TY - JOUR
T1 - The effect of certification and accreditation on quality management in 4 clinical services in 73 European hospitals
AU - Shaw, Charles D.
AU - Groene, Oliver
AU - Botje, Daan
AU - Sunol, Rosa
AU - Kutryba, Basia
AU - Klazinga, Niek
AU - Bruneau, Charles
AU - Hammer, Antje
AU - Wang, Aolin
AU - Arah, Onyebuchi A.
AU - Wagner, Cordula
AU - Kringos, D. S.
AU - Lombarts, K.
AU - Plochg, T.
AU - Lopez, M. A.
AU - Secanell, M.
AU - Vallejo, P.
AU - Bartels, P.
AU - Kristensen, S.
AU - Michel, P.
AU - Saillour-Glenisson, F.
AU - Vlcek, F.
AU - Car, M.
AU - Jones, S.
AU - Klaus, E.
AU - Garel, P.
AU - Hanslik, K.
AU - Saluvan, M.
AU - Depaigne-Loth, A.
AU - Shaw, C.
AU - Ommen, O.
AU - Pfaff, H.
AU - Kutaj-Wasikowska, H.
AU - Escoval, A.
AU - Franca, M.
AU - Almeman, F.
AU - Kus, H.
AU - Ozturk, K.
AU - Mannion, R.
AU - Chow, A.
AU - DerSarkissian, M.
AU - Thompson, C.
AU - Thompson, A.
AU - DUQuE Project Consortium
N1 - Copyright the Author(s) 2014. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2014/4
Y1 - 2014/4
N2 - Objective: To investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals. Design: A mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathways. Setting and Participants: Seventy-three acute care hospitals with a total of 291 services managing acute myocardial infarction (AMI), hip fracture, stroke and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Main Outcome Measure: Four composite measures of quality and safety [specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies (PSS) and clinical review (CR)] applied to four pathways. Results: Accreditation in isolation showed benefits in AMI and stroke more than in deliveries and hip fracture; the greatest significant association was with CR in stroke. Certification in isolation showed little benefit in AMI but had more positive association with the other conditions; greatest significant association was in PSS with stroke. The combination of accreditation and certification showed least benefit in EBOP, but significant benefits in SER (AMI), in PSS (AMI, hip fracture and stroke) and in CR (AMI and stroke). Conclusions: Accreditation and certification are positively associated with clinical leadership, systems for patient safety and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care. Further analysis of DUQuE data will explore the association of certification and accreditation with clinical outcomes.
AB - Objective: To investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals. Design: A mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathways. Setting and Participants: Seventy-three acute care hospitals with a total of 291 services managing acute myocardial infarction (AMI), hip fracture, stroke and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Main Outcome Measure: Four composite measures of quality and safety [specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies (PSS) and clinical review (CR)] applied to four pathways. Results: Accreditation in isolation showed benefits in AMI and stroke more than in deliveries and hip fracture; the greatest significant association was with CR in stroke. Certification in isolation showed little benefit in AMI but had more positive association with the other conditions; greatest significant association was in PSS with stroke. The combination of accreditation and certification showed least benefit in EBOP, but significant benefits in SER (AMI), in PSS (AMI, hip fracture and stroke) and in CR (AMI and stroke). Conclusions: Accreditation and certification are positively associated with clinical leadership, systems for patient safety and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care. Further analysis of DUQuE data will explore the association of certification and accreditation with clinical outcomes.
KW - Accreditation
KW - Certification
KW - Health care quality assessment
KW - Patient safety
KW - Quality management
UR - http://www.scopus.com/inward/record.url?scp=84920476208&partnerID=8YFLogxK
U2 - 10.1093/intqhc/mzu023
DO - 10.1093/intqhc/mzu023
M3 - Article
C2 - 24615598
AN - SCOPUS:84920476208
SN - 1353-4505
VL - 26
SP - 100
EP - 107
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - Supplement 1
ER -