International approaches for implementing accreditation programmes in different healthcare facilities: a comparative case study in Australia, Botswana, Denmark, and Jordan.

Healthcare accreditation programmes have been adopted internationally to maintain the quality and safety of services. Accreditation assesses the compliance of organizations to a series of standards. The evidence base supporting the benefits of accreditation is mixed, potentially influenced by differences in local implementation and operationalization of standards. Successful implementation is associated with optimizing regulation, funding, and government commitment. Implementation of accreditation is a complex intervention that needs to be tailored to meet contextual differences across settings. Comparing why and how accreditation is implemented across countries supports the effective implementation of new programmes and refinements to existing systems. This article presents four case studies from Australia, Botswana, Denmark, and Jordan to consider a geographic spread and mix of high- and upper-middle-income countries. The data were derived from a review of accreditation programme documents and follow-up discussions with directors of the accrediting bodies in the countries of interest. Each case study was summarized according to a standardized framework for comparison: (i) goals (why), (ii) programme implementation (how), (iii) outcomes based on pre-post measures (what), and (iv) lessons learned (enablers and barriers). The accreditation programmes were all introduced in the 2000s to improve quality and safety. Documents from each country outlined motivations for introducing an accreditation programme, which was predominantly initiated by the government. The programmes were adopted in demarcated healthcare sectors (e.g. primary care and hospital settings), with a mix of mandatory and voluntary approaches. Implementation support centred on the interpretation and operationalization of standards and follow-up on variation in compliance with standards, after announced surveys. Most standards focused on patient safety, patient centredness, and governance but differed between using standard sets on quality management or supportive processes for patient care. Methods for evaluation of programme success and outcomes measured varied. Frequently reported enablers of successful implementation included strong leadership and ownership of the process. A lack of awareness of quality and safety, insufficient training in quality improvement methods, and transfer of staff represented the most common challenges. This case analysis of accreditation programmes in a variety of countries highlights consistent strategies utilized, key enabling factors, barriers, and the influence of contextual differences. Our framework for describing why, how, what, and lessons learned demonstrates innovation and experimentation in approaches used across high- and upper-middle-income countries, hospital and primary care, and specialist clinics.

Accreditation in 2030.

With the rapid acceleration of changes being experienced throughout the world and in particular within health and health and social care, accreditation programmes must keep pace or go the way of the dinosaur. While accreditation has deep roots in some countries, in the past 30 years, it has spread to a considerably larger range of countries in a mix of mandatory and voluntary systems. Accreditation is a tool to improve the quality of healthcare and social care, and in particular, there is recent recognition of its value in low- and middle-income countries, with promotion by the World Health Organization (WHO). The challenge is that with the rapid pace of change, how does accreditation reframe and reposition itself to ensure relevance in 2030? Accreditation must adapt and be relevant in order to be sustainable. This article outlines the fundamental principles, reviews the global trends' impact on accreditation and the challenges with the existing model and, through the lens of living in 2030, outlines how accreditation programmes will be structured and applied 10 years from now.

Promoting patients' rights through hospital accreditation.

Legislation and accreditation standards both address patients' rights. The two approaches differ in important ways; they should not be seen as competing but as complementing efforts. Laws define minimum standards, whereas accreditation standards describe optimal performance; laws focus on the rights, whereas accreditation standards also point out ways in which hospitals may act to deliver these rights, which both serves to help hospitals implementing the rights and to standardize the measures taken across hospitals. A recent Israeli study underpins this view, but also highlights that international accreditation standards and national legislation may differ, when it comes to the definition of the actual rights.

[Potentially preventable deaths in a medium sized community hospital]. / Potentielt forebyggelige dødsfald på et mellemstort centralsygehus.

INTRODUCTION: The purpose of this study was to estimate the occurrence and causes of potentially preventable deaths at a medium sized community hospital. MATERIALS AND METHODS: A review of a consecutive series of records of 48 deceased patients (age 58-98 years, median 81 years, 40% males) was conducted by four observers, followed by a consensus conference in which the deaths were classified as potentially preventable according to a checklist, focusing on the occurrence of adverse events or failure to comply with evidence-based procedures. RESULTS: 10 of the 48 deaths were considered potentially preventable; in two cases the potential was considered significant, but the age and underlying diseases of the patients suggest that the potential number of saved life years is modest. The main reasons for preventability were unintended delays, ineffective treatment plans, and lack of reactions to new and important diagnostic information. CONCLUSION: The review of the deaths revealed a considerable number of potentially preventable cases. Furthermore, a number of suggestions for improvement were identified: (1) early identification and aggressive treatment of impending sepsis; (2) employment of routines to ensure that new diagnostic information is reviewed and acted upon and (3) systematic updating of competences in all staff members.

Physical training during intrahepatic chemotherapy.

OBJECTIVE: To evaluate the role of strength and endurance training for the muscular, cardiac, respiratory, and immune systems and the quality of life (QOL) during intrahepatic chemotherapy (folinic acid, 5-fluorouracil). DESIGN: Single case. SETTING: Teaching hospital in Germany. PARTICIPANT: An elderly athlete with liver metastasis after resection of a carcinoma of the rectum (pT3, N0, M-liver, G2). INTERVENTION: Strength and endurance training during chemotherapy. MAIN OUTCOME MEASURES: During the intervals between training cycles (14d), beginning in postoperative week 6, a strength and endurance training regimen was performed twice weekly for 13 weeks, with an intensity of 40% to 60% of the maximum postoperative individual power and endurance. Before and after chemotherapy, we checked echocardiograms, resting and exercise electrocardiograms, lung function, natural killer (NK) cells, and the Gastrointestinal Quality of Life Index (GIQLI) scores. RESULTS: The increase in strength was between 0% and 144%. The improvement in endurance expressed by reduction of heart rate and lactate concentration was 10% and 21.5%, respectively. Lung function also improved with regard to forced expiratory volume in 1 second (12.9%), forced vital capacity (11.3%), and inspiratory vital capacity (11.4%). The relative count of the NK cells increased to 27.2%. An improvement in the GIQLI was observed from 109 points (pathologic) to 129 points. CONCLUSION: Strength and endurance training was associated with an increase of physical strength and endurance with positive influence on illness-related QOL. Postoperative physical exercise during regional chemotherapy is beneficial.