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Opening Statements

"There really is no evidence that accreditation has improved the quality of care provided in hospitals or patient safety; in fact, the number of adverse events is increasing."

Moderator

John HelfrickDoes accreditation have any impact on the quality or safety of care? Is there any association between accreditation and performance improvement in accredited versus non accredited healthcare organizations. What is the evidence?

The impact of accreditation has been controversial and this debate focuses on the question of whether or not accreditation has a positive impact on healthcare quality and patient safety.

The statement to be debated is: "There really is no evidence that accreditation has improved the quality of care provided in hospitals or patient safety; in fact, the numbers of adverse events is increasing."

We have five experts who will weigh in on this question. Helen Crisp and Jeffrey Braithwaite will support the statement while Paul van Ostenberg and B K Rana will oppose the statement. Wendy Nicklin, CEO of Accreditation Canada, will then provide guest commentary. We are confident that this debate will be robust, probably a bit controversial, and will hopefully result in clarification of this issue. We look forward to hearing your perspectives throughout the debate.

Helen Crisp

Defending the Motion


Helen Crisp

It has been said that medicine used to be simple, ineffective and relatively safe. Now it is complex, effective and potentially dangerous. Over the past 50 years there has been an increasing acknowledgement that healthcare can inflict harm as well as benefit and that these harms can be prevented. Numerous studies have investigated the levels of harm that are inflicted on patients as a direct result of their healthcare. A recent review1 of these studies showed that there has been no decrease in these rates, despite the rise in the use of quality improvement approaches such as accreditation standards which aim to improve systems that will prevent harm.
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BK Rana

Opposing the Motion


BK Rana

Accreditation has resulted in embedding a quality culture in accredited hospitals. The accreditation standards provide a strong platform for hospitals to work on and this involves all areas of the organization: structure, processes and outcomes. The strengths and weaknesses of the system are objectively defined, problems are identified and corrective actions are taken.
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Jeffrey Braithwaite

Defending the Motion


Jeffrey Braithwaite

Accreditation: amidst the data deluge, a data trickle

This is the era of big data sets and evidence-based approaches. Unlike patient safety, where many large-scale studies have provided publicly-available data on the rates of adverse events, accreditation has failed the test. Across the world, accreditation programs have gathered volumes of data on health services and organisations: huge numbers of surveyor reports, self assessments and performance data measured by clinical indicators, for example. Unfortunately, this valuable information has been treated as confidential and infrequently made publicly available. Health systems are the worse for this.
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Paul vanOstenberg

Opposing the Motion


Paul vanOstenberg

It is no surprise that after decades there is little evidence that accreditation has improved the quality of care provided in hospitals. The World Health Organization and other authoritative sources have endorsed accreditation as the most effective “methodology” for improvement in health care however a research agenda has not been forthcoming from academia, providers or payers. In my opinion, there are reasons for this. First, as a “methodology” accreditation schemes around the world have chosen to shape and implement the “methodology” to meet different stakeholder needs. Even if every accreditation body used exactly the same standards, the separate and unique evaluation and decision processes would make it difficult to compare one accreditation program to another and impossible to study accreditation in general.
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