1. The Changing Face of Healthcare Accreditation and Regulation in Australia Ruth McPhail Mark Avery Ron Fisher Anneke Fitzgerald Liz Fulop Griffith Business School

2. A Review of Regulation and Accreditation in Health Care Review the background of accreditation in health care in Australia The NSQHS standards compliance assessment program development in Australia Focus on providers’ products and services in an effort to explore how these may impact on the Australian Health Care system. 2

3. Griffith Business School Findings  Australia is not alone in undergoing reforms in accreditation and performance in health care.  Other countries and international organisations have recently revised and renewed their interest in how health care systems perform.  This has led to the development of performance indicators for monitoring, assessing and managing health care systems to achieve effectiveness, equity, efficiency and quality. 3

4. Griffith Business School Findings  Although the indicators populate conceptual frameworks, it is not often clear just what the underlying concepts might be or how effectiveness is conceptualised and measured.  There is a gap in the knowledge of how the resultant performance data are used to stimulate improvement and to ensure health care quality. 4

5. Griffith Business School Findings  This paper reports on research from a larger study, and draws on interviews data analysis to examine the Australian NSQHS standards from the perspective of 3 of the 12 approving accrediting agencies. Analysis of major themes emerging from the first three interviews are discussed.  The presentation focuses on exploring the optimisation of the regulatory environment to drive performance and quality in health facilities. 5

6. Griffith Business School Findings  At the time this research commenced there were 12 accrediting agencies listed on the ACSQHC web site (as at 12 December 2012)  There may be changes in the future relating to the partnering and mergers of some of the approved accrediting agencies 6

7. Griffith Business School Accreditation development Accreditation began in the early part of the twentieth century in the USA as a mechanism to ensure an appropriate environment in which clinicians could practice effectively. In the past decade, these accreditation systems have been forced to change. Pressure for greater knowledge of clinical effectiveness by introducing indicators of clinical performance. Accreditation, originally perceived as a vehicle to enable organisational development, is increasingly an agent of government regulation (Scrivens, 1995).Scrivens, 1995 7

8. Griffith Business School Accreditation development Accreditation of health care systems is increasingly seen as an approach to ensuring health standards in both private and public system. The focus for accreditation standards in the past has been on organisational policies and procedures rather than the organisation of clinical activity. More recently, critics question the value of accreditation rather than certification or inspection. 8

9. Griffith Business School Accreditation development To date research has focused more on evidence of impact on provider institutions than overall impact on health systems. little has been published on the determinants of growth or decline of accreditation organisations and programs (Shaw, Kutryba, Braithwaite, Bedlicki, & Warunek, 2010).ShawKutryba, Braithwaite, Bedlicki, & Warunek, 2010 9

10. Griffith Business School Research design The research is a qualitative study where data were collected using open-ended, semi- structured interviews (Kvale, 1996; Minichello, 1997; Creswell, 2003) and the examination of relevant documents. Although the research is positioned across several organisations the purpose of this paper is not to focus on differences between organisations but on major themes that are common to each of them interviewed so far. 10

11. Griffith Business School Data Collection and Analysis Qualitative study with formal, open-ended, semi-structured interviews and the examination of relevant documents. Data were analysed using the constant comparison approach advocated by constant comparison process had generated 37 concepts, some of which were single concepts, while others were composite concepts. Composite concepts were constructed using an axial coding process (Strauss & Corbin, 1990, 1998) where concepts with similar meaning were combined. Five themes were identified (Kvale, 1996; Minichello, 1997; Creswell, 2003) Strauss and Corbin (1990, 1998) 11

12. Griffith Business School Findings Following are the emerging themes of the preliminary findings of the accrediting agencies who are shaping accreditation in Australia. The five themes were: 1) multiple levels of accreditation offered; 2) assessor recruitment and training; 3) business excellence; 4) improved processes; and 5) value versus price. 12

13. Griffith Business School Theme 1: Multiple levels of accreditation offered Optional products or approaches to accreditation are valued in addition to the NSQHS standards. There are variations across regions in Australia. Competition has entered and opened the market. Specialisation in accreditation products is occurring. 13

14. Griffith Business School Theme 2: Assessor recruitment and training Significant importance identified around the healthcare sector background and training of assessors/surveyors. National demand for competent and well trained assessors. Ongoing and comprehensive training, development and credentialing of assessors/surveyors. Differentiation between assessor skills and sector knowledge to application of high level assessor/surveyor acumen. There is a continuum of assessor development-experience. 14

15. Griffith Business School Theme 3: Business excellence Aspirations to move beyond current model to one which facilitates compliance but goes further to promoting excellence (improvement). Supporting sustainable and continuous improvement and quality improvements in the sector. Assessors/surveyors to identify and enable the sharing of best practice. Concern that assessors/surveyors not being seen as consultants - they should keep designated role and not step outside their auditors roles (need to promote improvement through the identification of positive performance in a qualitative way). The strength of accreditation is that it is a management tool that can be used to say that ‘yes’ or ‘no’ there is compliance - not to identify strengths. 15

16. Griffith Business School Theme 4: Improved processes Consistent set of standards with shared understanding of meaning and process should lead to improved processes and outcomes. Heavily reliant on assessor/surveyors skills and abilities and continuity of assessor/surveyors. “Accreditation is as only as good as the auditor.” Information gathering ‘arms’ will be very powerful instruments to help improve processes. 16

17. Griffith Business School Theme 5: Value versus price Discounting audit prices some clients might be influenced by price but it was envisaged that most would not. Recognition of the value of the accreditation. Driven by a need to identify weaknesses, leading to improvement, a focus on value not price of audit. Continuity and strengths of auditors is also perceived by clients as an important factor that provides value for them. 17

18. Griffith Business School Discussion Data: Identified the multiple layers of accreditation still apparent within the sector with NSQHS standards in some ways adding to that but hoping that it will ultimately replace some layers. The importance of the assessors; skills, contributions, inter-rater reliability. The importance of the need to attract, train, retain, and value assessors/surveyors as an important part of the standards compliance process 18

19. Griffith Business School Discussion A push to achieve more than compliance and reach a standard of business excellence beyond the NSQHS standards. Improved processes through the shared language of the 10 NSQHS. A value-driven accreditation market. 19

20. Griffith Business School Where to next… Remaining accrediting providers to be interviewed (some underway). More details to be collated in regards to the products and services. Future research: Potential longitudinal study of continued changes and outcomes in the landscape of Australian accreditation which is moving along a regulation continuum. 20

21. Griffith Business School Thank you Questions? 21