Nursing Perception Towards Hospital Re-Accreditation at National Guard Health Affairs Prof Mostafa A. Abolfotouh Dr. Mohamed AlKelya Mrs. Nawal AbuKhalid Mr. Mahmoud Salam (Speaker) Dr. Ahmed Alamry King Abdullah International Medical Research Center (KAIMRC), King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Quality management department, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Joint Commission International (since 1951) US non-profit accreditation leader in the world of health care (based in Illinois). Accredited 19,000 organizations in USA. Surveyed hospitals in more than 60 countries in the Middle East, Asia, Europe and South America. About 99% of inspected hospitals are accredited Estimated minimum of $46,000 for a full hospital survey ^ "Joint Commission On Accreditation Of Healthcare Organizations in Oakbrook Ter, Illinois (IL)". faqs.org. June 30, 1975. Retrieved October 17, 2011. ^ "Cost of Accreditation". Joint Commission International. Retrieved October 17, 2011. ^ "American Society for Healthcare Engineering". ^ "Patients Meet to Promote Mother and Child Health in the Americas". Paho.org. June 11, 2007. Retrieved October 17, 2011.

Overview on JCI Accreditation A JCI Accredited Hospital Met the highest international standards and requirements in health care Worldwide recognition Quality patient care

Purpose of Study The aim of this project was to assess the general perception of nursing service personnel towards JCI accreditation at King Abdulaziz Medical City (KAMC), Riyadh, KSA.

Significance of Study At NGHA no studies investigated nurses’ perception towards JCI accreditation. Health care quality is “nurse-sensitive” A key quality indicator of NDNQI is the nursing satisfaction. Alexander, G. ( 2007). Nursing Sensitive Databases Their Existence, Challenges, and Importance. Medical Care Research and Review. P.44s-62s.

Methodology Design: Cross sectional Area/Setting: King Abdulaziz Medical City (KAMC), National Guard Health Affairs (NGHA). Population: All nurses were involved (Population 4,000) Data collection: Mass electronic survey (1 month) Sampling technique: Consecutive (convenient) Ethical consideration: IRB exemption, Voluntary, Anonymous, confidential No participant identifiers.

Methodology (Ct’d) Sample size: Assuming 50% favorable perception of nurses Margin of error of 5%, and 95% CL, Estimated sample size was 386 . 63.38% Response rate Nurses surveyed: 751 Nurses responded: 476

Data collection tool The tool was previously utilized in literature (cross cultural validation). Various validity tests (content validity) Wording and timeliness tests Pilot test on 20 nurses at NGHA (Ward12 &13)…. (Thank you). Inter-rater reliability tests (Cronbach's α = 0.956 ) NGHA customized Revised and modified by Quality experts El-Jardali et al. (2008). The impact of hospital accreditation on quality of care: perception of Lebanese nurses. International Journal for Quality in Health Care. P. 363-371. Pomey, M. P., A. P. Contandriopoulos, et al. (2004). "Accreditation: a tool for organizational change in hospitals?" Int J Health Care Qual Assur Inc Leadersh Health Serv 17

Domains of Nurses’ Perception Quality of health services and patient satisfaction (4 statements) Leadership, commitment and support of management (8 statements) Strategic quality planning (9 statements) Human resources utilization for employee recognition, satisfaction, and continuous education. (5 statements) Quality management (6 statements) Usage of data Accreditation: Staff involvement and perceived benefits (12 statements)

Likert Scale Strongly – Disagree – Neutral – Agree – Strongly Disagree Agree 0 1 2 3 4 Negative Response Neutral Response Positive Response Scores were later converted to percentages The mean percentage scores were calculated. 0-50% 50%-75% 75%-100%

Results Male 11% Female 89% Gender vs nationality Saudi 14% Non Saudi 86% Gender vs nationality Female 89% Male 11% Saudi 4% Non Saudi 96% Mean of age : 40.7 + 9.2 yrs Mean of experience: 13.04 + 9.6yrs

Results 7% Surgical 31% Medical 62% Post Managerial Under Graduate 21% Job Positions Level of Education Managerial 21% Direct Patient care 79% Under Graduate 18% Graduates 72% Post 10% Medical 62% Surgical 31% Administrative 7% Area of Specialty

Percentage mean scores of Nursing Perception Domains Quality Leadership, commitment support Strategic Quality Planning Human resources utilization Quality Mgt Usage of data Accreditation Overall Perception 71.13+17.85 70.23+17.72 67.91+16.42 70.76+16.64 66.11 +17.76 65.89 +19.67 61.15+20.86 64.07+20.58 The 7 domains of perception all overlap, which means there is no major differences of percentage mean scores for nursing perception.

Percentage Scores of the Perception Domains Negative Neutral Positive Quality Leadership, commitment support Strategic Quality Planning Human resources utilization Usage of data Quality Mgt Accreditation Overall Perception 30.30% 21.60% 48.10% 31.90% 23.80% 44.30% 22.30% 24.50% 53.20% 36.80% 30.40% 32.80% 20.80% 25.80% 53.40% 34.90% 19.10% 46.00% 20.40% 27.30% 52.30% 10.10% 47.30% 42.60% Mean Percentage of Scores: 66.11 +17.76 65.89 +19.67 70.23+17.72 61.15+20.86 70.76+16.64 64.07+20.58 71.13+17.85 67.91+16.42

Over all Perception 11.3 60.3 28.4 Quality 11.8 40.1 48.1 Quality management 7.6 39.1 53.4 Usage of data 17.4 36.6 46 Human resources utilization 22.5 44.7 32.8 Leadership, commitment and support 13.7 42 44.3 Strategic quality planning 9.5 37.4 53.2 Accreditation 9.2 38.4 52.3

Mean Percentages of Overall Nursing Perception 63.59 68.42 58.18 68.43 64.87 68.73 67.67 68.91 59 67.42 69.05 67.51 64.98 68.65 69.21 66.78 60.69 20 40 60 80 100 Male Female Saudi Non <30yrs 30-45yrs >45yrs Tech/BS MS/PHD < 5 years 5–10 years > 10 years Direct patient care Managerial Medical Surgical Admin/Educ F=4.34, df=2, p=0.014* t =1.53, p=0.132 t =-2.497, p=0.02* F=1.46, p=0.233 t=4.029, p= 0.0001* F=0.428, p=0.652 t =1.96, p=0.050065 t: independent t-test F: one way ANOVA P= P value *: Statistical significance 1st) Braithwaite, J. et al . (2008). Health service accreditation as a predictor of clinical and organizational performance: a blinded, random, stratified study. BMJ Quality & Safety. P.14-21 “Findings were that the view of accreditation was between approving and supportive of accreditation as well as criticizing” 2nd) Tehewy, M., Salem, B., Habil, I. & El Okda, S. (2009). Evaluation of accreditation program in non-governmental organizations’ health units in Egypt: short-term outcomes. International Journal for Quality in Health Care. P.183-189. “ Higher satisfaction in accredited health units.It also concluded that accredited health centers showed higher patient satisfaction compared to non-accredited health units. 3rd) El-Jardali et al. (2008). The impact of hospital accreditation on quality of care: perception of Lebanese nurses. International Journal for Quality in Health Care. P. 363-371. “The results revealed that nurses perceived improvement in quality as a result of accreditation 4rth) Elkins, G. et al. (2010). Perceived stress among nursing and administration staff related to accreditation. Clinical Nursing Research. P. 367-385. “Increased stress increased the mental and physical health problems such as signs of anxiety, depression and decreased job satisfaction. Interventions from the health organizations to help decrease the stress on the nurses especially the ones in management’s positions were recommended.”

Linear Regression for Overall Nursing Perception Logistic Regression for Overall Nursing Perception Linear Regression for Overall Nursing Perception Exposures Beta S.E. t adjP-value Age 1 0.256 0.118 2.171 0.03* Experience2 -0.222 0.117 -1.899 0.058 Gender: Male=0 Female=1 1.968 2.478 0.794 0.428 Nationality Non Saudi=0 Saudi=1 -6.770 3.570 -1.896 0.059 Education3 categories MSN/PHD=0 Tech/BSN=1 8.623 2.526 3.414 0.001* Position4 Direct care=0 Managerial= 1 -1.567 2.092 -0.749 0.454 1 : The more age the better perception 2 : The less education the better perception

Recommendations Tailored educational interventions for nurses to emphasize the importance of hospital accreditation in upgrading the quality of health care. Further employee engagement in the accreditation process. Better Human Resource recognitions, rewards, incentives, continuous education, empowerment etc... Annual surveys to monitor and keep track of current progress.

Thank You…… …..Questions

References 1) Joint Commision International, 2011. Joint Commision International Accrediation And Certification.[Online]. Avaliable at: <http://www.jointcommissioninternational.org/Accreditation-and-Certification-Process/> [Accessed 3 March 2011] 2) Joint Commision Internatiol, 2011. About Joint Commision Resources . [Online]. Avaliable at: <http://www.jointcommissioninternational.org/About-JCR/>. [Accessed 6 March2011] 3) Braithwaite, J. et al. (2008). Health service accreditation as a predictor of clinical and organizational performance: a blinded, random, stratified study. BMJ Quality & Safety. P.14-21 4) The Joint Commision, 2011. History Of Joint Commsion. [Online]. Avaliable at: <http://www.jointcommission.org/assets/1/18/Joint_Commission_History.pdf> [Accessed 13 March2011] 5) Helen Ziegler and Associates, 2011. What is JCI Accreditation? [Online].Avaliable at: <http://www.hziegler.com/locations/middle-east/articles/jci-accreditation.html> [Accessed 15 March2011] 6) Joint Commision Internatiol, 2011. about joint commision international. [Online]. Avaliable at: <http://www.jointcommissioninternational.org/about-jci/>[Accessed 15 March2011] 7) National Guard Health Affairs, 2010. Accomplishments. [Online]. Avaliable at: <http://www.ngha.med.sa/English/MedicalCities/Dammam/About%20us/Pages/Accomp lishments.aspx>[Accessed 13 March2011] 8) National Guard Health Affairs, 2010. Define Accreditation in Medical Cities.[Online]. Available at: <http://www.ngha.med.sa/English/AboutNGHA/Pages/Accreditation.aspx> 9) National Guard Health Affairs, 2010. JCI Re-accreditation. [Online]. Available at: <http://www.ngha.med.sa/English/MediaCenter/News/Pages/2010-1-13_01.aspx> 10) Tehewy, M., Salem, B., Habil, I. & El Okda, S. (2009). Evaluation of accreditation program in non-governmental organizations’ health units in Egypt: short-term outcomes. International Journal for Quality in Health Care. P.183-189. 11) Alexander, G. ( 2007). Nursing Sensitive Databases Their Existence, Challenges, and Importance. Medical Care Research and Review. P.44s-62s. 12) El-Jardali et al. (2008). The impact of hospital accreditation on quality of care: perception of Lebanese nurses. International Journal for Quality in Health Care. P. 363-371. 13) Elkins, G. et al. (2010). Perceived stress among nursing and administration staff related to accreditation. Clinical Nursing Research. P. 367-385.