Dossier n. 165/2008 [Abstract] Institutional accreditation in Emilia-Romagna Region

The volume presents the results of a research started in the second semester of 2006 to study the first three-year-experience of accreditation in Emilia-Romagna Region.

Some production aspects were described: activities data on audits conducted and auditors employed, critical elements in the process such as technical modes to implement complex verifications and analyses on standbys from the verification path if requirements are not fully accomplished. Added to this, the research aimed at identifying the possible positive impact of accreditation on care delivery system and how this result can be defined and measured.

It is more and more recognized that a Public Administration - and the Health system inside it - needs to be responsible for its performance and accountability towards citizens. Law defines accreditation as the instrument to verify and guarantee care quality and safety, in a technical and professional context whose organizational, structural and technological requirements and expected behaviours are defined at regional level. The first evidence of process efficacy is therefore its capacity to reach the expected goal.

Research was then meant to precisely identify and determine the advantages of the accreditation process on the regional health system and to compare them with “costs” to be defined.

The choice of methods and tools was quite difficult. It was decided to begin with a field research based on some key passages: analysis of available literature to get every information on accreditation benefits; adoption of a reference model; integration of results with the expected ones.

From this first step, two researches were implemented:

• a study on the implementation of accreditation process (Chapter 4); for this study, the following instruments were used:
  
  
  • a scheme to analyse local context conditions that can positively or negatively influence process results (Chapter 5);
  • a semi-structured interview outline for the main process stakeholders (mayor, representative member of local Committees, Health Trust Board members, ...) (Chapter 6);
  • a questionnaire for professionals and workers at the Delta Hospital (Local Health Trust of Ferrara; Chapter 7);
• a study on “hidden work”, that is on planning, operative support, relationships, that allow process implementation (this study is still going on; its results are not presented in this document).

A parallel analysis highlighted that accreditation direct costs can be connected to some aspects easily identifiable but hardly understandable if not linked to the value of the results. Another analysis was therefore developed on the value of Public Administration’s action - social cohesion, common culture, relationships that produce common wellness, coherence with development choices in a community, … - and how this value can be measured, as it is constituted of intangible assets (Chapter 8).

The volume presents the development of the accreditation process in Emilia-Romagna Region (Chapters 1 and 2), theoretical analyses (Chapters 3, 4 and 8) and research methods to evaluate its impact (Chapter 5, 6 and 7). Some activity data, process critical aspects, ongoing activities and developments are also described, as well as researches in literature, theoretical analyses, and evaluations on accreditation benefits as experienced by workers at the Delta Hospital.

Some values coherent with regional policies are highlighted; in particular, accreditation:

• recalls values of transparency, integration, technical-professional quality, development of internal resources and professional skills, increase of organizational culture and participation;
• is an efficacious response when quality and safe services are needed;
• contributes to determine conditions for the development of general policies for integration and quality in Health Trusts;
• enables the development of innovation processes in services organization and management and of new professional figures and roles;
• promotes clinical professional roles;
• stresses attention to users’ rights, …

Other values of accreditation refer to qualitative aspects of interest for the local community; in particular the process:

• produces equity and promotes the development of a community culture;
• promotes confrontation and communication at different levels (among professionals, organizations, …);
• increases the attention to publicize performance results and favours accountability toward stakeholders;
• supports changes.

It is therefore necessary to monitor the process in order to document the maintenance of its coherence with regional policies (also according to new choices), of stakeholders’ involvement, and of its intrinsic capacity of evolution.