El-Jardali Fadi, Jamal Diana, Dimassi Hani, Ammar Walid, Tchaghchaghian Victoria
Health Management and Policy Department, American University of Beirut, Lebanon.
Int J Qual Health Care. 2008 Oct;20(5):363-71. doi: 10.1093/intqhc/mzn023. Epub 2008 Jul 1.
In developing countries, accreditation is increasingly being used as a tool for government regulation to guarantee quality of care. Although Lebanon is the first country in the East Mediterranean Region to develop and implement accreditation standards, little is known yet on its impact on quality of care.
To assess the perceived impact of accreditation on quality of care through the lens of health care professionals, specifically nurses. This paper also investigates the perceived contributing factors that can explain change in quality of care.
A cross-sectional survey design where all hospitals that successfully passed both national accreditation surveys (I and II) were included. A total of 1048 registered nurses from 59 hospitals were sampled. The survey tool, assessing quality of care and contributing factors, includes nine scales and subscales rated on five-point Likert scale.
The high score for the variable 'Quality Results' indicates that nurses perceived an improvement in quality during and after the accreditation process. Predictors of better Quality Results were Leadership, Commitment and Support, Use of Data, Quality Management, Staff Involvement and hospital size. The variable Quality Management, as measured by the scale Quality Management, had the greatest impact in medium-sized hospitals while the subscale measuring Staff Involvement had the greatest impact in small-sized hospitals.
According to Lebanese nurses, hospital accreditation is a good tool for improving quality of care. In order to ensure that accreditation brings effective quality improvement practices, there is a need to assess quality based on patient outcome indicators.
在发展中国家，认证越来越被用作政府监管的工具，以保证医疗质量。尽管黎巴嫩是东地中海区域第一个制定并实施认证标准的国家，但对于其对医疗质量的影响，目前所知甚少。
通过医疗保健专业人员，特别是护士的视角，评估认证对医疗质量的感知影响。本文还调查了可能解释医疗质量变化的感知促成因素。
采用横断面调查设计，纳入所有成功通过两次国家认证调查（第一次和第二次）的医院。从59家医院抽取了总共1048名注册护士作为样本。评估医疗质量和促成因素的调查工具包括九个量表和子量表，采用五点李克特量表评分。
“质量结果”变量的高分表明，护士认为在认证过程期间及之后质量有所改善。质量结果较好的预测因素是领导力、承诺与支持、数据使用、质量管理、员工参与和医院规模。以质量管理量表衡量的质量管理变量在中型医院影响最大，而衡量员工参与的子量表在小型医院影响最大。
根据黎巴嫩护士的看法，医院认证是提高医疗质量的良好工具。为确保认证带来有效的质量改进措施，有必要根据患者结局指标评估质量。
