A review of Canadian and Danish accreditation methodologies, to inform hospital inspections within Healthcare Improvement Scotland and support improved patient outcomes.
The overall aim of the study tour was to increase and broaden my knowledge and understanding of other survey and inspection processes in order to inform the methodology of the older people in acute care hospital inspections within Healthcare Improvement Scotland (HIS), my place of work. Although inspection differs from accreditation, in that Scottish hospitals are not graded and there are statutory powers in place of regulatory powers, the focus of both is on reviewing patient care against nationally recognised evidence based standards, identifying good practice and identifying areas which require improvement.
Visits to Canada and Denmark were organised to take place in 2014. ‘Accreditation Canada’ is the organisation which accredits all hospital settings and in Denmark it is ‘IKAS’. Both organisations are themselves accredited by the International Society of Quality in Healthcare which covers the survey processes and education programmes for surveyor competencies.
In Canada, accreditation is mandatory in Quebec and Alberta. For all other provinces, it is voluntary, although the vast majority do participate. Accreditation is also mandatory in Danish healthcare settings.
The opportunity to observe a full hospital survey as an observer with the accreditation team in both countries provided many opportunities to learn and discuss how surveyors plan, undertake and report on site visits. It was valuable to observe how surveyors interact and engage with different members of the hospital team and how they evidence hospital compliance in meeting the numerous accreditation standards. The focus is clearly on continuous quality improvement in patient care and the surveyors examine in a range of ways how individual hospitals are working to achieve this.
Some of the challenges and limitations of accreditation were also identified, including the preparation involved ahead of the announced survey visits, attributing accreditation to improved patient outcomes and the degree to which patient involvement and feedback is sought.
In addition to observing the hospital surveys, separate interview meetings were also held with managers in two hospitals in Ontario to discuss the accreditation process from their perspective. In Denmark, additional meetings were also held with the Deputy Chief Executive of IKAS, the Danish Institute for Quality and Accreditation in Healthcare and the Danish Medicine and Health Authority. All of these additional meetings provided context, background information and the opportunity to discuss aspects of the respective programmes in person.
In considering different aspects of each accreditation survey and the outcomes of each arranged meeting, several recommendations for consideration have been made, to inform the inspection methodologies within Healthcare Improvement Scotland.