1. Are clinical leaders and staff prepared for accreditation? Survey on knowledge, expectations and areas for improvement in the County of Copenhagen Gut R. 2, Lehmann Knudsen J. 1, Jensen A. J. 2, Freil M. 2 1: Central department for research and development in the County of Copenhagen, 2: Unit of Patient Evaluation in the County of Copenhagen Introduction Three University hospitals and the five psychiatric centres in the County of Copenhagen are preparing for accreditation in 2006. The engagement of clinical leaders and staff members is crucial. Conclusion and perspective Patient safety was the area where the greatest improvement was experienced and acknowledged by as well the staff as the leaders The results of the surveys have influenced the planning process. It has created a greater awareness about accreditation and preparation process. The surveys are baseline evaluations and will be repeated throughout the accreditation process. Due to remarkable discrepancy between the evaluation of quality by patients and by the leaders and staff in specific areas further investigations will be carried out. Contact : Chief of development in Copenhagen Country Janne Lehmann Knudsen: jalekn@shf.kbhamt.dk Figure 1: Quality improvement (staff and leaders) Methods and materials A survey among all clinical leaders at the departmental level was carried out in October 2003. A randomised sample of staff members participated in a similar survey in April 2004. The questionnaires consisted of a quantitative and a qualitative part. StaffLeaders Methods Survey Questions Quantitative and qualitative Themes Quality improvement Expectation to accreditation Suggestions and advice in planning process Knowledge about accreditation Statistics Bivariate analysis using simple tables Multivariate analysis using logistic regressions Project preparation and management Copenhagen County's: Unit of Patient Evaluation Central department for research and development Hospitals and the psychiatric centres Period October 2003 April 2004 Respond rate 77% 41% Survey sample Everyone 1285 (randomised sample) Responds Non anonymous Anonymous Reminder procedure Nonresponders Everyone Units Leaders from clinical units and laboratories All units Positions Nurses Doctors Other clinical position Nurses Doctors Other clinical position Non clinical position Validation 6 written comments 8 interviews Results  A need for quality improvement was found in many areas. The greatest need was found concerning patient safety. Continuity and the need for improvement of prevention were other major areas (figure 1).  The staff was in all aspect more critical about the current quality compared to the leaders. A survey on patients experiences is carried out every second year in the County of Copenhagen, the latest in 2004 (www.efb.kbhamt.dk). Though the results are not directly comparable to the results above it points out areas where patients have the same or different acknowledgement of quality problems than staff and leaders. The leaders’ and the staff's judgements about the need for improvement in specific areas are remarkably different from the patients’ evaluation. Ex. the patients experience that major improvement is needed in the hospitals co-operation with primary sector. This is not an area where the staff and especially the leaders find a major need for improvement. Facts about the County of Copenhagen Population: 620.000 University hospitals: 3 Psychiatric centres: 5 Treated patients per year: 230.000 (tjek psykiatrien) Hospital beds: 1.800 (tjek psykiatrien) Hospital staff: 15.000 Objective Among clinical leaders and staff in hospitals and psychiatric settings to asses:  Acknowledgement of quality problems in specific areas related to the patient pathways  Expectations to accreditation as a tool for quality improvement  Knowledge about accreditation and the Danish Quality Model (the upcoming national accreditation program)  Advices concerning the further planning. Doctor-patient continuity at the hospital? Safety culture (focus on the system not the individual)? Prevention toward the individual patient (adverse risks)? That department document/follow up/analyze adverse events? Focus on procedures connected with high risk for the patients? Involve patients in decision on examination and treatment? Relevant information to primary sector at patients discharge? Exchanging data/information on the patient at shifts?  There is in general high expectation to accreditation as a tool for quality improvement.  The highest expectation to accreditation was as a tool to improve patient safety and to insure a more equal level of quality across different settings.  The highest expectations are among leaders and staff with the best knowledge of accreditation. Leaders of the psychiatric units had the lowest expectations and the laboratory leaders had the highest.  The nursing leaders and the nursing staff found the greatest need for improvement and had the highest expectations to accreditation.  It is a general concern that accreditation will be time consuming, without involvement of the staff and without focus on the soft values. Patient safety  17% of the patients experienced adverse event during their stay at hospital. 29% of these thought that the staff handled the event bad or really bad when discovered.