Striving for Performance Excellence: Ten Years’ Experience & Impact of Accreditation on Quality, Safety, and Overall Performance in King Saud University Medical City (KSUMC) – A Mixed-Methods Study

Abstract BackgroundThe Kingdom of Saudi Arabia (KSA) has undergone a healthcare system transformation to improve healthcare delivery and quality and central to this is the accreditation for healthcare facilities. Hospitals in KSA have relied on international accreditation bodies and are now shifting to national accreditation boards. The objective of this paper is to assess long-term effects of national and international accreditation through measuring staff perception after ten years of participation in multiple accreditation surveys.MethodsThis mixed-methods study was conducted at the King Saud University Medical City. The quantitative tool was adapted from previous studies and was made available in both English and Arabic. Respondents were asked to evaluate their involvement in accreditation and hospital readiness for another accreditation survey using 11 subscales. ANOVA was used to evaluate differences in mean scores based on level of participation in accreditation surveys. A qualitative interview tool was also used to elicit input from key stakeholders, senior leaders, and managers from the university hospitals. ResultsA total of 630 respondents completed the survey. The subscale on Patient Safety scored highest with an average and those measuring Accreditation Impact, Quality Impact and Quality Management closely followed. ANOVA results showed a significantly increasing mean score with increasing involvement of respondents in accreditation with highest scores observed for the first accreditation survey. Linear regression results showed increases in selected outcomes when with increasing subscale scores for patient satisfaction, management and leadership and others. Findings from the qualitative component showed that accreditation supported improved and sustained quality of care. Despite some differences and challenges in implementing both international and national accreditation standards, there were areas of complementarity which supported quality improvement. Respondents also noted improvements in patient outcomes as a result of participation in accreditation.ConclusionThis study is the first to examine the long-term impact of accreditation over an extended period in KSA. The long-term assessment of accreditation conducted in this study revealed that staff perception about performance was highest during the first cycle and consistently decreased with consequent surveys. The slight and incremental decrease in scale scores reveal that the benefits of accreditation were retained.

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Psychosexual Development in Men with Congenital Hypogonadotropic Hypogonadism on Long-Term Treatment: A Mixed Methods Study

Sexual Medicine ◽

10.1002/sm2.50 ◽

2015 ◽

Vol 3 (1) ◽

pp. 32-41 ◽

Cited By ~ 17

Author(s):

Andrew A. Dwyer ◽

Richard Quinton ◽

Nelly Pitteloud ◽

Diane Morin

Keyword(s):

Mixed Methods ◽

Hypogonadotropic Hypogonadism ◽

Term Treatment ◽

Mixed Methods Study ◽

Psychosexual Development ◽

Congenital Hypogonadotropic Hypogonadism ◽

Long Term Treatment

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Implementing large-system, value-based healthcare initiatives: a realist study protocol for seven natural experiments

BMJ Open ◽

10.1136/bmjopen-2020-044049 ◽

2020 ◽

Vol 10 (12) ◽

pp. e044049

Author(s):

Mitchell N Sarkies ◽

Emilie Francis-Auton ◽

Janet C Long ◽

Andrew Partington ◽

Chiara Pomare ◽

...

Keyword(s):

Mixed Methods ◽

Quantitative Data ◽

Care Delivery ◽

Qualitative Interviews ◽

Healthcare Delivery ◽

Implementation Strategies ◽

Large System ◽

Natural Experiments ◽

System Transformation ◽

Delivery Models

IntroductionValue-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond ‘what works’ towards more nuanced understanding of ‘what tends to work for whom under which circumstances’. This research proposes a realist study of the implementation approach for seven large-system, value-based healthcare initiatives in New South Wales, Australia, to elucidate how different implementation strategies and processes stimulate the uptake, adoption, fidelity and adherence of initiatives to achieve sustainable impacts across a variety of contexts.Methods and analysisThis exploratory, sequential, mixed methods realist study followed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) reporting standards for realist studies. Stage 1 will formulate initial programme theories from review of existing literature, analysis of programme documents and qualitative interviews with programme designers, implementation support staff and evaluators. Stage 2 envisages testing and refining these hypothesised programme theories through qualitative interviews with local hospital network staff running initiatives, and analyses of quantitative data from the programme evaluation, hospital administrative systems and an implementation outcome survey. Stage 3 proposes to produce generalisable middle-range theories by synthesising data from context–mechanism–outcome configurations across initiatives. Qualitative data will be analysed retroductively and quantitative data will be analysed to identify relationships between the implementation strategies and processes, and implementation and programme outcomes. Mixed methods triangulation will be performed.Ethics and disseminationEthical approval has been granted by Macquarie University (Project ID 23816) and Hunter New England (Project ID 2020/ETH02186) Human Research Ethics Committees. The findings will be published in peer-reviewed journals. Results will be fed back to partner organisations and roundtable discussions with other health jurisdictions will be held, to share learnings.

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