Christine Jorm

A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737]

BackgroundAccreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted.Methods/designTo understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation.DiscussionThe accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it.

Marginal costs of hospital-acquired conditions: information for priority-setting for patient safety programmes and research

Objective To estimate the relative inpatient costs of hospital-acquired conditions. Methods Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospitals general ledger. Occurrence of hospital-acquired conditions was identified using an Australian ‘condition-onset’ flag for diagnoses not present on admission. These were grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions to summarize data coded with ICD-10. Standard linear regression techniques were used to identify the independent contribution of hospital-acquired conditions to costs, taking into account the case-mix of a sample of acute inpatients (n 5 1,699,997) treated in Australian public hospitals in Victoria (2005/ 06) and Queensland (2006/07). Results The most costly types of complications were post-procedure endocrine/metabolic disorders, adding AU

An innovative approach to strengthening health professionals' infection control and limiting hospital-acquired infection: video-reflexive ethnography

21,827 to the cost of an episode, followed by MRSA (AU

Does medical culture limit doctors' adoption of quality improvement? Lessons from Camelot

19,881) and enterocolitis due to Clostridium difficile (AU

A large-scale mass casualty simulation to develop the non-technical skills medical students require for collaborative teamwork

19,743). Aggregate costs to the system, however, were highest for septicaemia (AU

Enhancing students’ learning in problem based learning: validation of a self-assessment scale for active learning and critical thinking

41.4 million), complications of cardiac and vascular implants other than septicaemia (AU

Clinical Governance: Complexities and Promises

28.7 million), acute lower respiratory infections, including influenza and pneumonia (AU

Medical leadership is the New Black: or is it?

27.8 million) and UTI (AU

Patient Involvement Can Affect Clinicians’ Perspectives and Practices of Infection Prevention and Control: A “Post-Qualitative” Study Using Video-Reflexive Ethnography

24.7 million). Hospital-acquired complications are estimated to add 17.3% to treatment costs in this sample. Conclusions Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harm. Previous studies of the costs of adverse events have provided information on ‘indicators’ of safety problems rather than the full range of hospital-acquired conditions. Adding a cost dimension to priority-setting could result in changes to the focus of patient safety programmes and research. Financial information should be combined with information on patient outcomes to allow for cost-utility evaluation of future interventions.

Why Do Doctors Not Engage with the System

Objective To strengthen clinicians’ infection control awareness and risk realisation by engaging them in scrutinising footage of their own infection control practices and enabling them to articulate challenges and design improvements. Design and participants Clinicians and patients from selected wards of 2 hospitals in western Sydney. Main outcome measures Evidence of risk realisation and new insights into infection control as articulated during video-reflexive feedback meetings. Results Frontline clinicians identified previously unrecognised infection risks in their own practices and in their teams practices. They also formulated safer ways of dealing with, for example, charts and patient transfers. Conclusions Video-reflexive ethnography enables frontline clinicians to identify infection risks and to design locally tailored solutions for existing risks and emerging ones.