Vergelijkende studie van ... - KCE

24 Hospital Accreditation KCE reports 70
This in turn should play in favour of the eventual care received by the patient. The
reasons why the existing accreditation programmes have (yet) not integrated outcome
standards seem many-fold:
• Accreditation is not a single defined intervention 26 : Impact on the
outcomes is not merely related to the actions of the hospital but also
a result of the interactions with other actors
• Stakeholders rarely agree on the intended outcomes 27 : and as long as
the causal relationship between accreditation programmes is not
proven it will be ‘easier’ to include process indicators in the standards
• The respective authorities in the Member States do not formally
engage in an evaluation of the respective accreditation programmes in
place (except for NHS QIS and Healthcare Commission, who have
evaluations underway), meaning that apparently there is belief that the
creation of quality dynamics at hospital level, resulting in optimization
of processes & procedures, modified organisation structures and
creation of a quality culture, does inevitably lead to improved
outcomes.
As far as (scientific) comparative analyses were launched to evaluate established
programmes of their outcome impact, the lack of evidence is confirmed and/or the
evaluations have not used comparable methods to permit synthesis 20 .
The experience of the last decade shows that accreditation has been a valuable means
for quality improvement dynamics in many settings. Yet, as mentioned no link between
outcomes and accreditation programmes can be proven and the International survey did
not shed any additional light either. The effectiveness of an accreditation programme, as
well as its affordability and whether it will be sustainable, depends on many variable
factors (regulation, incentives, perception,…) of the specific healthcare environment of
the country or organisation involved. It also depends on the kind of programme, and
how it is implemented 4 .
To conclude, despite the amount of time and money spent on hospital accreditation
programmes, there is relatively little research into the cost effectiveness of these
schemes, and therefore still no proof of improved outcomes as a (direct) link to
programmes implemented. Based on the articles included in the literature study, with a
focus on the JCAHO experience, it could be stated however, that accreditation has
been a valuable means for quality improvement dynamics in many hospitals.
Key points
• No evidence was found for a positive causal relation between
accreditation and outcome
• Accreditation programs focus importantly on structure and
organisational processes with less importance given to clinical outcome
indicators
• A model based approach to study the relation between accreditation and
outcome should be defined
• Accreditation may initiate a quality improvement dynamic in an
organization