Title
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
WHO
World Health Organization
TABLE OF CONTENTS
iiDEDICATION
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
42
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’ rst 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, Franois, & 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 535 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.
Month Task
June
July
August
September
Literature review
Data collection
Data processing and analysis
Interpretation of results
Final report writing
Proofreading
EMBED StaticMetafile
Prospectus Meeting
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 1970s, Saudi Arabias 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 facilitys 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 facilitys 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
