Galukande Moses, Katamba Achilles, Nakasujja Noeline, Baingana Rhona, Bateganya Moses, Hagopian Amy, Tavrow Paula, Barnhart Scott, Luboga Sam
Makerere University College of Health Sciences, Kampala, Uganda.
Department of Global Health, University of Washington, Seattle, Washington, USA.
Int J Health Plann Manage. 2016 Jul;31(3):e204-18. doi: 10.1002/hpm.2317. Epub 2015 Oct 6.
Whereas accreditation is widely used as a tool to improve quality of healthcare in the developed world, it is a concept not well adapted in most developing countries for a host of reasons, including insufficient incentives, insufficient training and a shortage of human and material resources. The purpose of this paper is to describe refining use and outcomes of a self-assessment hospital accreditation tool developed for a resource-limited context.
We invited 60 stakeholders to review a set of standards (from which a self-assessment tool was developed), and subsequently refined them to include 485 standards in 7 domains. We then invited 60 hospitals to test them. A study team traveled to each of the 40 hospitals that agreed to participate providing training and debrief the self-assessment. The study was completed in 8 weeks.
Hospital self-assessments revealed hospitals were remarkably open to frank rating of their performance and willing to rank all 485 measures. Good performance was measured in outreach programs, availability of some types of equipment and running water, 24-h staff calls systems, clinical guidelines and waste segregation. Poor performance was measured in care for the vulnerable, staff living quarters, physician performance reviews, patient satisfaction surveys and sterilizing equipment.
We have demonstrated the feasibility of a self-assessment approach to hospital standards in low-income country setting. This low-cost approach may be used as a good precursor to establishing a national accreditation body, as indicated by the Ministry's efforts to take the next steps. Copyright © 2015 John Wiley & Sons, Ltd.
虽然认证在发达国家被广泛用作提高医疗质量的工具，但由于一系列原因，包括激励不足、培训不足以及人力和物力资源短缺，这一概念在大多数发展中国家并不适用。本文旨在描述为资源有限的环境开发的医院自评认证工具的优化使用情况和结果。
我们邀请了60名利益相关者审查一套标准（据此开发了一个自评工具），随后将其完善为包括7个领域的485项标准。然后我们邀请了60家医院进行测试。一个研究小组走访了同意参与的40家医院中的每一家，提供培训并对自评情况进行汇报。该研究在8周内完成。
医院自评显示，医院对坦率评估其绩效非常开放，并愿意对所有485项指标进行排名。在推广项目、某些类型设备和自来水的可用性、24小时员工呼叫系统、临床指南和废物分类方面表现良好。在弱势群体护理、员工宿舍、医生绩效评估、患者满意度调查和消毒设备方面表现不佳。
我们已经证明了在低收入国家背景下对医院标准采用自评方法的可行性。正如卫生部为采取下一步措施所做的努力所示，这种低成本方法可作为建立国家认证机构的良好前奏。版权所有© 2015约翰·威利父子有限公司。
