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1.  Impact of Accreditation on the Quality of Healthcare Services: a Systematic Review of the Literature 
Annals of Saudi Medicine  2011;31(4):407-416.
BACKGROUND AND OBJECTIVE:
Accreditation is usually a voluntary program in which trained external peer reviewers evaluate a healthcare organization's compliance and compare it with pre-established performance standards. The aim of this study was to evaluate the impact of accreditation programs on the quality of healthcare services
METHODS:
We did a systematic review of the literature to evaluate the impact of accreditation programs on the quality of healthcare services. Several databases were systematically searched, including Medline, Embase, Healthstar, and Cinhal.
RESULTS:
Twenty-six studies evaluating the impact of accreditation were identified. The majority of the studies showed general accreditation for acute myocardial infarction (AMI), trauma, ambulatory surgical care, infection control and pain management; and subspecialty accreditation programs to significantly improve the process of care provided by healthcare services by improving the structure and organization of healthcare facilities. Several studies showed that general accreditation programs significantly improve clinical outcomes and the quality of care of these clinical conditions and showed a significant positive impact of subspecialty accreditation programs in improving clinical outcomes in different subspecialties, including sleep medicine, chest pain management and trauma management.
CONCLUSIONS:
There is consistent evidence that shows that accreditation programs improve the process of care provided by healthcare services. There is considerable evidence to show that accreditation programs improve clinical outcomes of a wide spectrum of clinical conditions. Accreditation programs should be supported as a tool to improve the quality of healthcare services.
doi:10.4103/0256-4947.83204
PMCID: PMC3156520  PMID: 21808119
2.  Assessment of the accreditation standards of the Central Board for Accreditation of Healthcare Institutions in Saudi Arabia against the principles of the International Society for Quality in Health Care (ISQua) 
Annals of Saudi Medicine  2010;30(5):386-389.
BACKGROUND AND OBJECTIVES:
Accreditation is usually a voluntary program, in which trained external peer reviewers evaluate health care organization’s compliance with pre-established performance standards. Interest in accreditation is growing in developing countries, but there is little published information on the challenges faced by new programs. In Saudi Arabia, the Central Board for Accreditation of Healthcare Institutions (CBAHI) was established to formulate and implement quality standards in all health sectors across the country. The objective of this study was to assess a developing accreditation program (CBAHI standards) against the International Society for Quality in Health Care (ISQua) principles to identify opportunities for improvement of the CBAHI standards.
METHODS:
A qualitative appraisal and assessment of CBAHI standards was conducted using the published ISQua principles for accreditation standards.
RESULTS:
The CBAHI standards did not describe the process of development, evaluation or revision of the standards. Several standards are repetitive and ambiguous. CBAHI standards lack measurable elements for each standard. CBAHI standards met only one criterion (11.1%) of the Quality Improvement principle, two criteria (22.2%) of Patient/Service User Focus principle, four criteria (40%) of the Organizational Planning and Performance principle, the majority (70%) of the criteria for the safety principle, only one criteria (7.1%) for the Standards Development principle, and two criteria (50%) of the Standards Measurement principle.
CONCLUSIONS:
CBAHI standards need significant modifications to meet ISQua principles. New and developing accreditation programs should be encouraged to publish and share their experience in order to promote learning and improvement of local accreditation programs worldwide.
doi:10.4103/0256-4947.67082
PMCID: PMC2941252  PMID: 20697166
3.  Advantages and Disadvantages of Health Care Accreditation Mod­els 
Background: This systematic review seeks to define the general advantages and disadvan­tages of accreditation programs to assist in choosing the most appropriate approach.
Method: Systematic search of SID, Ovid Medline & PubMed databases was conducted by the keywords of accreditation, hospital, medical practice, clinic, accreditation models, health care and Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria. From initial analysis, 23 attributes were identified which appeared to define advantages and disadvantages of different accreditation approaches and the available systems were compared on these.
Results: Six systems were identified in the international literature including the JCAHO from USA, the Canadian program of CCHSA, and the accreditation programs of UK, Australia, New Zealand and France. The main distinguishing attributes among them were: quality improve­ment, patient and staff safety, improving health services integration, public’s confi­dence, effectiveness and efficiency of health services, innovation, influence global standards, information management, breadth of activity, history, effective relationship with stakeholders, agreement with AGIL attributes and independence from government.
Conclusion: Based on 23 attributes of comprehensive accreditation systems we have defined from a systematic review, the JCAHO accreditation program of USA and then CCHSA of Can­ada offered the most comprehensive systems with the least disadvantages. Other programs such as the ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accredita­tion programs were fairly comparable according to these criteria. However the decision for any country or health system should be based on an assessment weighing up their specific objec­tives and needs.
doi:10.5681/hpp.2011.001
PMCID: PMC3963612
Quality; Accreditation; Hospital; Health care
4.  Evaluation of current Australian health service accreditation processes (ACCREDIT-CAP): protocol for a mixed-method research project 
BMJ Open  2012;2(4):e001726.
Introduction
Accreditation programmes aim to improve the quality and safety of health services, and have been widely implemented. However, there is conflicting evidence regarding the outcomes of existing programmes. The Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork-Current Accreditation Processes (ACCREDIT-CAP) project is designed to address key gaps in the literature by evaluating the current processes of three accreditation programmes used across Australian acute, primary and aged care services.
Methods and design
The project comprises three mixed-method studies involving documentary analyses, surveys, focus groups and individual interviews. Study samples will comprise stakeholders from across the Australian healthcare system: accreditation agencies; federal and state government departments; consumer advocates; professional colleges and associations; and staff of acute, primary and aged care services. Sample sizes have been determined to ensure results allow robust conclusions. Qualitative information will be thematically analysed, supported by the use of textual grouping software. Quantitative data will be subjected to a variety of analytical procedures, including descriptive and comparative statistics. The results are designed to inform health system policy and planning decisions in Australia and internationally.
Ethics and dissemination
The project has been approved by the University of New South Wales Human Research Ethics Committee (approval number HREC 10274). Results will be reported to partner organisations, healthcare consumers and other stakeholders via peer-reviewed publications, conference and seminar presentations, and a publicly accessible website.
doi:10.1136/bmjopen-2012-001726
PMCID: PMC3449274  PMID: 22864419
Quality in health care; Protocols & guidelines; Clinical governance; Organisation of health services; Accreditation
5.  Validated instruments used to measure attitudes of healthcare students and professionals towards patients with physical disability: a systematic review 
Background
Instruments to detect changes in attitudes towards people with disabilities are important for evaluation of training programs and for research. While we were interested in instruments specific for medical students, we aimed to systematically review the medical literature for validated survey instruments used to measure attitudes of healthcare students and professionals towards patients with physical disability.
Methods
We electronically searched Medline, EMBASE, PsycINFO, Health and Psychosocial Instruments. We included papers reporting on the development and/or validation of survey instruments to measure attitudes of healthcare students and professionals towards patients with physical disability. We excluded papers in which the attitudes were not measured in a provider-patient context. Two reviewers carried out titles and abstracts screening, full texts screening, and data abstraction in a duplicate and independent manner using standardized and pilot tested forms.
Results
We identified seven validated survey instruments used for healthcare students and professionals. These instruments were originally developed for the following target populations: general population (n = 4); dental students (n = 1); nursing students (n = 1); and rehabilitation professionals (n = 1). The types of validity reported for these instruments were content validity (n = 3), criterion-related validity (n = 1), construct validity (n = 2), face validity (n = 1), discriminant validity (n = 1), and responsiveness (n = 1). The most widely validated and used tool (ATDP) was developed in the late 1960s while the most recent instrument was developed in the early 1990s.
Conclusion
Of the seven identified validated instruments, less than half were specifically designed for healthcare students and professionals and none for medical students. There is a need to develop and validate a contemporary instrument specifically for medical students.
doi:10.1186/1743-0003-7-55
PMCID: PMC2987969  PMID: 21062438
6.  Health service accreditation: report of a pilot programme for community hospitals. 
BMJ : British Medical Journal  1995;310(6982):781-784.
Voluntary accreditation in the United Kingdom is being used by health care providers to improve and market their services and by commissioners to define and monitor service contracts. In a three year pilot scheme in the south west of England, 43 out of 57 eligible community hospitals volunteered to be surveyed; 37 of them were ultimately accredited for up to two years by the hospital accreditation programme. The main causes for non-accreditation related to safety, clinical records, and medical organisation. Follow up visits in 10 hospitals showed that, overall, 69% of recommendations were implemented. An independent survey of participating hospitals showed the perceived benefits to include team building, review of operational policies, improvement of data systems, and the generation of local prestige. Purchasers are increasingly influenced by accreditation status but are mostly unwilling to finance the process directly. None the less, the concept may become an important factor moderating the quality of service in the new NHS.
PMCID: PMC2549168  PMID: 7711585
7.  An effectiveness analysis of healthcare systems using a systems theoretic approach 
Background
The use of accreditation and quality measurement and reporting to improve healthcare quality and patient safety has been widespread across many countries. A review of the literature reveals no association between the accreditation system and the quality measurement and reporting systems, even when hospital compliance with these systems is satisfactory. Improvement of health care outcomes needs to be based on an appreciation of the whole system that contributes to those outcomes. The research literature currently lacks an appropriate analysis and is fragmented among activities. This paper aims to propose an integrated research model of these two systems and to demonstrate the usefulness of the resulting model for strategic research planning.
Methods/design
To achieve these aims, a systematic integration of the healthcare accreditation and quality measurement/reporting systems is structured hierarchically. A holistic systems relationship model of the administration segment is developed to act as an investigation framework. A literature-based empirical study is used to validate the proposed relationships derived from the model. Australian experiences are used as evidence for the system effectiveness analysis and design base for an adaptive-control study proposal to show the usefulness of the system model for guiding strategic research.
Results
Three basic relationships were revealed and validated from the research literature. The systemic weaknesses of the accreditation system and quality measurement/reporting system from a system flow perspective were examined. The approach provides a system thinking structure to assist the design of quality improvement strategies. The proposed model discovers a fourth implicit relationship, a feedback between quality performance reporting components and choice of accreditation components that is likely to play an important role in health care outcomes. An example involving accreditation surveyors is developed that provides a systematic search for improving the impact of accreditation on quality of care and hence on the accreditation/performance correlation.
Conclusion
There is clear value in developing a theoretical systems approach to achieving quality in health care. The introduction of the systematic surveyor-based search for improvements creates an adaptive-control system to optimize health care quality. It is hoped that these outcomes will stimulate further research in the development of strategic planning using systems theoretic approach for the improvement of quality in health care.
doi:10.1186/1472-6963-9-195
PMCID: PMC2773779  PMID: 19852837
8.  The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon 
Background
In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC.
Methods
The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors.
Results
The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages.
Conclusions
To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well.
doi:10.1186/1472-6963-14-86
PMCID: PMC3946059  PMID: 24568632
Accreditation; Primary healthcare; Healthcare providers; Lebanon
9.  Accreditation and Continuous Quality Improvement In Athletic Training Education 
Journal of Athletic Training  2000;35(2):188-193.
Objective:
To apply the continuous quality improvement model commonly associated with the business sector to entrylevel athletic training education program accreditation.
Data Sources:
We applied athletic training educational program accreditation as a tool for ensuring quality in the entrylevel athletic training education programs accredited by the Commission on the Accreditation of Allied Health Education Programs. Literature from the business, education, and athletic training fields is integrated to support this paradigm shift in athletic training education.
Data Synthesis:
The advent of mandated entry-level athletic training educational program accreditation has forced institutions to evaluate their educational programs. Accreditation will promote continuous quality improvement in athletic training education through mechanisms such as control measures and process improvement.
Conclusions/Recommendations:
Although accreditation of entry-level athletic training education programs has created some dissonance among athletic training professionals, it will strengthen the profession as a whole. Athletic training educators must capture the synergy generated from this change to ensure quality educational experiences for all our students as we move forward to secure a strong position in the allied health care market.
PMCID: PMC1323416  PMID: 16558629
process improvement; Commission on Accreditation of Allied Health Education Programs (CAAHEP); Joint Review Committee on Educational Programs in Athletic Training (JRC-AT); leadership
10.  Development of Standards and Criteria for the Selection, Training, and Evaluation of Athletic Training Approved Clinical Instructors 
Journal of Athletic Training  2004;39(4):335-343.
Objective: To develop standards and associated criteria for the selection, training, and evaluation of athletic training approved clinical instructors (ACIs).
Design and Setting: A previously developed set of 7 physical therapy clinical instructor standards/criteria and 2 additional standards/criteria developed through a review of the literature were systematically adapted, judged, and revised through a Delphi technique.
Subjects: Athletic training education experts currently employed as program directors for entry-level Commission on Accreditation of Allied Health Education Programs—accredited athletic training educational programs and who had the following: a doctoral degree, at least 5 years of supervising athletic training students, and familiarity/experience with clinical instruction in various athletic training clinical education settings.
Measurements: We used panelists' critiques and ratings to make sequential revisions in a series of 3 Delphi rounds. Standards were rated as to whether they were clear, necessary, and appropriate. We rated criteria for the associated standard as to whether they were useful, helpful, clear, specific, and consistent.
Results: We developed a final set of 7 standards and 50 associated criteria to measure these standards. The accepted standards include the following: legal and ethical behavior, communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge.
Conclusions: The 7 standards and associated criteria developed in this research project could be used not only for selecting, training, and evaluating an ACI but also for developing an understanding of the requirements of clinical education in general. Further research should include validating these standards/criteria among athletic training ACIs representing different types of clinical settings.
PMCID: PMC535526  PMID: 15592606
clinical instruction; clinical education; clinical instructor educator
11.  Program Directors' and Clinical Instructors' Perceptions of Important Clinical-Instructor Behavior Categories in the Delivery of Athletic Training Clinical Instruction 
Journal of Athletic Training  2003;38(4):336-341.
Objective:
To investigate the perceived importance of clinical instructors' behaviors and behavior categories in the roles of program director (PD) and clinical instructor (CI) and to ascertain the relative importance of these items within each role.
Design and Setting:
From the literature, we developed a questionnaire, validated by a panel of experts, to collect data regarding the perceived importance of 30 specific CI behavior statements within 5 categories (instructional, interpersonal, evaluative, professional, and personal). The instrument used in the study had a Cronbach alpha of .92.
Subjects:
Independent groups of 75 PDs and 242 CIs from Commission on Accreditation of Allied Health Education Programs–accredited entry-level undergraduate athletic training programs returned usable surveys.
Measurements:
We computed mean and variation measures for each behavior and category and analyzed these items for between-role and within-role category differences.
Results:
Program directors and CIs differed significantly in the perceived importance of the evaluative category of CI behaviors as well as in 3 specific evaluative behaviors. Program directors and CIs did not differ in the other 4 categories. For within-role groupings, we noted significant differences of perceived importance among the behavioral categories.
Conclusions:
Program directors and CIs perceived all 5 categories to be very important, and they should work to demonstrate these behaviors in clinical-education settings. Collaboration between the groups enhances the understanding of role responsibility in the delivery of athletic training clinical instruction.
PMCID: PMC314394  PMID: 14737217
teaching and learning; education; pedagogy
12.  Developing a theory-based instrument to assess the impact of continuing professional development activities on clinical practice: a study protocol 
Background
Continuing professional development (CPD) is one of the principal means by which health professionals (i.e. primary care physicians and specialists) maintain, improve, and broaden the knowledge and skills required for optimal patient care and safety. However, the lack of a widely accepted instrument to assess the impact of CPD activities on clinical practice thwarts researchers' comparisons of the effectiveness of CPD activities. Using an integrated model for the study of healthcare professionals' behaviour, our objective is to develop a theory-based, valid, reliable global instrument to assess the impact of accredited CPD activities on clinical practice.
Methods
Phase 1: We will analyze the instruments identified in a systematic review of factors influencing health professionals' behaviours using criteria that reflect the literature on measurement development and CPD decision makers' priorities. The outcome of this phase will be an inventory of instruments based on social cognitive theories. Phase 2: Working from this inventory, the most relevant instruments and their related items for assessing the concepts listed in the integrated model will be selected. Through an e-Delphi process, we will verify whether these instruments are acceptable, what aspects need revision, and whether important items are missing and should be added. The outcome of this phase will be a new global instrument integrating the most relevant tools to fit our integrated model of healthcare professionals' behaviour. Phase 3: Two data collections are planned: (1) a test-retest of the new instrument, including item analysis, to assess its reliability and (2) a study using the instrument before and after CPD activities with a randomly selected control group to explore the instrument's mere-measurement effect. Phase 4: We will conduct individual interviews and focus groups with key stakeholders to identify anticipated barriers and enablers for implementing the new instrument in CPD practice. Phase 5: Drawing on the results from the previous phases, we will use consensus-building methods to develop with the decision makers a plan to implement the new instrument.
Discussion
This project proposes to give stakeholders a theory-based global instrument to validly and reliably measure the impacts of CPD activities on clinical practice, thus laying the groundwork for more targeted and effective knowledge-translation interventions in the future.
doi:10.1186/1748-5908-6-17
PMCID: PMC3063813  PMID: 21385369
13.  Strengthening organizational performance through accreditation research-a framework for twelve interrelated studies: the ACCREDIT project study protocol 
BMC Research Notes  2011;4:390.
Background
Service accreditation is a structured process of recognising and promoting performance and adherence to standards. Typically, accreditation agencies either receive standards from an authorized body or develop new and upgrade existing standards through research and expert views. They then apply standards, criteria and performance indicators, testing their effects, and monitoring compliance with them. The accreditation process has been widely adopted. The international investments in accreditation are considerable. However, reliable evidence of its efficiency or effectiveness in achieving organizational improvements is sparse and the value of accreditation in cost-benefit terms has yet to be demonstrated. Although some evidence suggests that accreditation promotes the improvement and standardization of care, there have been calls to strengthen its research base.
In response, the ACCREDIT (Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork) project has been established to evaluate the effectiveness of Australian accreditation in achieving its goals. ACCREDIT is a partnership of key researchers, policymakers and agencies.
Findings
We present the framework for our studies in accreditation. Four specific aims of the ACCREDIT project, which will direct our findings, are to: (i) evaluate current accreditation processes; (ii) analyse the costs and benefits of accreditation; (iii) improve future accreditation via evidence; and (iv) develop and apply new standards of consumer involvement in accreditation. These will be addressed through 12 interrelated studies designed to examine specific issues identified as a high priority. Novel techniques, a mix of qualitative and quantitative methods, and randomized designs relevant for health-care research have been developed. These methods allow us to circumvent the fragmented and incommensurate findings that can be generated in small-scale, project-based studies. The overall approach for our research is a multi-level, multi-study design.
Discussion
The ACCREDIT project will examine the utility, reliability, relevance and cost effectiveness of differing forms of accreditation, focused on general practice, aged care and acute care settings in Australia. Empirically, there are potential research gains to be made by understanding accreditation and extending existing knowledge; theoretically, this design will facilitate a systems view of accreditation of benefit to the partnership, international research communities, and future accreditation designers.
"Accreditation of health-care organisations is a multimillion dollar industry which shapes care in many countries. Recent reviews of research show little evidence that accreditation increases safety or improves quality. It's time we knew about the cost and value of accreditation and about its future direction." [Professor John Øvretveit, Karolinska Institute, Sweden, 7 October 2009]
doi:10.1186/1756-0500-4-390
PMCID: PMC3199265  PMID: 21981910
14.  Knowledge, attitude and practice of women in Campinas, São Paulo, Brazil with respect to physical exercise in pregnancy: a descriptive study 
Reproductive Health  2011;8:31.
Background
Pregnancy is a good time to develop healthy lifestyle habits including regular exercise and good nutrition. Programs of physical exercise for pregnant women have been recommended; however, there are few references on this subject in the literature. The objective of this study was to evaluate the knowledge, attitude and practice of pregnant women with respect to appropriate physical exercise during pregnancy, and also to investigate why some women do not exercise during pregnancy.
Methods
A descriptive study was conducted in which 161 women of 18 to 45 years of age were interviewed in the third trimester of pregnancy. These women were receiving prenatal care at National Health Service (SUS) primary healthcare units and had no pathologies for which physical exercise would constitute a risk. The women were selected at an ultrasonography clinic accredited to the SUS in Campinas, São Paulo. A previously elaborated knowledge, attitude and practice (KAP) questionnaire was used to collect data, which were then stored in an Epinfo database. Statistical analysis was conducted using Pearson's chi-square test and Fisher's exact test to evaluate the association between the study variables (p < 0.05).
Results
Almost two-thirds (65.6%) of the women were sufficiently informed about the practice of physical exercise during pregnancy and the vast majority (93.8%) was in favor of it. Nevertheless, only just over 20% of the women in this sample exercised adequately. Significant associations were found between an adequate knowledge of physical exercise during pregnancy and education level (p = 0.0014) and between the adequate practice of physical exercise during pregnancy and having had fewer pregnancies (p = 0.0001). Lack of time and feeling tired and uncomfortable were the principal reasons given by the women for not exercising.
Conclusion
These results suggest that women's knowledge concerning the practice of physical exercise during pregnancy is reasonable and their attitude is favorable; however, relatively few actually exercise during pregnancy.
doi:10.1186/1742-4755-8-31
PMCID: PMC3220627  PMID: 22051371
15.  Changing education to improve patient care 
Quality in Health Care : QHC  2001;10(Suppl 2):ii54-ii58.
Health professionals need competencies in improvement skills if they are to contribute usefully to improving patient care. Medical education programmes in the USA have not systematically taught improvement skills to residents (registrars in the UK). The Accreditation Council for Graduate Medical Education (ACGME) has recently developed and begun to deploy a competency based model for accreditation that may encourage the development of improvement skills by the 100 000 residents in accredited programmes. Six competencies have been identified for all physicians, independent of specialty, and measurement tools for these competencies have been described. This model may be applicable to other healthcare professions. This paper explores patterns that inhibit efforts to change practice and proposes an educational model to provide changes in management skills based on trainees' analysis of their own work.
Key Words: physician education; improvement skills; accreditation; competency
doi:10.1136/qhc.0100054..
PMCID: PMC1765748  PMID: 11700380
16.  The National Board of Public Health Examiners: Credentialing Public Health Graduates 
Public Health Reports  2007;122(4):435-440.
SYNOPSIS
The National Board of Public Health Examiners (NBPHE, the Board) is the result of many years of intense discussion about the importance of credentialing within the public health community. The Board is scheduled to begin credentialing graduates of programs and schools of public health accredited by the Council on Education for Public Health (CEPH) in 2008. Among the many activities currently underway to improve public health practice, the Board views credentialing as one pathway to heighten recognition of public health professionals and increase the overall effectiveness of public health practice. The process underway includes developing, preparing, administering, and evaluating a voluntary certification examination that tests whether graduates of CEPH-accredited schools and programs have mastered the core knowledge and skills relevant to contemporary public health practice. This credentialing initiative is occurring at a time of heightened interest in public health education, and an anticipated rapid turnover in the public health workforce. It is fully anticipated that active discussion about the credentialing process will continue as the Board considers the many aspects of this professional transition. The Board wishes to encourage these discussions and welcomes input on any aspects relating to implementation of the credentialing process.
PMCID: PMC1888516  PMID: 17639645
17.  Athletic Trainers' Beliefs Toward Working With Special Olympics Athletes 
Journal of Athletic Training  2009;44(3):279-285.
Context:
Certified athletic trainers (ATs) are often the first health care providers to treat injured athletes. However, few researchers have studied ATs' beliefs concerning working with Special Olympics athletes.
Objectives:
To examine ATs' beliefs toward working with Special Olympics athletes by using the theory of planned behavior model and to examine the influence of moderator variables.
Design:
Cross-sectional survey.
Setting:
Athletic Trainers' Beliefs Toward Special Olympics Athletes survey instruments were mailed to 147 directors of Commission on Accreditation of Allied Health Education Programs–accredited athletic training education programs (ATEPDs) in 43 states and 120 cities.
Patients or Other Participants:
One hundred twenty ATEPDs (44 women, 76 men).
Main Outcome Measure(s):
We used stepwise multiple regression analysis to determine whether attitude toward the behavior, subjective norm, and perceived behavioral control predicted intention and to determine which moderator variables predicted attitude toward the behavior, subjective norm, and perceived behavioral control. Pearson product moment correlations were used to determine ATEPDs' beliefs about how competent they felt working with Special Olympics athletes and whether they were currently working with these athletes.
Results:
We found that subjective norm, attitude toward the behavior, and perceived behavioral control predicted intention (R  =  0.697, R2  =  0.486, F3,112  =  35.3, P < .001) and that intention predicted ATEPDs' actual behaviors (R  =  0.503, R2  =  0.253, F1,118  =  39.995, P < .001). Moderator variables that predicted attitude toward the behavior included more years of experience working with Special Olympics athletes, completion of 1 or more courses in adapted physical activity, ATEPDs' competence, completion of 1 or more special education courses, and sex (R  =  0.589, R2  =  0.347, F5,111  =  11.780, P < .001). Moderator variables that predicted subjective norm included more experience working with Special Olympics athletes and more Special Olympics certifications (R  =  0.472, R2  =  0.222, F2,112  =  16.009, P < .001). Moderator variables that predicted perceived behavioral control included ATEPDs' competence, more years of experience working with Special Olympics athletes, and a higher educational degree (R  =  0.642, R2  =  0.412, F4,113  =  19.793, P < .001).
Conclusions:
Certified athletic trainers had favorable attitudes about the behavior beliefs toward working with Special Olympics athletes; however, their subjective norm, perceived behavioral control, and intention beliefs were unfavorable. The ATEPDs reported they did not feel competent to work with Special Olympics athletes.
PMCID: PMC2681214  PMID: 19478841
disability sport injury; intellectual disabilities; autism; theory of planned behavior; attitude research
18.  IMIA Accreditation of Health Informatics Programs 
Healthcare Informatics Research  2013;19(3):154-161.
Objectives
Health informatics programs usually are evaluated by national accreditation committees. Not always are the members of these committees well informed about the international level of (education in) health informatics. Therefore, when a program is accredited by a national accreditation committee, this does not always mean that the program is of an international level. The International Medical Informatics Association (IMIA) has expertise in the field of education. The IMIA Recommendations on Education in Biomedical and Health Informatics guide curricula development. The goal of this article is to show that IMIA can also play the role of accreditation agency and to present the IMIA accreditation protocol and experiences obtained with it.
Methods
The accreditation procedure used in the Netherlands and Belgium was taken as a template for the design of the IMIA accreditation protocol. In a trial period of one and a half year the protocol is tested out on six health informatics programs.
Results
An accreditation protocol was designed. For judging the curriculum of a program the IMIA Recommendations are used. The institution has to write a self-assessment report and a site visit committee visits the program and judges its quality, supported by the self-assessment report and discussions with all stakeholders of the program.
Conclusions
After having visited three programs it appears that the IMIA accreditation procedure works well. Only a few changes had to be introduced. Writing the self-assessment report already appears to be beneficial for the management of the program to obtain a better insight in the quality of their program.
doi:10.4258/hir.2013.19.3.154
PMCID: PMC3810522  PMID: 24175114
Accreditation; Education; Medical Informatics; International Medical Informatics Association; Quality Assurance
19.  The New Quality Assurance Standard of the Joint Commission on Accreditation of Hospitals 
Western Journal of Medicine  1980;132(2):166-170.
The Joint Commission on Accreditation of Hospitals (JCAH) has continuously emphasized improvement in the quality of care provided in hospitals as the central purpose of the accreditation process. In striving to assure such improvement, the JCAH has stressed the need for, and the responsibility of, the medical and other professional staffs to provide continuing review and evaluation of patient care. In recent years, quality assessment activities have evolved, proliferated and matured to the extent that they require a purposeful integration if they are to effect sustained improvement in patient care and clinical performance. To assist hospitals in the coordination or integration of quality assessment activities, the Board of Commissioners of the JCAH has approved an important new quality assurance standard.
Significant requirements of the new standard are a comprehensive quality assurance program, a written plan, a problem-focused approach to the review and evaluation of patient care and clinical performance, an annual reassessment of the program, and an improvement in patient care or clinical performance. The new standard reflects the JCAH belief that an integrated, problem-focused approach to quality assurance will significantly improve the quality of care provided throughout a hospital. Such an approach recognizes the interdependence of hospital departments and services in the provision of patient care, and, therefore, requires a purposeful integration or coordination of quality assessment data and activities. Consequently, quality assessment data may be utilized effectively and efficiently, and many potentially useless or duplicative quality assessment activities can be eliminated. The new standard affords hospitals considerable flexibility in the manner in which they implement and administer the program and encourages innovation.
PMCID: PMC1272009  PMID: 6930132
20.  The health sciences librarian in medical education: a vital pathways project task force 
Objectives:
The Medical Education Task Force of the Task Force on Vital Pathways for Hospital Librarians reviewed current and future roles of health sciences librarians in medical education at the graduate and undergraduate levels and worked with national organizations to integrate library services, education, and staff into the requirements for training medical students and residents.
Methods:
Standards for medical education accreditation programs were studied, and a literature search was conducted on the topic of the role of the health sciences librarian in medical education.
Results:
Expectations for library and information services in current standards were documented, and a draft standard prepared. A comprehensive bibliography on the role of the health sciences librarian in medical education was completed, and an analysis of the services provided by health sciences librarians was created.
Conclusion:
An essential role and responsibility of the health sciences librarian will be to provide the health care professional with the skills needed to access, manage, and use library and information resources effectively. Validation and recognition of the health sciences librarian's contributions to medical education by accrediting agencies will be critical. The opportunity lies in health sciences librarians embracing the diverse roles that can be served in this vital activity, regardless of accrediting agency mandates.
doi:10.3163/1536-5050.97.4.012
PMCID: PMC2759163  PMID: 19851492
21.  Teaching physiotherapy skills in culturally-diverse classes 
BMC Medical Education  2011;11:34.
Background
Cultural competence, the ability to work in cross-cultural situations, has been acknowledged as a core skill for physiotherapists and other health professionals. Literature in this area has focused on the rationale for physiotherapists to provide culturally-competent care and the effectiveness of various educational strategies to facilitate the acquisition of knowledge about cultural competence by physiotherapists and physiotherapy students. However, there is a paucity of research on how students with different cultural needs, who are attending one university class, can be accommodated within a framework of learning core physiotherapy skills to achieve professional standards.
Results
This paper reports on steps which were taken to resolve the specific needs of a culturally-diverse body of first year physiotherapy students, and the impact this had on teaching in a new physiotherapy program located in Greater Western Sydney, Australia. Physiotherapy legislative, accreditation and registration requirements were considered in addition to anti-discrimination legislation and the four ethical principles of decision making.
Conclusions
Reflection on this issue and the steps taken to resolve it has resulted in the development of a generic framework which focuses on providing quality and equitable physiotherapy education opportunities to all students. This framework is generalizable to other health professions worldwide.
doi:10.1186/1472-6920-11-34
PMCID: PMC3146421  PMID: 21679404
22.  Projects in Medical Education: “Social Justice In Medicine” A Rationale for an Elective Program as Part of the Medical Education Curriculum at John A. Burns School of Medicine 
Background
Research has shown that cultural competence training improves the attitudes, knowledge, and skills of clinicians related to caring for diverse populations. Social Justice in medicine is the idea that healthcare workers promote fair treatment in healthcare so that disparities are eliminated. Providing students with the opportunity to explore social issues in health is the first step toward decreasing discrimination. This concept is required for institutional accreditation and widely publicized as improving health care delivery in our society.
Methods
A literature review was performed searching for social justice training in medical curricula in North America.
Results
Twenty-six articles were discovered addressing the topic or related to the concept of social justice or cultural humility. The concepts are in accordance with objectives supported by the Future of Medical Education in Canada Report (2010), the Carnegie Foundation Report (2010), and the LCME guidelines.
Discussion
The authors have introduced into the elective curriculum of the John A. Burns School of Medicine a series of activities within a time span of four years to encourage medical students to further their knowledge and skills in social awareness and cultural competence as it relates to their future practice as physicians. At the completion of this adjunct curriculum, participants will earn the Dean's Certificate of Distinction in Social Justice, a novel program at the medical school. It is the hope of these efforts that medical students go beyond cultural competence and become fluent in the critical consciousness that will enable them to understand different health beliefs and practices, engage in meaningful discourse, perform collaborative problem-solving, conduct continuous self-reflection, and, as a result, deliver socially responsible, compassionate care to all members of society.
PMCID: PMC3347740  PMID: 22737646
23.  Distribution and determinants of patient satisfaction in oncology: A review of the literature 
Cancer is one of the leading causes of morbidity and mortality in the United States. It places considerable mental, physical, and emotional stress on patients and requires them to make major adjustments in many key areas of their lives. As a consequence, the demands on health care providers to satisfy the complex care needs of cancer patients increase manifold. Of late, patient satisfaction has been recognized as one of the key indicators of health care quality and is now being used by health care institutions for monitoring health care improvement programs, gaining accreditation, and marketing strategies. The patient satisfaction information is also being used to compare and benchmark hospitals, identify best-performance institutions, and discover areas in need of improvement. However, the existing literature on patient satisfaction with the quality of cancer care they receive is inconsistent and heterogeneous because of differences in study designs, questionnaires, study populations, and sample sizes. The aim of this review was therefore to systematically evaluate the available information on the distribution and determinants of patient satisfaction in oncology.
PMCID: PMC2778427  PMID: 19936172
patient satisfaction; determinants; oncology
24.  Accreditation council for graduate medical education (ACGME) annual anesthesiology residency and fellowship program review: a "report card" model for continuous improvement 
BMC Medical Education  2010;10:13.
Background
The Accreditation Council for Graduate Medical Education (ACGME) requires an annual evaluation of all ACGME-accredited residency and fellowship programs to assess program quality. The results of this evaluation must be used to improve the program. This manuscript describes a metric to be used in conducting ACGME-mandated annual program review of ACGME-accredited anesthesiology residencies and fellowships.
Methods
A variety of metrics to assess anesthesiology residency and fellowship programs are identified by the authors through literature review and considered for use in constructing a program "report card."
Results
Metrics used to assess program quality include success in achieving American Board of Anesthesiology (ABA) certification, performance on the annual ABA/American Society of Anesthesiology In-Training Examination, performance on mock oral ABA certification examinations, trainee scholarly activities (publications and presentations), accreditation site visit and internal review results, ACGME and alumni survey results, National Resident Matching Program (NRMP) results, exit interview feedback, diversity data and extensive program/rotation/faculty/curriculum evaluations by trainees and faculty. The results are used to construct a "report card" that provides a high-level review of program performance and can be used in a continuous quality improvement process.
Conclusions
An annual program review is required to assess all ACGME-accredited residency and fellowship programs to monitor and improve program quality. We describe an annual review process based on metrics that can be used to focus attention on areas for improvement and track program performance year-to-year. A "report card" format is described as a high-level tool to track educational outcomes.
doi:10.1186/1472-6920-10-13
PMCID: PMC2830223  PMID: 20141641
25.  A multimethod research investigation of consumer involvement in Australian health service accreditation programmes: the ACCREDIT-SCI study protocol 
BMJ Open  2012;2(5):e002024.
Introduction
Health service accreditation programmes are a regulatory mechanism adopted to drive improvements inpatient safety and quality. Research investigating the benefits or limitations, of consumer involvement in accreditation programmes is negligible. To develop our knowledge in this area the ACCREDIT collaboration (Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork) has developed a research plan, known as the ACCREDIT-SCI (Standards of Consumer Involvement) study protocol. Two complementary studies have been designed: one, to examine the effectiveness of a standard for consumer participation and two, to explore how patient experiences vary across a range of settings with differing accreditation results.
Methods and design
The research setting is the Australian healthcare system, and the two studies focus on three accreditation programmes in the primary, acute and aged care domains. The studies will use multimethods: document analysis; interviews and surveys. Participants will be stakeholders across the three domains including: policy officers; frontline healthcare professionals; accreditation agency personnel, including surveyors and healthcare consumers. Drawing on previous experience, the research team has developed purpose-designed tools. Data will be analysed using thematic, narrative and statistical (descriptive and inferential) procedures.
Ethics and dissemination
The University of New South Wales Human Research Ethics Committee has approved the two studies (HREC 10274). Findings will be disseminated through seminars, conference presentations, academic publications and research partner websites. The findings will be formulated to facilitate uptake by policy and accreditation agency professionals, researchers and academics, and consumers, nationally and internationally.
doi:10.1136/bmjopen-2012-002024
PMCID: PMC3488739  PMID: 23059848

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