Cohesion and diversity bring opportunity: a survey of the critical elements, strengths and challenges to an Australian primary care accreditation program

Objectives: Accreditation programs are designed to stimulate improvements in quality and safety and produce sector cohesion in the direction and goals of quality care. Whether stakeholders understand and accept this proposition is rarely investigated. This study investigates stakeholders’ attitudes towards a well-established primary care accreditation program.
Methods: The study was conducted in 2013 and focused upon the Royal Australian College of General Practice’s (RACGP’s) accreditation program. Participants (n=210), accredited by the Australian General Practice Accreditation Limited, completed an online survey questionnaire. Respondents rated statements (n=56) related to the critical elements, relative strengths and consequences of the RACGP accreditation program on a five-point Likert Scale. Descriptive statistics were used to analyse data.
Results: Respondents’ views were aligned with the philosophy, purpose and contribution of the accreditation program. Accreditation and organisational transparency were recognised as essential components to engender improvements in primary care practices. Participants reported the independence
of the accrediting agency and financial incentives to participate, created a positive environment in which the program operated. There was widespread acceptance that several elements contributed to driving improvements for organisations. These included: accreditation standards; staff participation; on-site visits by collaborative multi-disciplinary survey teams, with appropriate knowledge and skills; and, surveyor feedback, grounded in evidence, and the advice they provided for improvements. Accreditation outcomes were perceived as fair and surveyors were respected by the sector. Respondents indicated that surveyor personalities influenced the process and that the public needed further education about the accreditation program.
While there was agreement across the respondent group, there was increasing diversity of opinions on a number of items, including: whether the program is valued by healthcare professionals; if the focus was on the right organisational process responsible for safety and quality; the program implementation and
education processes; surveyor and survey team reliability; and, the cost-benefits and contribution of the program to organisational quality and safety.
Sector-wide agreement was lacking for a range of issues. Respondents had diverse views on: whether participation should be mandatory or not; the organisational impacts of the accreditation process; the cost-benefits and benefits of accreditation over time; consumers’ roles in and perceptions of the program; the disclosure of results to the public; the contribution of surveyors to their own organisations; how insurance agencies perceive the program; and, altering the established survey process.
Conclusion: Respondents’ views of the critical elements, strengths and impact of the accreditation program are largely aligned. However, some discordance with program aims is apparent. The primary care sector remains on the whole committed to the accreditation process, to improving care processes, and attempting to do so in a unified and transparent way. Resolution of issues may not be possible, nor required, as quality and safety actions evolve over time. Examining the status quo of accreditation stakeholders provides opportunities for stimulating improvements to programs and further building quality and safety into the healthcare system.