Evaluating the costs and benefits of health services accreditation in Australian Hospitals

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Copyright: Mumford, Virginia
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Abstract
Ensuring the acute health system provides a safe and high quality service is critical, with at least 6% of patients harmed through largely preventable adverse incidents. Accreditation is designed to improve patient safety and quality of care through assessing whether hospitals have appropriate clinical governance systems and training programs in place. Australian hospitals have been undergoing accreditation since 1974, yet there is little evidence of whether the program is effective. The overall aim of the thesis is to develop a framework to investigate the costs and benefits of Australian acute care accreditation programs, and to assess their role in improving patient safety and quality of care. The component studies use a mixed methods approach encompassing qualitative and quantitative methods to identify and quantify the costs and benefits through a purpose-designed logic model and a cost benefit framework. Activity costing techniques were used to collect primary data to measure accreditation costs in six hospitals across four states and territories in Australia. The benefits of accreditation were assessed using two infection control related indicators – hand hygiene compliance, and hospital acquired Staphylococcus aureus (SAB) infection rates. Retrospective, longitudinal, multisite comparative analysis techniques were employed using accreditation and indicator data collected from 2009–2013 in acute public hospitals in New South Wales. This research showed that larger hospitals with higher accreditation related infection control scores had significantly lower SAB rates. However, this effect was reversed in small and medium hospitals. The smallest hospital incurred accreditation costs at twenty times the rate of the largest hospital in the sample. Despite having significantly higher hand hygiene compliance rates and lower SAB rates, no small hospitals recorded higher accreditation related infection control scores. The original contributions of this thesis include: models and frameworks to evaluate accreditation; estimation of accreditation costs; analysis of accreditation indicators; identification of a significant differential across hospital size in terms of costs and indicator data; and an case study to show the parameters under which accreditation benefits would outweigh the costs. Small hospitals comprise 42% of acute facilities nationally (but only 2.7% of patient separations). This work has important implications for designing quality improvement interventions that identify high performance across all hospital types.
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Mumford, Virginia
Supervisor(s)
Braithwaite, Jeffrey
Forde, Kevin
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Publication Year
2014
Resource Type
Thesis
Degree Type
PhD Doctorate
UNSW Faculty
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