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(2017) Assessing the Impact of Healthcare Accreditation from the Perspective of Professionals’ in Primary Healthcare Centres: a Mixed Methods Case Study from Kuwait

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(2017) Assessing the Impact of Healthcare Accreditation from the Perspective of Professionals’ in Primary Healthcare Centres: a Mixed Methods Case Study from Kuwait Alaradi, Limya Khalil (2017) Assessing the impact of healthcare accreditation from the perspective of professionals’ in primary healthcare centres: A mixed methods case study from Kuwait. PhD thesis. https://theses.gla.ac.uk/8855/ Copyright and moral rights for this work are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This work cannot be reproduced or quoted extensively from without first obtaining permission in writing from the author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Enlighten: Theses https://theses.gla.ac.uk/ [email protected] Assessing the Impact of Healthcare Accreditation from the Perspective of Professionals’ in Primary Healthcare Centres: A Mixed Methods Case Study from Kuwait Limya Khalil Alaradi MBBS, MPH Submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy General Practice and Primary Care Institute of Health and Wellbeing College of Medical, Veterinary, and Life Sciences University of Glasgow August, 2017 Abstract Objective: Although a modest body of literature exists on accreditation, little research has been conducted on the impact of accreditation on primary healthcare organizations in the Middle East. This study aimed to assess the impact of accreditation on primary healthcare centres in Kuwait, from the perspective of healthcare professionals. The study also aimed to develop an understanding of the impact of implementing an international programme of accreditation in the country‘s developing primary care system and to identify the facilitators and barriers resulting from the introduction of such a programme in the primary healthcare setting. Context: A range of methods were used in order to evaluate the impact of accreditation on primary healthcare centres in Kuwait following an accreditation programme implementation in selected public PHC centres. This included a systematic review, followed by fieldwork in Kuwait. Fieldwork comprised a quantitative survey based on Primary Healthcare (PHC) centres and qualitative interviews conducted with key healthcare professionals. The PHC centres were divided into early adopters and late adopters in order to explore possible differences in the perceptions of the health professionals in each setting. Subjects and Methods: The work employed a mixed methods approach, with three inter- linked studies in order to answer the research questions. The first study was a systematic review of the international literature published between 2003 and 2013. The results were analysed and guided using Normalization Process Theory which is often used to understand the implementation of complex interventions such as accreditation. The second study was a self-administered anonymous questionnaire distributed to 520 employees in three PHC centres defined as early adopters conducted in summer 2015. The return was 375 questionnaires achieving a 72 % response rate. Analysis included Pearson‘s Chi- squared tests to test for significance, Kruskal-Wallis tests and multiple regression models. The third study was qualitative semi-structured interviews with 18 key stakeholders in the Kuwaiti Ministry of Health, including the Quality and Accreditation department, local surveyors and heads of PHC centres. The interviews were conducted between October 2015 and June 2016. Finally the key results from each study were compared and synthesised using Normalization Process Theory to fully understand the ‗work‘ underpinning the implementation of accreditation. Results: Results from all the research methods were analysed and synthesised using Normalization Process Theory. While policies and those involved in the strategic planning of accreditation may have a clear idea of what accreditation was trying to achieve, this was ii not always clear to those on the ground. Becoming involved in the accreditation process and doing the work required by accreditation enabled individuals to develop a clearer view, and understanding of what accreditation was about. Taking part also helped individuals see the value and benefits of being an accredited organisation. Employee engagement and participation in the accreditation programme helped break down professional barriers, created a sense of teamwork, and increased confidence in the process and what accreditation was aiming to achieve. The systematic review identified several strategies that promoted staff engagement in the accreditation process, including selecting key facilitators or ‗champions‘, assigning credible leaders that champion continuous quality improvement, and explaining the ethos behind the accreditation process. The qualitative interviews suggested that staff awareness and involvement had increased, and that this may have empowered employees within the workplace and allowed them to voice their opinions more freely. The data across the three studies suggest that the more staff participated in the tasks associated with accreditation work, the more confident they tend to be about the positive impact that accreditation plays on quality improvement and the role they have to play in the process. Financial support for accreditation came up in all three studies, but particularly in the review and the interviews. Financial support was a major barrier which has affected several different aspects of the accreditation programme, including staffing issues, information dissemination, and training. Staff shortages and turnover were another issue that impacted the sustainability of the programme. An important facilitator during the accreditation process was the provision of training and documentation, including guidelines and clear standards. Finally accreditation was seen to improve the quality of services delivered, in particular through standardising delivery of services, improving the local healthcare culture and improving teamwork and collaboration across the PHCCs. Conclusion: The suggested findings show that while professionals project a positive attitude towards accreditation, their views are not built on substantial information and not supported by evidence based research or monitoring plans that could determine and quantify the exact benefits to accreditation when it comes to quality. While evaluating such quality improvement programmes can be difficult, it is not impossible. While this study contributed to the knowledge of how professionals perceive the outcomes of accreditation, there was no opportunity to assess patient views. Patient views of accreditation remains an under researched area and, again, a programme of research would beneficial to the long-term implementation of accreditation programmes. iii Table of Contents Abstract ................................................................................................................................. ii Table of Contents ................................................................................................................. iv List of Appendices ................................................................................................................. x List of Tables........................................................................................................................ xi List of Figures ...................................................................................................................... xv List of Boxes and Diagrams ............................................................................................... xvi Dedication ......................................................................................................................... xvii Declaration ........................................................................................................................... xx List of Abbreviation ........................................................................................................... xxi Definition of Key Terms .................................................................................................. xxiii CHAPTER 1: Introduction and overview of the study .......................................................... 1 1.1. Introduction ............................................................................................................. 1 1.2. Background ............................................................................................................. 2 1.2.1. Accreditation in the Middle East ............................................................................. 4 1.3. Context .................................................................................................................... 4 1.4. Outline of the thesis topic ........................................................................................ 4 1.5. Aim and objectives .................................................................................................. 5 1.6. Methodological approach ........................................................................................ 5 1.7. Thesis structure ........................................................................................................ 6 CHAPTER 2: The history and characteristics of the state of Kuwait .................................... 8 2.1. Introduction ............................................................................................................
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