Are accreditation surveys reliable?
Impact of Accreditation
Australia
- Greenfield, David
- Naylor, Justine
- Pawsey, Marjorie
- UNSW Centre for Clinical Governance Research
- Australian Council on Healthcare Standards (ACHS) and Ramsay Health Care
- Australian Research Council.
The purpose of this article is to test whether healthcare accreditation survey processes are
reliable.
Purpose – The purpose of this article is to test whether healthcare accreditation survey processes are reliable.
Design/methodology/approach – The study uses multiple methods to document stakeholder
experiences and views on accreditation survey reliability. There were 29 research activities,
comprising 25 focus groups, three interviews and a survey questionnaire. In total, 193 stakeholders
participated; 134 in face-to-face activities and 56 via questionnaire. All were voluntary participants.
Using open-ended questioning, stakeholders were asked to reflect upon accreditation survey
reliability.
Findings – Stakeholders perceived healthcare accreditation surveys to be a reliable activity. They
identified six interrelated factors that simultaneously promoted and challenged reliability: the
accreditation program, including organisational documentation and surveyor accreditation reports;
members’ relationship to the accrediting agency and survey team; accreditation agency personnel;
surveyor workforce renewal; surveyor workforce management; and survey team conduct including
coordinator role. The six factors realised shared expectations and conduct by accreditation
stakeholders; that is, they enabled accreditation stakeholder self-governance.
Practical implications – Knowledge gained can be used to improve accreditation program
reliability, credibility and ongoing self-governance.
We used a two-phase multi-method integrated approach to data collection and
analysis. We label this process the “stakeholder verification process”. Participants
were stakeholders directly associated with the ACHS accreditation program EQuIP;
they were surveyors drawn from the ACHS surveyor workforce, representatives from
ACHS member organisations and ACHS personnel. Participation was voluntary, with
no inducements. Data collection was through focus groups, interviews and a
questionnaire. Data recording was by hand at the time of each research activity. All
were conducted by the first investigator and used open-ended questioning to examine
stakeholder views on the study topics. We undertook thematic data analysis as they
were collected and engaged in reflexive discussions. The themes that emerged through
this process were discussed with focus groups participants and interviewees to confirm
their relevance, after they had revealed their views. Additionally, the literature
provided further issues for consideration in an iterative process whereby collection and
analysis were interwoven (Hammersley and Atkinson, 1995) – an analytic process that
has been used effectively in other research (Reeves and Lewin, 2004).
Phase one, conducted in late 2005, involved the surveyors. The research activities
involved 91 participants in 20 focus groups. Phase two, conducted during 2006 and
early 2007, involved representatives from member organisations and accreditation
agency personnel. In this phase there were nine research activities and 102
participants. Representatives from member organisations participated in one of four
focus groups held during 2006 or by responding to a questionnaire in early 2007;
participants numbered 35 and 56 respectively, within these activities. In 2006, eight
accreditation agency personnel participated in a focus group and another three in
individual interviews. In total, 29 research activities were undertaken with 193
participants; 134 in 25 focus groups, three individual interviews and 56 by
questionnaire.
Stakeholders perceived healthcare accreditation surveys to be a reliable activity. They
identified six interrelated factors that simultaneously promoted and challenged reliability: the
accreditation program, including organisational documentation and surveyor accreditation reports;
members’ relationship to the accrediting agency and survey team; accreditation agency personnel;
surveyor workforce renewal; surveyor workforce management; and survey team conduct including
coordinator role. The six factors realised shared expectations and conduct by accreditation
stakeholders; that is, they enabled accreditation stakeholder self-governance.
Our study identifies six factors that the shape accreditation process reliability. Further
research is necessary to understand the intricacies of inter-relationships between these
factors and also to quantify surveyor and survey team reliability on measurable
aspects of their roles. Through an analysis of these factors, we argue that reliability is
constructed into the accreditation process. That is, our research has described how
stakeholders are continually enacting a self-governing system that involves the
ongoing negotiation of all stakeholder expectations, interpretations and conduct. Not
surprisingly, the endeavour of creating accreditation judgements under conditions of
reliability is challenging and complex.
Completed