Improving patient experience and safety in National Health Service (NHS) hospital wards through a ward based clinical accreditation scheme (CAS): an exploratory trial and process evaluation

Abstract

In response to local and national drivers for improvements in quality of hospital nursing care an acute care NHS Trust developed an innovative ward based Clinical Accreditation Scheme (CAS). The scheme aims to assure quality of care and encourage quality improvements.
This study aimed to identify changes in the quality and outcomes of care associated with the CAS, to explore the contextual factors and processes by which any effect is achieved and explore how the CAS is embedded into routine clinical practice by examining key participant perspectives on the feasibility and utility of the CAS. A controlled before-and-after study design explored outcomes from three matched pairs of adult general medical and surgical wards over a twelve month period.
The Hospital Survey on Patient Safety Culture and Nursing Practice Environment Scale were administered to all study ward staff at study commencement and as follow up at study end. There was no evidence of an association between participation in the CAS and a change in ward culture. Statistical process charts were used to identify changes over time for rates of hospital acquired infections, pressure ulcers and falls but no clear trend emerged. Findings from staff interviews suggest that staff value the assurance and sense of recognition the accreditation process gives. The process of preparing for self-assessment has potential to promote immediate quality improvements but a number of dysfunctional effects and behaviours, and contextual factors such as constant change, were identified as hindering embedding of the process into routine practice.
This study provides new knowledge demonstrating how an accreditation scheme is operationalised at the microsystem level. The scheme appears to assure quality of care and promote short term quality improvement but it is a resource intensive scheme and a number of structural changes are required to promote ongoing participation in quality improvement activities.

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ORCID for Peter Griffiths: orcid.org/0000-0003-2439-2857

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