Carrasco-Peralta J A, Herrera-Usagre M, Reyes-Alcázar V, Torres-Olivera A
Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain.
Andalusian Agency for Healthcare Quality/Pablo de Olavide University, Department of Sociology, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain.
J Healthc Qual Res. 2019 Mar-Apr;34(2):59-65. doi: 10.1016/j.jhqr.2018.09.007. Epub 2019 Feb 1.
Healthcare accreditation seeks to promote the organisational change in healthcare organisations from an approach that values the level of progress achieved through a validated reference framework. The aim of this paper is to analyse the role played by accreditation through the experience perceived by health professionals during the process of self-assessment and external evaluation, taking into account three dimensions of analysis: focus on the patient, internal organisation and leadership, and impact on the clinical aspects of healthcare.
Design: Semi-structured interviews with key informants from clinical management units (CMU) within the Andalusian Health System (Spain).
The key informants in each CMU were the clinical leader, the head of nursing and two health professionals (doctors and nurses). A qualitative research protocol was employed to conduct the semi-structured interviews (n=52 interviews) with physicians and nurses, in order to analyse their experience with the accreditation process.
The analysis identified four main outcomes related to the accreditation process perceived by professionals: (1) A benchmarking conceptualisation of the process; (2) Improvements in patient-centred care, quality of clinical records, and organisational culture of the units; (3) Improvement of patient safety culture; (4) As negative outcomes, a slight perception of bureaucratisation and standardisation of the clinical practice.
The described initiative of accreditation process in Andalusia (Spain) is widely perceived as positive by health professionals since it fosters the organisational change, although it also has a slightly negative bureaucratisation effect on clinical practice.
医疗保健认证旨在通过一种重视通过经过验证的参考框架所取得的进展水平的方法，来推动医疗保健组织的组织变革。本文的目的是通过卫生专业人员在自我评估和外部评估过程中的感知经验，分析认证所发挥的作用，同时考虑三个分析维度：以患者为中心、内部组织与领导，以及对医疗保健临床方面的影响。
设计：对西班牙安达卢西亚卫生系统内临床管理单位（CMU）的关键信息提供者进行半结构化访谈。
每个CMU的关键信息提供者为临床负责人、护理主管和两名卫生专业人员（医生和护士）。采用定性研究方案对医生和护士进行半结构化访谈（共52次访谈），以分析他们在认证过程中的经验。
分析确定了专业人员对认证过程感知到的四个主要结果：（1）该过程的标杆管理概念；（2）以患者为中心的护理、临床记录质量和单位组织文化得到改善；（3）患者安全文化得到改善；（4）作为负面结果，临床实践中存在轻微的官僚化和标准化感知。
西班牙安达卢西亚所描述的认证过程举措被卫生专业人员广泛视为积极的，因为它促进了组织变革，尽管它对临床实践也有轻微的负面官僚化影响。
