Accreditation cycles’ outcomes: Prospective study and Evaluation

As a rule, it is at the launching of a new accreditation cycle that the organisation prepares its staff for another round of challenges. It frequently includes the presentation of the new set of standards to be aimed for, responsibilities and the work timeline for the new season of improvements.

It is also supposed that at each of these pro-improvement cyclical movements, the organisation refreshes its values and reinforces the spirit of its mission as a motivation for success, in scenarios that change in accordance with internal and external factors.

Experience has shown us that healthcare accreditation programmes foster necessary changes and significant improvements in those institutions that adopt them consistently and coherently. However, despite their being felt and demonstrated in everyday practice, the real contributions of those cyclical changes have been subjected to little scientific proof over time. This is due, in part, to the lack of available data analysis at the end of accreditation cycles.

From my view, information on accreditation, besides that which is generated and registered through the on-going process, further requires a complementary source based on:

a) A comparative study of prospected outcomes at the start of the cycle and that, which was accomplished at the end;

b) An assessment of the success achieved, and

c) The level of value added to the day-to-day practice.

The data derived from these analyses are fundamental to a better understanding of the effectiveness of accreditation programmes within the scope of the participating organisations, around the world. 

A prospective study involves the capacity for a broad vision and a thorough search for the best that may be extracted from the actions stemming from the accreditation plans. Prospecting results from a 2- or 3-year cycle of corrective, preventative and internal development actions are the starting point for a self-result analysis. And it is a way of outlining the context on which the health organisation will focus its critical scrutiny and evaluation of the progress achieved, to create sustainable scenarios for its quality projects within the scope of its mission.

However, the exercise of outcome's prospection is not easy and requires a prior understanding of the accreditation methodology and an internal cultural level of foreseeing measurable results for operational improvement plans.

Organisations in their first accreditation cycle usually go through an initial period of cultural adaptation. The prospection of results at this phase is always a challenge. The first implementation's steps are slow. Organisations are focused on structuring the "what to do" to achieve the standards. The time of "organisational maturing" for the first external evaluation, from another side, is long and depends on a very well laid out strategy for engaging the entire staff. During this cycle, the institutional projects are thought through and designed, then undergo modifications as their operational plans are put into practice. The hits and misses many times define the best satisfactory result-oriented courses for achieving the standards. Also, generally, this maturation is not homogeneous. The staff's engagement and their commitment are not consistent. With rare exceptions, the start-up of an accreditation project is not a straight-line, uniform process, nor is it consensual. This is an obscure stage that generates a lot of “expectation” and little discernment about what the actual result will be in practical terms. Learning is a constant, but not always in the interest of all. Thus, the challenges of the management groups of these initial projects increase in proportion to the levels of adherence or resistance.

Starting the second cycle, with a broader understanding of the methodology adopted, organisations are already able to better define their goals for the accreditation.

In these cases, prospective studies help organisations to refine “expectations”, which were not tangible in the first cycle, and to establish attainable goals for critical measurements at the end of the second one.

This is a much clearer phase for everyone. From here on, the process changes in form and contents. What was supposed to be developed and what was put into practice have been presented in the first external assessment. In the second external evaluation, the basis for operational sustainment has possibly been implemented, and the processes are evaluated by the improvement they promote. The questions are no longer centre around what “exists” and deal with “how is it working” and whether is “useful” for the development of the institution.

It is assumed that organisations that have already gone through more than three accreditation cycles have an accumulated experience that allows them to design more reliable scenarios with a higher probability of being a correct choice in a prospection scenario. But even these more experienced institutions, in part, have not generated improvements' historic series or outcome's records over time they are involved in accreditation projects.

Based on this presupposition, I see that a greater systematisation of the record of the success achieved by a health organisation is still needed. And the prospection at the start of a cycle tends to help assume and prioritise the areas on which the effects of the accreditation should have the most significant impact as duly recorded at the end of the cycle.

In recent exercises with hospitals participating in accreditation programmes, it became clear that the most significant results for those hospitals are the effects on people's experiences when using their services, whether under in-patient or outpatient system. From this, we've concluded that the whole continuing improvement-oriented movement impacts, directly or indirectly, the touch points that each person has with the organisation. Whether a health professional, patient, family member or supplier, it is in the internal relational environment that the accreditation results need to be better identified, recorded and evaluated.

Along with this line of thought, I would say that prospective studies and evaluation of Accreditation cycles’ outcomes are still trends. But, reflecting on their applicability, one sees their relevance as a significant source of information, especially for future academic studies, for development and the innovation of the existing models of accreditation. 

©GOES DE SOUZA, C.H.
London, December 2017