Clinical Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
Emergency Department, Health Sciences North, Sudbury, Ontario, Canada.
BMJ Open. 2023 Sep 14;13(9):e073064. doi: 10.1136/bmjopen-2023-073064.
Social accountability is an equity-oriented health policy strategy that requires institutions to focus on local population needs. This strategy is well established in health professional education, but there is limited understanding of its application in healthcare service delivery. Building on what is known in the education setting, this study aimed to explore the development of a framework of comprehensive, evidence-based social accountability standards for healthcare service delivery institutions.
This qualitative, multipart, multimethods study consisted of a modified Delphi process guided by an evidence-based social accountability tool for health professional education and complementary methods including developmental evaluation and a review of select literature to capture emerging evidence and contextual relevance.
The study took place in Northern Ontario, Canada at a medical school and a tertiary, regional academic health sciences centre that are both grounded in social accountability.
Eight expert participants from diverse, multidisciplinary backgrounds, including a patient advocate, were purposefully recruited from both institutions, enrolled and seven completed the study.
The resulting framework of social accountability standards is organised into 4 major sections that capture broad and critical concepts; 17 key component reflective questions that address key themes; 39 aspirations that describe objective standards and 197 indicators linked to specific expectations.
Three modified Delphi rounds were completed producing a framework of consensus derived standards. Developmental evaluation helped identify facilitators, barriers and provided real-time feedback to the study's processes and content. The literature reviewed identified 10 new concepts and 43 amendments.
This study highlights the development of a comprehensive, evidence-based framework of social accountability standards for healthcare service delivery institutions. Future studies will aim to evaluate the application of these standards to guide equity-oriented social accountability health policy strategies in healthcare service delivery.
社会问责制是一种以公平为导向的卫生政策策略，要求各机构关注当地人口的需求。该策略在卫生专业教育中已经得到很好的建立，但在医疗服务提供方面，对其应用的理解有限。本研究旨在借鉴教育背景下的已有知识，探索制定一套全面、以证据为基础的医疗服务提供机构社会问责制标准框架。
这是一项定性的、多部分的、多方法研究，包括一个经过修改的德尔菲流程，该流程由卫生专业教育的循证社会问责制工具指导，并辅以发展性评估和对精选文献的审查，以捕捉新出现的证据和背景相关性。
该研究在加拿大安大略省北部的一所医学院和一所三级区域性学术卫生科学中心进行，这两个机构都以社会问责制为基础。
从两个机构中，有目的的招募了来自不同学科背景的 8 名专家参与者，包括一名患者倡导者，他们都具有多样性，完成了研究的招募并完成了 7 轮调查。
产生的社会问责制标准框架分为 4 个主要部分，涵盖广泛而关键的概念；17 个关键组成部分的反思性问题，解决关键主题；39 个愿望，描述客观标准和 197 个与具体期望相关的指标。
完成了三轮修改后的德尔菲调查，产生了一套共识标准框架。发展性评估有助于确定促进因素、障碍，并为研究的过程和内容提供实时反馈。所审查的文献确定了 10 个新概念和 43 个修正案。
本研究强调了为医疗服务提供机构制定全面、以证据为基础的社会问责制标准框架。未来的研究将旨在评估这些标准的应用，以指导医疗服务提供方面以公平为导向的社会问责制卫生政策策略。
