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Title: The impact of hospital accreditation on quality improvement in Kuwait : perceptions of staff and patients
Author: Alkhabbaz, M.
ISNI:       0000 0004 7428 4149
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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Introduction and methods: Healthcare organizations are constantly looking for ways to improve quality, safety and outcome of care, while reducing cost. Quality of health care was identified as a key element for improved health outcomes and efficiency. Many approaches to improve the quality of healthcare have been identified and accreditation programs are among the most popular ones. In Kuwait, the national accreditation program has been developed and implemented recently as part of the health reform strategy. Although many countries are embarking on accreditation, and despite being a complex and resource intensive process, the evidence base for accreditation is incomplete. The aim of this study is to investigate the relationship between implementation of accreditation and quality improvement in Kuwait's public hospitals as perceived by staff and patients. The study had a prospective longitudinal design (baseline and 16-18 months later) and used mixed methods, where the Malcolm Baldrige dimensions were used to examine the effects of accreditation implementation on staff and patient quality perceptions. Four public hospitals were involved in the study, which were divided into two groups based on their degree of accreditation implementation: hospitals with broad implementation of accreditation (BIA) and hospitals with limited implementation of accreditation (LIA). Results: Accreditation was implemented adequately in both hospital types to have an impact on quality. Staff identified a number of enablers and barriers during the process of implementation. They also reported that accreditation resulted in a number of improvements in care provided by Kuwait's hospitals. Comparison of BIA and LIA hospitals showed that BIA hospitals scored higher than LIA hospitals in all Baldrige dimensions at baseline, these dimensions improved significantly in LIA hospitals as they implemented accreditation, and scores of Baldrige dimensions of LIA hospitals at followup increased towards those of BIA hospitals at baseline where they would be at a similar stage of implementing accreditation. Analysis of staff data from BIA and LIA hospitals indicated a strong positive relationship between implementing accreditation and staff perceptions of quality. Analysis of patient data from BIA and LIA hospitals again showed a positive relationship between implementing accreditation and patient perceptions of quality. Four of the Baldrige dimensions mediated the impact of accreditation on staff perceptions of quality, while all dimensions were linked to patient perceptions of quality. Analysis of patient group interviews showed an overlap between the concerns of patients about hospital service quality with the quantitative measures used in this study. Conclusions: In this study, accreditation was positively associated with quality improvement in the public hospitals, as perceived by staff and patients. A number of challenges faced the implementation of accreditation and that need to be resolved to improve the program's application. Equally, a number of enablers were identified and these should be encouraged in hospitals embarking on accreditation. Implementation of accreditation brought a number of positive changes to the quality of care in Kuwait's hospitals. This study could encourage the Ministry of Health to adopt a national strategy for quality in healthcare to gain the most out of their quality improvement activities including the national accreditation program.
Supervisor: Hassan, A. ; Mohamed, G. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral