Department of Economic, risk management and planning, University of Stavanger, 4036, Stavanger, Norway.
Department of Health and Nursing Science, University of Agder, 4604, Kristiansand, Norway.
BMC Health Serv Res. 2020 Mar 23;20(1):242. doi: 10.1186/s12913-020-05093-w.
Hospital certification is an external assessment mechanism to assure quality and safety systems. Auditors representing the certification body play a key role in certification processes, as they perform the assessment activities and interact with the involved healthcare organizations. There is limited knowledge about the approaches and methods that auditors use, such as role repertoire, conduct, and assessment practice. The purpose of this study was to explore auditors' practice in hospital certification processes, guided by the following research questions: What styles do auditors apply in hospital certification processes, and how do auditors perceive their role in hospital certification processes?
The study was performed in two stages. In the first stage, non-participant observations (59 h) were conducted, to explore the professional practice of three lead auditors in certification processes of Norwegian hospitals. In the second stage, semi-structured interviews were conducted with these three observed lead auditors. The role repertoires and conducts identified were analyzed by using a deductive approach according to a surveyor (equivalent with auditor) styles typology framework.
Two distinct auditor styles ("explorer" and "discusser") were identified among the three studied auditors. Both styles were characterized by their preference for an opportunistic and less structured type of interview practice during certification audits. All three auditors embedded a guiding approach (reflections about findings, stimulate improvements, experience transfer from other industries) to their perception and practice of certification audits, interacting with the auditees. The use of group interviews instead of individual interviews during certification audits, was the rule of their professional practice.
The auditors' perceptions and styles demonstrated a multifaceted certification reality, in contrast to what is often presumed as consistent, stringent and independent practices. These findings may have implications for reliability judgements when developing hospital certification programs, and for the refinement of the current framework used here to study the different auditing practices.
医院认证是一种保证质量和安全系统的外部评估机制。认证机构的审核员在认证过程中起着关键作用，因为他们执行评估活动并与相关医疗机构进行互动。关于审核员使用的方法和手段，例如角色、行为和评估实践，知识有限。本研究的目的是探讨审核员在医院认证过程中的实践，研究问题如下：审核员在医院认证过程中采用哪些风格，以及他们如何看待自己在医院认证过程中的角色？
该研究分两个阶段进行。在第一阶段，进行了非参与式观察（59 小时），以探讨三位首席审核员在挪威医院认证过程中的专业实践。在第二阶段，对这三位观察到的首席审核员进行了半结构化访谈。根据审核员风格类型学框架，使用演绎法分析确定的角色和行为。
在研究的三位审核员中，确定了两种不同的审核员风格（“探索者”和“讨论者”）。这两种风格的特点都是在认证审核中偏爱机会主义和较少结构化的访谈方式。三位审核员都将一种引导方法（对发现的思考、激励改进、从其他行业转移经验）嵌入到他们对认证审核的看法和实践中，与被审核者进行互动。在认证审核中使用小组访谈而不是单独访谈是他们专业实践的规则。
审核员的看法和风格展示了多方面的认证现实，与通常认为的一致、严格和独立的做法形成对比。这些发现可能对制定医院认证计划时的可靠性判断以及对当前用于研究不同审核实践的框架的改进产生影响。
