Quality accreditation has an increasingly high profile. But is it just another certificate to go on the wall in radiology services’ reception? Or does it genuinely bring something new to standards and to patient care?
Accreditation is slowly but surely moving into the mainstream, both in healthcare and in other industries. In the UK, the Imaging Services Accreditation Scheme (ISAS) was opened for registration in June 2009 and the first Radiology Departments are now in the process of being accredited. However, many departments are taking a ‘wait and see’ approach. Questions such as, ‘What’s the point?’, ‘Is this going to become the norm?’, ‘How hard is it?’, ‘Does it make any difference?’, ‘Is it worth it?’ and ‘Will we have to?’ are asked commonly. This article explores the bigger picture about accreditation and the accumulating international evidence base that going through an accreditation process changes practice and improves care, but also describes a personal experience of going through the ISAS accreditation process first hand and what it really means in practice.
In 2006 Braithwaite et al stated: “Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in healthcare is viewed, as in other sectors, as a valid indicator of high quality organisational performance. However few studies have empirically demonstrated this assertion. The value of accreditation therefore remains uncertain and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers.”1
Two years later, Greenfield and Braithwaite further commented, “Accreditation, quality and continuous improvement have become an intrinsic part of the discourse and activities of health services. Internationally dating from the 1970s, health care accreditation programmes and accrediting organisations have emerged and developed. There are now many national accreditation organisations and an international body, the International Society for Quality in Health Care (ISQua) which has enrolled members in over 70 countries.” 2
This work by Greenfield and Braithwaite is the largest international study to date systematically reviewing the impact and/or effectiveness of accreditation. The review included a range of health accreditation schemes, including hospital accreditation, and was not confined to imaging, which is a relatively recent entrant into the accreditation arena. Topics considered included professional attitudes to accreditation, promoting change, organisational impact, financial impact, quality measures, programme assessment, consumer views or patient satisfaction, public discourse, professional
development, and surveyor issues.
Two consistent findings were recorded: that of accreditation promoting change in the organisation, and in promoting professional development. The activity of preparing and undergoing accreditation has been shown in several studies to promote change in health organisations3,4
43 2011 , particularly with respect to organisation and safety. In the studies reviewed,
the positive outcomes included the chance for staff to reflect on, and become engaged in, the operation of the organisation; the introduction of continuous quality programmes, improved documentation, improved safety and improved review systems. However to balance this accreditation was not shown to ensure high-quality care but was positively associated with some measures of quality. Yet, accredited hospitals showed significant positive change in six defined areas, which was not recognised in non-accredited organisations.
Pomey et al3 describe how the context in which accreditation takes place, including the
organisational context, influences the type of change dynamics that occur in Healthcare Organisation (HCO). They found that while accreditation itself was not necessarily the element that initiated change, the accreditation process was a highly effective tool for helping to introduce continuous quality improvement programmes to newly accredited or not-yet-accredited organisations; creating new leadership for quality improvement initiatives; increasing social capital by giving staff the opportunity to develop relationships; and for fostering links between HCOs and other stakeholders. They concluded that the accreditation process is an effective leitmotiv for the introduction of change but is nonetheless subject to a learning cycle and a learning curve. Institutions invest greatly to conform to the first accreditation visit and reap the greatest benefits in the next three accreditation cycles (three to 10 years after initial accreditation)3
.
work out your timesCale and double it
So how do these findings translate into, specifically, radiology accreditation programmes across the world? Accreditation has been in place in North America for a number of years. There are two major programmes, one run by the American College of Radiology5
, and another by the Joint Commission (an independent, not-for-profit
organisation that accredits and certifies more than 18,000 healthcare organisations and programmes in the United States6
).
IMAGING & ONCOLOGY
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