.1%) and the internal control of implementing the information security measure (19.6%). The measures introduced into the Health Care Services were mainly technological actions (28.5%), which were related to the increasing presence of electronic history. It also frequently provided solutions related to implementation (17.9%) and dissemination (22.3%) protocols for use of medical records. CONCLUSIONS: Accreditation processes help to identify areas for improvement and the introduction of procedures for ensure confidentiality of data in the healthcare system. Technological solutions that respond to the needs created by the computerisation of medical records, and the effective implementation of protocols and monitoring the adherence to these protocols using self-assessment, strengthen the efforts to ensure confidentiality. Furthermore, it promotes the involvement and responsibility of the professionals on this topic.

[Critical points in the storage and expiry of drugs. Improvements implemented by healthcare units in the accreditation process]. / Puntos críticos en la conservación y caducidad de medicamentos. Mejoras implantadas por unidades clínicas en procesos de acreditación.

OBJECTIVE: Measures for controlling the expiry date and storage conditions of the drugs is a standard used in the accreditation program. The present paper has two principal aims: to identify the critical points in the clinical units evaluated, and to find out the different actions for improvement introduced in these areas. MATERIALS AND METHODS: A descriptive-retrospective study was used. For analysing the critical points, the units that did not achieve the referred standard (n=64) during the accreditation process were selected. All the information analysed on the units (n=48) that had introduced improvements was obtained from the computer application that supports the accreditation processes. RESULTS: The critical points (drug expiry date and storage conditions, were found in 32.98% of the units evaluated. These were mainly due to associated with lack of responsibility, absence of refrigeration control records and standard procedures. The 241 improvement actions made in the 48 units analysed were recorded in the computer program. The deficiencies were resolved, which enabled them to achieve accreditation. CONCLUSIONS: The actions introduced to resolve the critical points regarding drug storage and expiry in clinical units, can be easily implemented by other healthcare units in order to achieve accreditation.

[Skills accreditation as an impetus for continuous professional development]. / Utilidad de la acreditación de competencias profesionales en el desarrollo profesional continuo.

AIM: To analyse the perceived usefulness of continuous professional development (CPD) of the Professional Skills Accreditation Programme of the Andalusian Agency for Healthcare Quality, with 64 Skills Manuals available, one for each professional discipline. MATERIAL AND METHODS: A quantitative and longitudinal study by questionnaire. Field of the study: every professional who has finished their professional skills accreditation process. PERIOD OF STUDY: 2006-2009. A validated questionnaire on the perceived quality of the professional skills accreditation process was distributed online to the targeted population. The questionnaire analysed the professionals' perception on the usefulness of the accreditation process in the "self-learning and reflection of their practice", the "maintenance and improvement of their skills" and the "maintenance and improvement of their results". RESULTS: In 2009, 10,300 professionals were in some phase of the skills accreditation process, 1427 of whom have achieved some accreditation level. A total of 886 completed questionnaires were received (62.0%); the overall rating obtained by the Accreditation Programme was 7.7/10. The rating of the perceived usefulness in continuous professional development was: "self-learning and reflection of their practice": 7.8/10; "maintenance and improvement of their skills": 7.7/10; and "maintenance and improvement of their results": 7.5/10. The average length of their professional practice self-assessment was 168 days. CONCLUSIONS: The Professional Skills Accreditation Programme of the Andalusian Agency for Healthcare Quality was perceived by the professionals as useful for their continuous professional development.

[Assessment and learning from the 27th Conference of the Spanish Society for quality in healthcare]. / Evaluación y aprendizaje del 27 Congreso de la Sociedad Española de Calidad Asistencial.

OBJECTIVE: To analyse the results of the 27th Conference of the Spanish Society for Quality in Health Care (SECA) held in Seville (October 2009). MATERIAL AND METHODS: A retrospective descriptive study was conducted using the conference databases. POPULATION: All abstracts received (1231). 36 pairs of reviewers using explicit criteria evaluated abstracts and assignment as Experiences or Electronic Communications. Participant satisfaction in the Conference and Workshops was evaluated by an anonymous questionnaire. RESULTS: A total of 1213 communications were accepted. The average score of accepted abstracts was 6.38 ± 0.95 points. Experiences had an average score of 7.55 ± 0.41 points, while Electronic Abstracts had an average score of 6.26 ± 0.9 points. Andalusia (557) and Catalonia (140) had the highest amount of abstracts in the Conference, but Murcia and Andalusia obtained the highest rates per million inhabitants. CONCLUSIONS: The assessment of abstracts and organising a national conference are methodologically complex processes. Accountability for actions and decisions made by the Organising and Scientific Committees are an ethical requirement of transparency.