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Effect of Hospital Accreditation on Patient Safety Culture and Satisfaction: a Systematic Review

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Effect of Hospital Accreditation on Patient Safety Culture and Satisfaction: a Systematic Review EFFECT OF HOSPITAL ACCREDITATION ON PATIENT SAFETY CULTURE AND SATISFACTION: A SYSTEMATIC REVIEW Yunita Hapsari, Amal Chalik Sjaaf Faculty of Public Health, Universitas Indonesia ABSTRACT Background: Hospital accreditation is carried out to improve the quality of hospital services and patient safety. This study aimed to statistically review the effect of hospital accreditation on patient safety culture and satisfaction. Subjects and Methods: A systematic review was conducted through articles searching. Four electronic databases namely PubMed, ProQuest, Scopus, and EBSCO were used in this study. The keywords were "hospital accreditation", "patient safety culture", "patient satisfaction", “improving”, and “impact". The inclusion criteria in this study were articles in the span of ten years of publication, and using English. The articles were selected by PRISMA flow diagram. Results: Ten journal reported that accreditation had a significant influence on patient safety culture. There was difference in patient satisfaction among accredited and non-accredited hospitals, but it was not statistically significant. Two articles mentioned that patient satisfaction was driven by hospital physical facilities. Patient safety culture after hospital accreditation was associated with commitment and support from all hospital staff and leadership. Service quality and patient satisfaction were associated with ongoing evaluation of the accreditation implementation. Conclusion: Hospital accreditation has an effect on patient safety culture and satisfaction. Improving patient safety culture after hospital accreditation requires commitment and support from al hospital staff and leadership. Ongoing evaluation of the accreditation implementation needs to be carried out to improve service quality and patient satisfaction. Keywords: accreditation, patient safety, culture, patient satisfaction, hospital Correspondence: Yunita Hapsari. Faculty of Public Health, Universitas Indonesia, Depok, West Java. Email: [email protected]. Mobile: 081808101539. BACKGROUND providing patient safety culture in hospitals, Accreditation is a learning process and conti- controlling costs, making management effect- nuous quality improvement in maintaining tive, and building initiative in term of patient the quality of services of patient health with a safety from organizations that participate in predetermined standard (Al-Awa et al., accreditation. Achieving accreditation is a 2012). One of the efforts carried out by strong statement to show the public about countries around the world in improving per- the organization's efforts to provide the formance are through accreditation, because highest quality service. (Marzban et al., 2017; it is an influential mechanism for assessing Sack et al., 2011). the performance of health care organizations Nowadays, international accreditation (Pomey et al., 2010, Jaafaripooyan et al., organizations require assessing patient safety 2011). culture to identify strengths and weaknesses Accreditation is considered a key com- of patient safety culture, evaluating emplo- ponent and prioritizes patient safety and qua- yees in teamwork, management and leader- lity of service. In addition, accreditation is ship that support patient safety, frequency of useful for improving risk management, incident reporting, and identifying existing The 6th International Conference on Public Health Best Western Premier Hotel, Solo, Indonesia, October 23-24, 2019 | 547 https://doi.org/10.26911/the6thicph-FP.04.42 patient safety culture problems (Deilkås and standards might not be sensitive enough to Hofoss, 2008; El-Jardali et al., 2011). evaluate the actual improvement. Therefore, The truth of the statement of “hospital the evaluation can be seen on the spot only accreditation will ensure good quality health during the accreditation survey. In addition, service” is doubtful. It shows the need to the impact is over after the survey is provide evidence that accreditation proce- completed. dures can surely improve health services, thus increasing patient satisfaction (Sack et SUBJECTS AND METHOD al., 2010; Pomey et al., 2010). 1. Study Design However, the impact of accreditation This was systematic review study using PRIS- on quality of services and patient safety is MA-P (Preferred Reposting Items for little known (Al-Awa et al., 2012). A previous Systematic Review and Meta-Analysis Pro- study on the impact of hospital accreditation tocol). The researchers searched for articles status on patient satisfaction showed that from 4 databases namely PubMed, ProQuest, there was non-significant impact of hospital Scopus, and EBSCO. The keywords were accreditation on patient satisfaction (Hayati, "hospital accreditation", "patient safety et al., 2010; C. Sack et al., 2011). culture", "patient satisfaction", “improveing”, Another study showed that there were and “impact". differences and there was no correlation bet- 2. Inclusion and Exclusion Criteria ween quality of services and the accreditation The inclusion criteria were journal articles in program based on the patient perspective the span of ten years of publication and using (Aboshaiqah et al., 2016). According to English. Based on the investigation, there Devkaran and O'Farrell (2015), accreditation were 10 relevant articles to be reviewed. The 6th International Conference on Public Health Best Western Premier Hotel, Solo, Indonesia, October 23-24, 2019 | 548 https://doi.org/10.26911/the6thicph-FP.04.42 Records identified Records identified Records Records identified through ProQuest through Pubmed identified through (n = 88 ) database through Scopus EBSCO ( n = 48 ) ( n = 12 ) ( n = 15 ) Overall search result (n = 893) Duplicate removed n = 721 Records Records screened for last 5 years and public health article excluded n = 172 n = 141 Records screened for title and abstracts Article n =31 Excluded n = 21 Full texted article assessed for eligibility in synthesis study n = 10 Figure 1. PRISMA Flow Diagram RESULTS that there was no significant difference Based on 10 articles reviewed, 3 articles between accredited and non-accredited mentioned that the implementation of pa- hospitals and patient satisfaction. This means tient safety culture significantly increased that there is no correlation between hospital after accreditation. Accredited hospital had a accreditation and patient satisfaction. better overall perceived safety, including the However, 2 other articles mentioned that frequency of reporting incidents/safety inci- patient satisfaction increased after accredit- dents compared to hospitals that had not tation. been accredited yet. Four other articles stated The 6th International Conference on Public Health Best Western Premier Hotel, Solo, Indonesia, October 23-24, 2019 | 549 https://doi.org/10.26911/the6thicph-FP.04.42 Table 1. Article of systematic review Author No Tittle Place Study Design Results Conclusion (year) There was a correlation between patient The study states the satisfaction scores and length of stay, importance of developing Association between type of hospital, human resources, an accreditation system Mohebbifar et Hospital Accreditation and cross-sectional physical structure and medical devices, based on outcome Iran 1 al. (2017) Patient Satisfaction: A information and education, access to parameters and providing Survey in the Western services, management and service responsive services to Province of Iran coordination. There was non-significant patients that can have a correlation between hospital positive impact on their accreditation and patient satisfaction. satisfaction. Cross-sectional Benchmarking the post- retrospective 605 nurses who answered the Accreditation is accreditation patient Jeddah, and questionnaires strongly agreed that significantly related to 2 Al-Awa et al. safety culture at King Saudi prospective accreditation increased the perception of patient safety culture (2012) Abdulaziz University Arabia. study post- patient safety culture Hospital accreditation "Recommendation rate Challenging the holy grail of a given hospital" for accredited Hospital accreditation can of hospital accreditation: hospitals (65.6%, 95% Confidence Sack et al. increase quality of service, 3 A cross sectional study of German Cross-sectional Interval (CI) 63.4 - 67.8%) and non- (2010) but it does not increase inpatient satisfaction in accredited hospitals (65.8%, 95% CI 63.1 patient satisfaction. the field of cardiology - 68.5%) showed non-significant differences This study confirms the Most of the patients (76.34%) were not importance of considering satisfied with the quality of service. There Exploring the Relationship patient perspectives in the was statistically non-significant between Accreditation and development and correlation between the classification of Patient Satisfaction – The implementation of 4 Hajali et al. accreditation and patient satisfaction. Case of Selected Lebanese Lebanon Cross sectional accreditation systems. (2014) However, tangibility dimensions that Hospitals Accreditation is not the reflect structural aspects of the hospital only cause of patient such as physical facilities and equipment satisfaction. However, were related to patient satisfaction. hospitals are asked to The 6th International Conference on Public Health Best Western Premier Hotel, Solo, Indonesia, October 23-24, 2019 | 550 adopt complementary ways to increase patient satisfaction. Investigation of the Hospitals with project preparation for If accredited hospitals in conditions affecting
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