Striving for Performance Excellence: Ten Years’ Experience & Impact of Accreditation on Quality, Safety, and Overall Performance in King Saud University Medical City (KSUMC) – A Mixed-Methods Study

Abstract BackgroundThe Kingdom of Saudi Arabia (KSA) has undergone a healthcare system transformation to improve healthcare delivery and quality and central to this is the accreditation for healthcare facilities. Hospitals in KSA have relied on international accreditation bodies and are now shifting to national accreditation boards. The objective of this paper is to assess long-term effects of national and international accreditation through measuring staff perception after ten years of participation in multiple accreditation surveys.MethodsThis mixed-methods study was conducted at the King Saud University Medical City. The quantitative tool was adapted from previous studies and was made available in both English and Arabic. Respondents were asked to evaluate their involvement in accreditation and hospital readiness for another accreditation survey using 11 subscales. ANOVA was used to evaluate differences in mean scores based on level of participation in accreditation surveys. A qualitative interview tool was also used to elicit input from key stakeholders, senior leaders, and managers from the university hospitals. ResultsA total of 630 respondents completed the survey. The subscale on Patient Safety scored highest with an average and those measuring Accreditation Impact, Quality Impact and Quality Management closely followed. ANOVA results showed a significantly increasing mean score with increasing involvement of respondents in accreditation with highest scores observed for the first accreditation survey. Linear regression results showed increases in selected outcomes when with increasing subscale scores for patient satisfaction, management and leadership and others. Findings from the qualitative component showed that accreditation supported improved and sustained quality of care. Despite some differences and challenges in implementing both international and national accreditation standards, there were areas of complementarity which supported quality improvement. Respondents also noted improvements in patient outcomes as a result of participation in accreditation.ConclusionThis study is the first to examine the long-term impact of accreditation over an extended period in KSA. The long-term assessment of accreditation conducted in this study revealed that staff perception about performance was highest during the first cycle and consistently decreased with consequent surveys. The slight and incremental decrease in scale scores reveal that the benefits of accreditation were retained.