Angus Corbett

Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study

Background Despite the widespread use of accreditation in many countries, and prevailing beliefs that accreditation is associated with variables contributing to clinical care and organisational outcomes, little systematic research has been conducted to examine its validity as a predictor of healthcare performance. Objective To determine whether accreditation performance is associated with self-reported clinical performance and independent ratings of four aspects of organisational performance. Design Independent blinded assessment of these variables in a random, stratified sample of health service organisations. Settings Acute care: large, medium and small health-service organisations in Australia. Study participants Nineteen health service organisations employing 16 448 staff treating 321 289 inpatients and 1 971 087 non-inpatient services annually, representing approximately 5% of the Australian acute care health system. Main measures Correlations of accreditation performance with organisational culture, organisational climate, consumer involvement, leadership and clinical performance. Results Accreditation performance was significantly positively correlated with organisational culture (rho=0.618, p=0.005) and leadership (rho=0.616, p=0.005). There was a trend between accreditation and clinical performance (rho=0.450, p=0.080). Accreditation was unrelated to organisational climate (rho=0.378, p=0.110) and consumer involvement (rho=0.215, p=0.377). Conclusions Accreditation results predict leadership behaviours and cultural characteristics of healthcare organisations but not organisational climate or consumer participation, and a positive trend between accreditation and clinical performance is noted.

An action research protocol to strengthen system-wide inter-professional learning and practice [LP0775514]

BackgroundInter-professional learning (IPL) and inter-professional practice (IPP) are thought to be critical determinants of effective care, improved quality and safety and enhanced provider morale, yet few empirical studies have demonstrated this. Whole-of-system research is even less prevalent. We aim to provide a four year, multi-method, multi-collaborator action research program of IPL and IPP in defined, bounded health and education systems located in the Australian Capital Territory (ACT). The project is funded by the Australian Research Council under its industry Linkage Program.Methods/DesignThe program of research will examine in four inter-related, prospective studies, progress with IPL and IPP across tertiary education providers, professional education, regulatory and registration bodies, the ACT health systems streams of care activities and teams, units and wards of the provider facilities of the ACT health system. One key focus will be on push-pull mechanisms, ie, how the education sector creates student-enabled IPP and the health sector demands IPL-oriented practitioners. The studies will examine four research aims and meet 20 research project objectives in a comprehensive evaluation of ongoing progress with IPL and IPP.DiscussionIPP and IPL are said to be cornerstones of health system reforms. We will measure progress across an entire health system and the clinical and professional education systems that feed into it. The value of multi-methods, partnership research and a bi-directional push-pull model of IPL and IPP will be tested. Widespread dissemination of results to practitioners, policymakers, managers and researchers will be a key project goal.

Can Questions of the Privatization and Corporatization, and the Autonomy and Accountability of Public Hospitals, Ever be Resolved?

Although there is a long-standing international debate concerning the privatization and corporatization of health services, there has been relatively little systematic analysis of the ways these types of reform manifest. We examine the impact of privatization and corporatization on public hospitals, and in particular on hospitals’ autonomy and accountability, with two aims: to uncover the key themes in the literature, and to consider implementation issues. The review of 2,319 articles was conducted using content analysis and a discussion of selected key issues. Several major themes appear in the privatization and corporatization literature, including their use as tools in health systems reform, and the role of governments in sponsoring the processes. We show that much of the underlying argument is ideological rather than evidence based. Those who promote versions of privatization or corporatization claim that decreased government involvement in the management of hospitals leads inter alia to benefits such as greater efficiency, better quality services, and increased choice for patients. Those who argue against say that increased privatization leads to deleterious outcomes such as decreased equity, compromised efficiency and poorer quality of care. The evidence is often weak and at times conflicting. Privatization and corporatization are difficult to implement, and at best produce mixed results, and their impact seems to depend more on the motivation of the evaluator than the standard of the results. These debates are of a type that is to a large extent only resolvable ideologically.

Corporate Social Responsibility: Do We Have Good Cause to Be Sceptical about it?

The external world is creating a series of ‘shocks’ for organisations, governments and individuals. These include the impact of climate change and the increasing costs for energy. The challenge for organisations is to develop new governance mechanisms to accommodate these external shocks. This article investigates the potential for corporate social responsibility to act as a catalyst in generating these new governance mechanisms. It sketches out two regulatory frameworks of corporate law and corporate governance that may create the conditions for the emergence of effective systems of corporate social responsibility. These frameworks of regulation are formed around an economic analysis of corporations and around a constitutional view of the corporation as a site for a decision-making process centred on the principles of deliberation, accountability and contestability. Each of these frameworks contributes to our understanding of corporate social responsibility, and each offers some glimmers of hope. But there are also good reasons to be sceptical about whether either will create the conditions for the emergence of effective systems of corporate social responsibility. This scepticism about corporate social responsibility should, though, be tempered by recognition of the complexity of the problem of generating the new forms of governance that we, as a community, need to accommodate the challenges that we face.

The Future of Regulation to Improve the Safety and Quality of Health Care: The individual Dimension of Successful Regulatory Interventions to Improve Safety

The publication in 1999 of To Err is Human unleashed the potential for systems of regulatory governance to improve the safety and quality of health care services for patients (Institute of Medicine, 2000). In addition, it marked a point at which patients, health care professionals and health care organizations came to recognize the potential for regulation to change the pathways for the delivery of health care services. The mobilization of individual, organizational and governmental resources to reduce the occurrence of preventable harm in health care is a manifestation of what John Braithwaite has called ‘regulatory capitalism’. Over the last three decades or more ‘states have become rather more preoccupied with the regulation part of governance and less with providing’ (Braithwaite, 2008, p 1). But as David Levi-Faur has argued there has also been an expansion of the ‘regulation society and global regulations’. Levi-Faur argues that the ‘co-expansion of voluntary as well as coercive regulation’ is part of the phenomenon of ‘regulatory capitalism’ and that this phenomenon is transforming both civil society and the state (Levi-Faur, 2008, p viii). This article investigates both the potential of regulation to improve the safety and quality of health care and its potential to modify processes, organizations and practices that support the delivery of health care services. It follows work in other areas of public concern such as the problem of improving the safety of imported goods (Zaring and Coglianese, 2009).

Pragmatism, Law and Economics, and Corporate Law

Review(s) of: An Economic and Jurisprudential Genealogy of Corporate Law by Michael J Whincop Ashgate, Dartmouth, 2001, ISBN 1840147733, 266 pp. Includes references. Includes footnotes.