personal
Research2
Running Head: RESEARCH
37
Perception of impact of CBAHI accreditation among health workers on the quality of health care
By
Student:
ID:
2020 semester
HSAE 698
DEDICATION
ACKNOWLEDGEMENT
ABSTRACT
Background
Methods
Results
Discussion
Conclusion
Keywords
CBAHI, accreditation, health workers, kingdom Saudi Arabia
LIST OF ABBREVIATIONS
Lists of Abbreviations
AAAHC Accreditation Association for Ambulatory Health Care
AACI
American Accreditation Commission International
ACHC Accreditation Commission for Health Care, Inc
ACHS
Australian Council for Health Care Standards
CBAHI Central Board for Accreditation of Healthcare Institutions
CCHSA Canadian Council on Health Services Accreditation
CHAP
Community Health Accreditation Program
HQAA Healthcare Quality Association on Accreditation
ISO
International Standards Organization
ISQua
International Association for Quality in Health Care
JCAHO Joint Commission on Accreditation of Healthcare Organizations
JCI
Joint Commission International
MOH
Ministry of Health
MRQP
Makkah Regional Quality Program
NCQA
National Committee on Quality Assurance
NGO
Non-governmental agency
NHS
National Health Services
OECD
Organization for Economic Co-operation and Development
QM Quality management
TQM
Total
Quality Management
WHO
World Health Organization
TABLE OF CONTENTS
ii
DEDICATION
iii
ACKNOWLEDGEMENT
iv
ABSTRACT
vi
LIST OF ABBREVIATIONS
vii
TABLE OF CONTENTS
xi
LIST OF TABLES
xii
List of Figures
1
CHAPTER I: INTRODUCTION
1
1.
Background
1
2.
Research Problem
3
3.
Research objectives
3
4.
Research significance
3
4.1.
Scientific significance
3
4.2.
Practical significance
3
4.3.
`Policy significance
3
5.
Variables in research
3
5.1.
Dependent variable
4
5.2.
Independent variable
4
6.
Research Questions
4
7.
Research hypothesis
4
8.
Research terminology
4
9.
Research methodology
4
9.1.
Research design
4
9.2.
Population and Sample
4
9.3.
Sample size / calculation
4
9.4.
Data collection
5
9.5.
Type of data (primary or secondary)
5
9.6.
Statistical techniques
5
10.
Research scope
5
11
.
Summary of literature review
5
12.
Work plan
5
13.
Research structure
6
CHAPTER II: LITERATURE REVIEW
6
1.
Preface:
6
2.
Issue background
6
3.
Literature review
7
3.1.
Previous studies related to the research problem/ topic
9
3.2.
Previous studies related to the research questions
10
3.3.
Previous studies related to methodology
11
3.4.
Summary of findings related to the research variables
14
3.5.
Summary of statistical techniques used in similar studies
15
4.
Gap in literature
20
CHAPTER III: RESEARCH METHODOLOGY
20
1.
Preface
20
2.
Research Questions
20
3.
Research hypothesis
20
4.
Research design
20
5.
Population and Sample
20
5.1.
Sampling
20
5.2.
Sample size and selection of sample
21
5.3.
Sampling technique
21
6.
Tool for data collection
21
7.
Data Collection Methods
21
8.
Type of data (primary or secondary)
21
9.
Variables
21
9.1.
Dependent variable
22
9.2.
Independent variable
22
10.
Statistical techniques (Data Analysis Plan)
22
SPSS and Chi Square were the preferred statistical techniques for analyzing data.
22
11.
Validity and Reliability
23
12.
Ethical Considerations
24
CHAPTER IV: DATA ANALYSIS AND RESULTS
24
1.
Preface:
24
2.
Data analysis:
26
3.
Research Results (Findings) (answers to research questions_
38
4.
Discussion of the results:
40
CHAPTER V: CONCLUSION AND RECOMMENDATIONS
40
1.
Preface:
40
2.
Summary:
42
3.
Implications:
42
3.1.
Practical implication
42
3.2.
Policy implications
42
3.3.
Scientific implications
4.
Recommendations:
42
4.1.
Theoretical recommendations
42
4.2.
Practical recommendations
43
4.3.
Policy recommendations
43
5.
Limitations of research:
43
6.
Conclusions:
44
REFERENCES :
Chapter 1
Perception of Impact of CBAHI accreditation among health workers
Introduction
Background
Health care organizations have several institutional, administrative, organizational, and professional standards that organizes the quality of care provided to patients based on the vision, mission, and goals of the institution. These standards represent firm rules that all employees of the institution must apply to achieve the institution’s purpose. Quality of patient care is one of the priorities of practitioners and health care organizations (Algahtani, Aldarmahi, Manlangit, & Shirah, 2017). Hospital accreditation evaluates the performance of the hospital per international and local standards. The main objective attaining certification is to assess internal and external mechanisms and to provide specific criteria that can help with the improvement of hospitals’ capacity to provide quality care. The interests of stakeholders in different countries are also ensured through the accreditation process, and providing chances for knowledge exchange in different contexts and frameworks in international settings (Alkhenizan & Shaw, 2011).
Accreditation may lead to improved health care practices. The World Health Organization (WHO) works with organizations and entities to protect the health systems through certification. Countries can also set their accreditation standards based on the priorities of their health system to maintain health care principles of inclusiveness, equity, efficiency, sustainability, and quality (Brubakk, Vist, Bukholm, Barach, & Tjomsland, 2015).
Recently, using accreditation in Saudi Healthcare enhancing programs has been taken into considerations. In 2000, The Makkah Regional Quality Program (MRQP) was established to improve the quality of health services being provided to the people of Makkah region and the process was successful. High-quality strategies and organizations such as the Canadian Standard and Joint Commission on Accreditation of Healthcare organizations were studied before the formulation of the standards. The health standards’ first version was released for application throughout the region in 2003 (M. Almasabi & Thomas, 2017). The Central Board for Accreditation of Healthcare Institutions (CBAHI) was firs established in 2005 as a result of the Council of Health Services recommendations.
The CBAHI was developed for the development and implementation of standards related to quality and patient safety in all health institutions in Saudi Arabia to improve health services. Most of the accreditation programs are voluntary, but CBAHI is mandatory. In Saudi Arabia, the Health Services Council, announced that all public and private health institutions should be subjected to CBAHI accreditation. Despite the implementation of widespread accreditation standards around the world and the increased access of citizens to high-quality health care (Pomey, Contandriopoulos, François, & Bertrand, 2004), it is not clear yet whether accreditation programs can enhance healthcare services (Greenfield et al., 2014).
Research problem
Currently, Saudi Arabia is adopting CBAHI to improve quality in health care institutions, however, there is a lack of evidence to show that healthcare organizations can have the best use of their resources in aim to improve healthcare quality and patient safety (M. Almasabi & Thomas, 2017). This is because the research conducted on its effect is still at an early stage. The shortage of research in the CBAHI accreditation program contributes to the lack of understanding of the program and its application in a way that makes it impossible to make the most of it. Without looking into the mechanisms of implementation of CBAH, the pros and cons of their impact on the quality of health care will remain questionable. Therefore, there is a strong need to evaluate the perception of health professionals of the impact of CBAHI on the quality of health care.
Research objectives
1- to assess the perception of health professional related to the benefits of CBAH accreditation.
2- to examine the perception of health professional regarding quality of result.
3- to explore the impact of CBAHI accreditation on the quality of health care.
Research significance
The research significance will be geared towards improving service delivery in impact of CBAHI accreditation among health workers. Health institutions all over the world need this research to improve performance of their workers. The effect of the independent variable will be the recipient to measurable effects of the research. The objectives will be achieved if the CBAHI accreditation are improved and which improves healthcare quality.
Scientific significance
The scientific significant of the research will be to expand the preview of research in the scientific perspective. Drawing from the research findings, it will be used for future literature reviews on other projects. Weakness and limitations of this research project will be remedied in the future projects.
Practical significance
The research will be instrumental in general service delivery in the healthcare industry.
Policy significance
The study endeavors to inform the formulation of decent policies.
Variables in research
Dependent variable: Quality result
Independents variables: Benefits of accreditation
Research Model
Figure (1)
Research Questions
1- What is the level of benefits of CBAHI accreditation rating by health professionals?
2- What is the level of quality result rating by health professionals?
3- Is there statically significant impact of CBAHI accreditation on quality result?
Research terminology
Terminologies for use in this case include CBAHI, accreditation, and change implementation. The terms have been well stated and abbreviations given in the index.
Research methodology
Research design
This cross-sectional study will be conducted at King Fahad Hospital in Madinah, Saudi Arabia between
June
2020 and
September
2020. The hospital has 500 beds in different health care specialties and is attached to Saudi Arabia ministry of health. The first accreditation was on 5 November 2010, and since that time, the hospital has been periodically reaccredited.
Population and Sample
The population of this study is comprised of physicians, nurses, medical technologists, dietitians, and other allied healthcare professionals. Respondents are not selected by random sampling. Rather, questionnaires are manually distributed to all health professionals in their designated department and collected with the cooperation of department heads, managers, and staff. To increase the retrieval rate, factors such as shifting of duty, day-offs and leaves will be determined to identify their availability and to assure that they received survey questionnaires. The collection and retrieval of survey forms for every department will take approximately one week. All retrieved questionnaires are will be screened based on the criteria for inclusion which allowed only participants who started working before accreditation and continued to work during and after accreditation and reaccreditation.
Sample size / calculation
The total of population is 5
35
health professionals, random sample method has been used in order to determine the sample size as follow: 95% confidence level, margin of error 5%. A total of 224 questionnaires will be distributed to the different professions.
Tools for data collection
This study will use a validated questionnaire adapted from the tool used by El-Jardali et al 10 which has been used in many studies. The English version of the questionnaire consists of 14 items divided into two main domains: benefits of accreditation (9 items), and quality of the results of accreditation (5 items). There were no modifications or changes in wording in all items so as to maintain the meaning of the content. The questionnaire employs the five-point Likert scale with corresponding verbal interpretations: 1 for Strongly Disagree, 2 for Disagree, 3 for Neither Disagree, 4 for Agree, and 5 for Strongly Agree. Demographic data about the participants including age, gender, educational attainment, profession, length of service, and department were also collected. Data will distribute and retrieve by hand, not by electronic means.
Data will be analyze using IBM SPSS. Demographic data it will be summarized by frequency and percentage, and mean and standard deviation of each score. Chi-squared test and the t test will be used to determine differences between groups in demographic variables. The Pearson correlation coefficient will be calculated for the dependent variable (quality of results) and benefits of accreditation (independent variables).
Type of data (primary or secondary)
Both primary and secondary data for this study are going to be used to be effective. Primary data will be extracted from the distributed questionnaires. Also, literature review and past records are a source of secondary information.
Research scope
Thematic limit: Impact of CBAHI accreditation among health workers
Temporal limit: Fall semester 2020
Spatial limit: King Fahad Hospital, Madinah
Summary of literature review
The literature review covers accreditation in the healthcare industry. The performance standards can be most transparent and can be involved with clinical components to assess the clinical proposal. According to the articles, the goal of the accreditation is that the healthcare organization can deliver its services on an acceptable level to the patients and stakeholders. In addition, it will address the variables including benefit of accreditation rating by employees that impact quality health care by CBAHI. In addition, variables in the research will be addressed from studies that has been done before. Hospital accreditation, will be defined and specifically in Saudi Arabia.
Work plan
The research will be completed in phases and segments starting with the introduction, literature review, methodology, data analysis, and finally conclusion phases accordingly. Each section will be allocated a defined timeline.
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Chapter 2
Literature review
Accreditation
Usually, Accreditation is voluntary, and also maintained and regulated by a non-governmental agency (NGO), in which trained individual can provide external peer review to evaluate the organizational compliance with pre-determined standards related to organization performance (Alkhenizan & Shaw, 2011). Healthcare quality standards were developed by the American College of Surgeons, were first introduced in the United States for the hospitals in the ‘Minimum Standard for Hospitals” in 1917. After World War II, increased world trade in manufactured goods led to the creation of the International Standards Organization (ISO) in 1947. Accreditation formally started in the United States with the formulation of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 1951. This model was exported to Canada and Australia in the 1960s and 1970s and reached Europe in the 1980s. Accreditation programs spread all over the world in the 1990s (Alkhenizan & Shaw, 2011).
Healthcare and hospital accreditation
Basically, healthcare accreditation is concerning about the way of delivery of care and the quality received by the patient. Accreditation is defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve” (Groene & Organization, 2006). Accreditation is an important component in patient safety. However, there is limited and contested evidence supporting the effectiveness of accreditation programs (Hinchcliff et al., 2012).
Early 20th century, The USA was concerned about creating the appropriate standards for the environment for healthcare professionals to enhance healthcare facility environment control. The standards subsequently grow to be an accreditation frame that can facilitate and improve the development of the organization. It’s not related to the process assessment of quality but also enhancing and improving quality. Countries such as United Kingdom, USA, Canada, New Zealand, have multiple accreditation groups in some cases they provide the survey for health care in the community. Therefore, accreditation can be declared into more than a specific group or area in healthcare such as psychiatric services and laboratory services etc. (Hinchcliff et al., 2012).
Accreditation of hospitals in Saudi Arabia
The government of Saudi Arabia take a large positive step in order to improve healthcare services in Saudi Arabia. Adopting and implementing of Total Quality Management (TQM) activities at healthcare sector in Saudi Arabia considered as a key to success for decision making. Since the 1970’s, Saudi Arabia’s government focus on improvement of healthcare quality of their system. The healthcare sector as experience a growth, either public or private sector, total number of healthcare facilities and healthcare professionals is incresing. The expenditure of healthcare services also increases respectively (M. H. Almasabi, 2013).
Saudi Arabia was the first country introduced the quality assurance programs in the Gulf Area. At the government National Development Plan (five-year strategic plan developed by Ministry of Health); Healthcare improvement Framework was initiated. The forest activity carried out by the government ministry of health was in 1984. In 1987, The Ministry of Health Central Committee is aiming to monitor and check the quality of programs in Ministry of Health. The committee objective was analyzing and providing feedback all operations processes carried out by hospitals and Healthcare facilities. The program starting with 14 hospitals. (M. H. Almasabi, 2013).
At 1993, MOH established National Committee on Quality Assurance (NCQA) and the supervision of World Health Organization. The main objective of this committee is to reinforce healthcare system especially primary healthcare sector to achieve higher specified level of service quality. NCQA also responsible to provide a guidance for primary healthcare centers to develop and maintain affordable patient care. At 1995, NCQA has started a new program to train and educate managers how to enhance the efficiency of healthcare quality services. (Al-Awa et al., 2012).
In 2000, The Makkah Regional Quality Program (MRQP) was set up under the supervision of the Prince of Makkah, to improve the healthcare administrations being given to the general population of this city. Quality Standards were set for all open and private emergency clinics in the locale and a broad survey of the quality healthcare programs for MRQP was done. These models were adjusted from the quality frameworks being executed at Canadian emergency clinics accreditation and JCAHO. In 2003, the main distribution for health principles was discharged and connected to all Makkah emergency clinics to upgrade the medicinal services frameworks all through the district (Al-Awa et al., 2012).
In 2005, the Central Board for Accreditation of Healthcare Institutions (CBAHI) was set up, following the proposals of the Council of Health Services. The CBAHI was framed to create and execute quality norms in all healthcare facilities in Saudi Arabia to improve healthcare services and activities. Despite the fact that most of accreditation programs are a voluntary program, CBAHI is obligatory. In 2011, the Council of Health Services in Saudi Arabia proclaimed that all open and private establishments must acquire CBAHI’s accreditation.
Previous studies
Accreditation enables the improvement of patient care
With regard to the study conducted by Shaw et al. (2013), accreditation is a formal declaration by a designated authority that an organization has met predetermined standards. For any high-performing health system, ensuring the quality of services delivered through improved patient care is critical. According to an analysis conducted by El-Jardali et al. (2014), being able to access health care alone is not enough: Rather, all patients who seek medical attention from any hospital, clinic, or any other facility should be confident that the care they receive will be safe, consistent, effective, and in line with the latest medical evidence. This aspect is especially vital for clinical facilities offering care to terminally or acutely ill patients. However, despite the government and other policy-making bodies pushing for most health facilities to get accredited, patient care in some approved facilities is often still behind. For example, in their article, Mohammad et al. (2014) note that some gold star certified hospitals are still struggling to ensure they meet the essential quality and safety outcomes for their patients, and that some of these facilities are yet to improve their patient care even though they have good ratings with The Joint Commission and CBAHI. Despite the accreditation process being voluntary, many healthcare facilities consider it essential for their effective operation because of the substantial benefits it brings.
Accreditation enables the motivation of staff and encourages teamwork and collaboration.
Hong & Park (2016) apply the perception of nurses to assert that a highly motivated workforce will improve the healthcare facility’s internal efficiency through cost reduction, faster decision making, and process simplification; aspects that resultantly leads to improved patient care. Furthermore, motivated staff experience higher job satisfaction and are less likely to be stressed; hence, they will always perform their duties as required. Hospital accreditation is a well-established international process that intends to improve patient safety and quality of care provided in health facilities. By conducting a health study analysis in Saudi Arabia, Algahtani et al (2017) asset that health facilities accreditation induces staff to participate in management activities through the provision of excellent chances and opportunities to create multidisciplinary and multi-professional working groups. Through these forged groups, teams can develop and maintain new connections as well as create new working relationships and collaborations that lead the organization towards less hierarchical and more complementary relationships. These relationships are majorly formed during the many meetings held internally during the self-assessment process aimed to exchange different views on the oncoming accreditation standards.
Accreditation enables the development of values shared by all professionals at the hospital.
Before the accrediting process, many meetings are held internally to self-assess the standards of the facility. An actual hospital study carried out by Jeong & Chun (2015) explain that these forums create a platform where front line staff ca exchange their values, opinions and thus achieve a greater sense of belonging. By sharing their views on what should be improved in the facility, these staff members get a chance to be heard and have their work recognized on a higher level. This is particularly important because being workers together on the ground, the staff gets to interact with patients more than those in the upper management positions. Therefore, the front-line staff have a better understanding of what the facility needs and what should be done to improve overall patient care and outcome.
Accreditation enables the hospital to use its internal resources better (e.g., finances, people, time, and equipment).
Accreditation reports often include underfunded and overfunded sectors in the health facility. Additionally, according to Mumford et al. (2015), before being accredited five stars, divisions that The Joint Commission deems vital in the facility, which are otherwise missing, are usually outlined, and the hospital management is required to stipulate a plan to develop and run them effectively. Therefore, from a financial point of view, this report given by the accreditation firm can be used by regional healthcare authorities to modify their local budget and expenditure on different sectors in the facility to gear the available resources towards a particular specific critical objective.
Accreditation enables the hospital to better respond to population needs.
The goal of hospital accreditation is to assess the facility’s performance against the set explicit standards. In a study conducted by Mosadeghrad et al. (2017), the performance of accredited hospitals was far better than that of nonaccredited health facilities. For example, in most accredited hospitals, the rate of patients returning to the ICU within 24 hours after an operation was lower than that displayed by nonaccredited hospitals. Therefore, staff working on accredited hospitals better understand the needs of their population and strive to meet them maximumly and ensure that every patient is satisfied with the care provided.
Accreditation enables the hospital to better respond to its partners (other hospitals, diverse hospitals, private clinics, and others.).
A comprehensive study conducted by Hort, Djasri & Utarini (2013), accredited hospitals stand a better chance of receiving aid from other organizations in the health sector because the general community has confidence in the services provided. Also, due to the improved performance, quality patient care systems, and commitment to the set accreditation standards gives most accredited health facilities a vantage position when seeking to attract the best health care providers and as well as gain their commitment and loyalty as they try to for long term relationships to enhance patient care and outcome. In their article, Mast & Gambescia (2013) note that most insurance institutions rely on the accreditation process and report when deciding which facilities to go in business with.
Accreditation contributes to the development of collaboration with partners in the healthcare system.
Authors like Brubakk et al. (2015) and Morton et al. (2014) agree that majority of major-care organizations in the healthcare sector regard accreditation as a crucial indicator that is hospital offering high-quality care for its patients. Therefore, when a healthcare facility is accredited, the probability of it finding partners to collaborate with in terms of improving the quality of care and the overall infrastructure increases significantly compared to unaccredited facilities. Additionally, when a facility has been accredited, the cost of collaborating with other firms or insurers reduces due to the better risk management carried out by the hospital.
Accreditation is a valuable tool for the hospital to implement changes.
For a healthcare facility to be accredited for example, by The Joint Commission, a standard procedure has to be followed. First, the facility has to make an application to the Office of Accreditation just like Woodhead (2013) emphasize in his article. Next, the hospital needs to conduct a self-assessment using its team to determine whether the facility standards are at par with the nationally set standards. After which the actual assessment will be conducted by a group of assessors jointly selected by the applicant and the Office of Accreditation. An assessment report will then be issued out by the Board of Accreditation Approval. This report is particularly important as the facility will be able to identify areas where their strength lies and areas where they still need to improve. Therefore, through the accreditation process, a healthcare facility will be able to identify critical areas that need changes and how to implement these changes.
Hospital participation in accreditation enables it to be more responsive when changes are to be implemented.
According to Smits et al. (2014), after the accreditation processing, application by a healthcare facility may either be approved or deferred. If the Board Review Committee decides the later action, then the applicant will be expected to make the outlines changes to the facility and reschedule a new board review for reconsideration. Furthermore, Smits et al. (2014) go ahead to explain that if the facility application is approved, it does not mean the healthcare organization is off the hook for good. Instead, the accreditation has to be maintained every three years, where the facility will submit annual reports for evaluation by the board. If the submitted reports do not meet the required standards, then the accreditation status of the facility may change. Therefore, by participating in the accreditation process, the hospital will always be responsive on when to make critical changes to maintain their functional status with the Board Review Committee.
The hospital has recorded a steady measurable improvement in the quality of customer satisfaction, quality of services offered by the administration, and the quality of care provided to patients through participating in the accreditation process.
This is because according to Lee & Lee (2014), facility now meets the quality and safety standards set by the national health hence improved patient care due to the top-notch care offered in the facility. Furthermore, the improved customer satisfaction recorded is attributed to the fact that the majority of families and individual patients take into consideration these standards when making crucial healthcare decisions such as which hospital they are to visit or take their beloved ones.
Gaps in the literature
Despite the availability of diverse literature endorsing accreditation programs, there still is a gap in materials criticizing this process. Accreditation programs are not all beneficial as depicted by most of the available research because some of the set standards and programs are conducted inappropriately. Therefore, some health facilities may have their accreditation applications approved while at the ground, some of the required standards have not been met. Additionally, although Saudi Arabia is setting out on CBAHI accreditation to advance quality improvement in healthcare services facilities, the proof that it is the best utilization of assets for improving quality procedures and results is deficient.
Chapter three
Research methodology and results
Preface
The ability of sick care depends on the way of implementing healthcare institutions in their goals, mission, and vision, and every health center company has its organizational, institutional, professional, and administrative set of standards (Lindh, Tamparo, Dahl, Morris & Correa, 2017). The standards act as a mandate for every individual in complying with the achievement of a specific objective. Each healthcare has its procedures and policies that are on the grounds of general normalities, traditional as well as the culture in ensuring higher ability sick care. The power in sick care is among the requirements in healthcare together with Practitioners Company. Per the WHO, a total of 19,217 healthcare and hospital facilities are all over the world.
Healthcare certification assesses the performance of the hospital against expressed standards, specifically in the views in terms of trading as well as globalization in facility services. The main objective will be an externality assessment together with an internal mechanism that gives references that can aid in improving the healthcare capacity in the offer of care quality, regulation, and accountability. Furthermore, the stakeholder’s interest in several nations is assured through the accreditation process, which gives chances of knowledge interchange in several frameworks and contexts in evidenced-based practices internationally.
Besides, certification can increase the health care consistency of the practice and the total status of health centers in delivering the systems. Through certification, the World Health Organization may work with the globe in the protection of the policy of international health centers. Countries may introduce their certification standards based on the best interest of their health care system to protect the main facility principles of equity, universal, sustainability, efficiency, and quality measures. The JCI is a non-profitable association that is formed by the JC and gives leading platforms in hospital quality. There are only nine hundred and twelve hospitals that are now certified by Joint Commission International. In the Middle East, only three hundred and seventy-three facilities are in certification. The majority are in Saudi Arabian and have 102 facilities. The United Arab Emirates had 153 facilities.
There is modified information on the effectiveness of the Joint Commission International certification. However, uncommitted writing suggests that JCI is effective in quality increasing and safety of care in facilities that participate in the certification forum. The hospital system in the country has a compulsory rule that the entire private with the public health care should be in certification by the native certification body in the nation, the CBAHI (Gassiot, Searcy & Giles, 2016). Furthermore, some hospital institutions in the country have obtained certification in some national organs as Joint Commission International. Objectives in the research were in the evaluation of the perception in health professionals of the consequences of Joint Commission International on the health care quality. The work was an accomplishment in the certification center that of late joined an educational university.
Research questions
Research hypothesis
Research design
The cross-section research was at a Medical City in King Abdulaziz of Jeddah, Saudi Arabia, June and September 2016. A cross-section study collects information by interfering with an interest of the population in the element of time. Cross-section research has been in the description as exposure to the accumulation of the way they gather the information. Cross-section research may be in place several times. In a repeated cross-sectional study, respondents to the research at durations of times have no intentions in the sample, even if a respondent to an administration of the investigation may be in the random selection for an antecedent one.
Cross-sectional research may therefore line with pad research, for which a person respondents are followed over a while. Pad research usually is in conduction to measure the population change in learning. The healthcare has six hundred and fifty beds in several tertiary institutions of their specialist. It is in an attachment to Jeddah King Saud bin Abdulaziz, Saudi Arabia in Health Science University. The prior certification was at 23rd Nov year 2006, and from the time, it is then re-certified in periods. The research was in approval by the IRB of the Medical Research Centre (Ng, 2012).
Population and sample
The study populace was in comparison with medical technologies, nurses, dieticians, physicians, and other types of healthcare professionals. The responders were not in selection as a sampling method. Questions were distributed manually to all health care professionals in their decided department and collection by the use of cooperation with the managers, staff, and health professionals. To improve the rate of retrieval, factors like duty shifting, leaves, and day-offs were in determination to identify their availability and to ensure that they receive questions on the survey. The retrieval and collection of the research forms for each department tool had duration of about one to three weeks. All queries retrieved were screened based on the procedure for the inclusion that permitted only those participating. It started working before certification and continued with the job after and during certification and recertification.
The study utilized validated questions in adoption from the used tool by El-Jardalietal that is in utilization in many types of research. The English version of the queries has nineteen items that are divisive into three main parts; the first one is participation in certification that has five components. The second is the benefits of certification that have nine elements. Last, the quality of the outcomes of accreditation that has five items quality of results of accreditation. There were no changes and modifications in expression in all elements so that to maintain the content meaning. The questions employ the 5 points Likert scale with a verbal correspondence interpretation, first, strongly disagree, second, for the disagreeing, third, for neither disagree, fourth, agree, and finally strongly agree (Bourque, Clark & Clark, 2019).
In former researches, the reliability of the inter-later in the instruments for the three domains in both English and other languages, for example, Arabic and Turkey had a Cronbach’s of 0
.87
to 0.96, with an indication of higher responsibility. Demographic data concerning the participants inclusive of educational attainment, gender, profession, age, service department, and length were also in the collection. Information was retrieved and distributed by hand, not utilizing electronics.
Sampling techniques
Information was in analyzation by the use of IBMSPSS of version twenty-three. Demographic data is simplified by percentage together with frequencies, standard deviation together with means in every score (Meyers, Gamst & Guarino, 2013). A single way to test together with ANOVA was in use in determining the differences between groups in variables demographic. The coefficient of the Pearson correlation was in the calculation for the quality of the results. Significances in statistics were in definition by the five percent probability level with reliability of 95 percent.
Chapter four
Results
Data analysis
The 1360 research questions that in distribution, nine hundred and thirty-four were in return. Based on the criteria for comprehension, thirty-three were in exclusion, and nine hundred and one were in inclusion in the analysis. The majority of those who participated were nurses (n equals 488, over 54 percent), followed by the number of physicians (n equals 1
66
, over 18 percent). Most of the respondents who provided a department were from surgery (n equals 92, over 10 percent). There were only four (0.4 percent) respondents from the ICU. Healthcare certification had a significant suitable response from the many groups of professional health in all of the dimensions. The mean of this dimension measures participation in a certification (
3.7
9[0.66]), certification benefits (3
.85
[0
.84
]), this results in the ability of certification (3.54 [1.01])
Research results
Table one
Respondent’s demographic characteristics where n represents
901
|
Features |
n |
Percentage |
|||
|
Age |
|||||
|
25 to 30 |
283 |
31.4 |
|||
|
31 to 35 |
182 |
20.2 |
|||
|
36 to 40 |
128 |
14.2 |
|||
|
41 to 45
|
120 |
13.3 |
|||
|
46 to 50 |
63 |
7.0 |
|||
|
less than 51 |
66 |
7.3 |
|||
|
Total |
842 |
93.5 |
|||
|
Uncategorized |
59 |
6.49 |
|||
|
Overall |
901 |
100.0 |
|||
|
Sex |
|||||
|
Men |
226 |
25.1 |
|||
|
Ladies |
673 |
74.9 |
|||
|
Education level |
|||||
|
Certificate course |
11 |
1.2 |
|||
|
Diploma course |
137 |
15.2 |
|||
|
Bachelor’s |
607 |
67.4 |
|||
|
Masters holdings |
4.7 |
||||
|
Degree in doctorate |
45 |
5.0 |
|||
| Overall |
842 |
93.5 |
|||
|
Unsorted |
6.5 |
||||
| 901 | 100.0 | ||||
|
Service length |
|||||
|
Less than or equal to 5 |
406 |
45.1 |
|||
|
6 to 10 |
279 |
31.0 |
|||
|
11 to 15 |
148 |
16.4 |
|||
|
16 to 20 |
33 |
3.7 | |||
|
Greater than or equal to 21 |
35 |
3.9 |
Table two
The professional health team perception concerning the accreditation
|
A. Components on the participation of the respondents in the accreditation |
Mean |
Standard Deviation |
||
|
1. In the last study, the preparation of vital changes was in implementation in the hospital. |
882 |
3 .78 |
.80 |
|
|
2. I was inclusive in the implementation of the changes. |
880 |
3.76 |
.87 | |
|
3. I gained knowledge concerning recommendations in the hospital from the previous study (positive response). |
873 |
.78 | ||
|
4. The recommendations were a chance in the implementation of vital changes in the health center. |
878 |
3.88 |
||
|
5. I was included in the changes as a result of the accreditation referral. |
861 |
3 .79 |
.79 | |
| Total |
882 |
3.79 |
.68 |
|
|
B. Items concerning the benefits of certification |
||||
|
1. Certification grants improvement of sick care. |
886 |
4.06 |
.84 | |
|
2. Accreditation helps staff motivation and encourages collaboration and teamwork. |
883 |
3.90 |
.86 |
|
|
3. Accreditation helps in the development of the value shared by hospital professionals. |
884 |
3.94 |
||
|
4. Accreditation helps hospitals inappropriate usage of internal materials (for example; equipments, time, people, and finances) |
3.84 |
.85 |
Research discussion
In accreditation participation, the item “the recommendations were a chance to develop vital changes in the health center” had a larger reaction rate (standard deviation and mean, [0.78] 3.88). The next was “I was inclusive in the changes as a result of certification recommendations ([0.79] 3.79). The third one was “in the preparation of the last study, vital changes were in implementation in the healthcare” ([0.80] 3.78). It indicates important changes happening in the hospital in the survey preparation and participants inclusive in the study.
For accreditation benefits, the item “certification helps in improving the sick care” ([0.84] 4.06) had a vast reaction rate. The second one was “certification is a valuable item in implementing changes in the hospital” ([0.75] 4.05). The term “certification helps hospitals in the proper response to the populace needs” had a lower reaction rate ([0.82] 3.81). For the quality of the result in a component “over the last few years, facilities have had a huge health services quality” had a higher reaction response ([0.822] 3.77). The element, “over the last years, the facility had depicted measurable and steady improvements in the quality of the service provided by the administration (human materials and finance) had a lower reaction rate ([0.85] 3.57).
Team differences in certification participation had a significant difference in terms of age; F equals 4.39, df equals 5,830 and P is greater than .05. Sex; F equals 9.0, df equals 1,880 and P is greater than .05. Profession; F equals 5.20, df equals 11,824 and P is greater than .05. Department F equals 4.67, df equals 13,822 and P is greater than .05. In the category of accreditation benefits, respondents were differing. Profession; F equals 5.88; df equals 11,830, and P greater than .05. Department; F equals 8.27; df equals 13,828, and P greater than 05. Service length F equals 3.03; df equals 4,896 and P greater than 05. In the category of results quality, there was a huge difference in education levels; F equals 4.37, df equals 4,837, and P greater than 05. Profession; F equals 4.31; df equals 11,830, and P greater than 05. Department; F equals 4.13; df equals 13,828, and P greater than 05. Service length; F equals 2.97, df equals 4,896, and P greater than 05 (Perception of hospital accreditation among health professionals in Saudi Arabia, 2017).
Female scores; 3.87and those with fifty years and above are 3.97 had the highest participation rate. Certificates were 3.67 while those with a degree in bachelors have 3.67 with the highest scores in results quality. The sick technicians had higher scores of 3.98 in the participation category while medical practitioners had a higher score in accreditation benefits of 4.45 and the quality of a result of 4.07.
In terms of participation, the physicians have the lowest score of 3.47, 3.69 in accreditation benefits, and 3.28 in the quality of the result. Those in work between 11 and 15 years had 3.90 and between 16 and 20 years had 3.90 with the higher scores in participation. Five years and below had 3.92 in accreditation benefits. Between 11 and 15 ages, they had a score of 3.70 in the quality of the result. The business category had 4.00 and ambulatory care had 3.98 with the highest participation rate. Pathology and laboratory had higher results quality of 4.05 and accreditation benefits of 4.43.
Table three
Association independent and independent things
|
Independent variables |
Dependent variable (results quality) |
|||
|
Beta |
t |
P symbol |
||
|
Invariant |
.469 |
3.064 |
.002 |
|
|
Certification |
||||
|
Worker participation |
.335 |
7.482 |
.001 |
|
|
Accreditation benefits |
.478 |
10.871 |
Total ANOVA: R2 equals .331, F equals 217.491, and P equals .001
There was a statically positive relationship between results quality and accreditation benefits; t equals 10.87 and p equals .000. Workers’ participation; t equals 7.482 and p equal .000. The accreditation benefits where beta equals 0.478 accounts for the majority of variables in the dependent results quality variable. The total fixation equation had the highest significance; p is more than .001. A thirty-three percent of variances in results quality had its explanation in combined effects of accreditation benefits as well as workers’ participation. The unexplained variables will need further research.
Chapter Five
Conclusion
Accreditation is an evaluation process that can be in use to ensure hospitals are maintaining the highest standard of care. It is an externally administered instrument to promote continuous quality improvement. Obtaining accreditation is considered an indicator of commitment to quality and safety. It is becoming a substantial element for healthcare organizations to gain credibility, not only in developed countries but also in developing countries. Other than assuring patients of an acceptable level of quality of healthcare, for the organization itself, it stimulates continuous improvement in quality through self-assessment, review, and measurement by external auditors. There is an increase in recognition globally that healthcare institutional reforms are necessary to achieve Sustainable Development Goals and other health targets.
Key among them is institutional reforms aimed at strengthening the quality and safety of services and products provided through the health systems. It has become particularly important in the present time; with more informed patients seeking better service, and unlimited access to social media and puts providers at risk should they fail to meet client expectations. To remain relevant in the highly competitive industry, healthcare facilities are in force to adopt mechanisms that increase the likelihood of delivering quality and safe services. One way of providing this assurance is through seeking accreditation.
In research by Lutfivya, the performance difference in non-accredited and accredited hospitals was significant in favour of hospitals with accreditation (Babar, 2017). Certified hospitals tended appropriate performance baseline when in comparison with non-certified peer hospitals. It has its support from public reported measures of quality with the quality differences are most pronounced. Similarly, in four-year related research by Halasa, the JCI certification process may be improved in terms of sick care, inclusive of ICU return reduction in twenty-four hours of discharge, staff turnover reduction, and medical records completeness.
In our research, the results depict that healthcare employees are conformable to participate in the certification process since it has apparent importance. In our thoughts, complying with the measures set by the certification organization must benefit the hospitals in the change implementation in hospitals towards sick care services quality. The participation of various healthcare professional teams as well as ensuring motivation is crucially beneficial in aligning with the certification measures into practice.
Regardless of the substantial participation in our populace, physicians had a lower participation rate. Furthermore, they depicted lower scores on the accreditation benefits and the quality of the result of accreditation. The explanation of the outcomes needs further research. All participants in the previous JCI study participated once more in the certification and implementation of vital changes in the facility. It indicates their strong belief in the positive impacts of accreditation on the facility.
Accreditation may improve sick care as well as changes implemented in the facility, as depicted adopting of hand washing. However, in the research, we notice the perspective is limited in the facility context and do not address the populace’s health engagement and needs. We put a suggestion that accreditation must promote the health of communities. Updates in accreditation must encourage facilities to take programs partnering with MOH and population stakeholders in promoting healthy habits and appropriate management of chronic illnesses (Zwanenberg, 2019). Furthermore, accreditation must help in addressing other factors like social and economic factors that affect health. It should also encourage teaching facilities in training health workers in promoting proper practices as they go hand in hand with the populace management of health. Through this, accreditation should propel a cultural and professional shift in prioritizing the activities.
From periodic certification, the hospital in the research has maintained quality health delivery in those years. There was service inefficiency as a result of the facility administration, implying the certification must involve an evaluation and review of steps improving the service quality. Data usage in the accreditation method may help facilities in tracking improvement tasks, performance measures as well as evidence provision in complying with the accreditation measures.
There was one institution research and no comparison over the rest of large, medium, and small-sized facilities in Saudi Arabia that were certified by JCI. The study had its focus on the perceived effects of JCI certification on the process together with change implementation in the facility in healthcare tasks. The satisfaction of patients prior and after accreditation was non inclusive. Other outer elements would impact the ability of the result certification can be subjects in more research. There are problems on JCI reliability and transparency practices used in determination of the effect on care ability after accreditation. Empirical evidence is lacking in sustaining many claims concerning accreditation benefits.
In line with the study findings, accreditation had impacts on the method and change implementation as in perceptio n by healthcare professionals. Delivery of sick care implementation and the rest of the services were in observation by the participants. The study gives support to the conclusion that accreditation should be in consideration as a necessary tool in the improvement of quality in the delivery of healthcare systems. The research will help in increasing awareness of health workers specifically the physicians to the accreditation importance and encouraging accreditation participation.
It has been in confirmation by the adequate healthcare workforce that it is necessary to deliver the appropriate healthcare services and improve the health results (Kelly, 2011). In many countries developing such as Rwanda, there is an absence of facility supplies and staple equipment is one of the main issues that are often in depiction. The certification implementation benefit emerges as a theme on the safety of patients.
Most of the interviewees said that certification had an enhancement in this area and they had a view of preventing the unnecessary errors and reduction of risks in practice, so care systems and services are in optimization in general. The information analysis discloses that the two interviewee categories (doctors and nurses) had a claim that the implementation of the standards had an improvement towards the empowerment of staff and enabling them to make a better choice in their practice of the profession. The view below was in personification in the following quotes from individuals working as doctors and nurses at the sampled health center.
It declines mistakes and improves diseased safety, so this generally leads to diseased satisfaction. It stops wrongs and inclines the safety of the diseased, so I think it is a tool of initiating the culture of quality and safety. It is related to healthcare safety in a direct manner. It declines medical mistakes. I think the certification implementation in the hospital leads to reducing errors and costs and inclines the diseased security, to meet patient’s requirements and attain staff satisfaction and making sure they are satisfied.
Recommendations
Work Environment
On the issue of staffing levels and workload, the hospital should make efforts to increase the number of nurses working in each department based on the workload. It would then improve the working hours. It should not be a stop-gap measure like hiring locum nurses (temporary staff who are hired when there seems to be a need). More permanent nurses need to be employed. The clinical staff does not contest that documentation is important, however, changes need to be made to make it more focused and less burdensome. It, however, would need to be in practice in collaboration with JCI.
Even as this is in place, it is better not to compromise on the core principles of the quality initiative. There should also be an effort to improve the remuneration and benefits of nurses so that they are paid their working hours and towards the current market rates. It was in perception that since they do more work than nurses in other hospitals, then they should be paid more and given extra benefits. Any overtime work also needs to be compensated.
Involvement of nurses in decision making
Even as the management seeks the input of nurses through online surveys and department meetings, they should make a concerted effort to update staff on the findings of such surveys and the actions followed. This feedback would prevent disillusionment among nurses (Gurbutt, 2016). Management also needs to ensure that there are open communication channels and that staff feels free to air their views without victimization. It could be by holding open forums with select nurses representing various departments so that employees can give their suggestions and express their concerns; management can then respond directly. Staff involvement and participation will positively affect satisfaction.
Internal motivators
The management should improve on their recognition of nurses. It can be by simple mechanisms such as offering gratitude if they do something well or through official appreciation and recognition by senior management. When it comes to training, the managers should find a way of offering higher-level training opportunities inclusive of Bachelor’s degrees to those who have shown a commitment to working in the hospital. They can start small – sponsoring one or two nurses per department every year and then grow the numbers with time. Nurses should also have a fair chance when it comes to professional growth and career advancement. It is significant since for them to feel satisfied in the long run, they need to be challenged and have opportunities for promotion.
Certification must be in use for; Give formal acceptance by friends, both in the institution and all over the country. Encourages planning, provides vast data, and identifies areas to be changed. It is very significant in the recruitment of prominent students and faculty. Contribute to the authority that graduates of the programs have conventional preparation that meets the quality and nationally accepted standards. Credibility is enhanced. Help in the position program in accommodation of change in building institutional world. Site visits and self-study processes give chances to help in academic, institutional leadership and unit personnel to better have an understanding concerning the FCS program. Help in ensuring that an institution is a leader in the growth of consumer and family science professionals.
Help FCS discussion unit concerning the allocation of resources with university administrations. It may be a very firm factor in program retention discussion. May affect the amount of the state monies that an institution or unit receives. It offers a competitive advantage for careers, students, and programs. The satisfaction diseased after and before certification must be in inclusion. Sick comfort is a vital and mostly utilized indicator in measuring health quality because it affects clinical results, medical malpractice, and diseased retention. It impacts the timely, patient-centered, and efficient delivery of health care quality.
Diseased satisfaction is vital but an indicator that is very effective in measuring the success of hospitals and doctors. The article discusses the way of ensuring diseased satisfaction in a dermatologic manner. Diseased satisfaction is an attitude. Even if it does not guarantee that the diseased shall remain in loyalty to the hospital and doctors, it is still a firm factor of motivation. Diseased satisfaction is only a proxy or an indirect quality of hospital or doctor performance. Delivery of the diseased-focussed care needs that we give care in a particular manner, not only usually or sometimes, but always. It should be every sick at every period. Quality does not stand firm; it should be ascending and linear always. One should work to give a soar over and better care above every diseased expectation. A satisfied diseased is a builder practice.
Policymakers and managers in the Saudi Arabia healthcare center must expand the implementation of certification to cover all Healthcare’, whether private sector or public sectors, to ensure better quality care and excellence (Stover, 2019). The outcomes of this project must give a better lesson from the certification implementation in Saudi Arabia healthcare, in particular, and beyond the Middle East, in more pacifically, where this health care recently plan and implement to implement certification. Since the recent project did not measure diseased satisfaction from their future study, opinions needed to research the effects of the application of a certification program to satisfy the diseased.
To achieve quality and safety employees need to be involved and motivated. Highly motivated staffs are likely to have more job satisfaction and be less stressed. They are also more likely to be whole-heartedly involved in the organization. Healthcare professionals’ motivation to be involved in the accreditation process is critical. It is beneficial to ensure the full participation of healthcare workers in the accreditation process. Furthermore, healthcare organizations must not overlook the satisfaction of their staff as they are critically important in putting into practice accreditation standards.
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