ABSTRACT
Healthcare accreditation programmes have been developed and implemented in many countries based on the expectation that they will improve patient safety and quality of healthcare. Accreditation is not a new phenomenon, having a history of almost 100 years in the United States and Canada and was launched in Australia more than 40 years ago (Scrivens, 1995). While it maintains its importance in these countries, a steep increase in the number of accreditation programmes in operation began in the 1990s and amounted to 44 in 2009, some of which were operating in several countries (Shaw et al., 2013). In Denmark, accreditation was adopted as a national strategy in 2005 but has been partially discontinued in 2015 (see Box 8.1). In the other Nordic countries, it has never gained a foothold, although there are isolated examples of hospitals choosing to go for accreditation or ISO certification (e.g., Hasman, 2012; Lie and Bjørnstad, 2015; Norén and Ranerup, 2015). The Danish Healthcare Quality Programme
The Danish Healthcare Quality Programme (DDKM – Den Danske Kvalitets-model) was established in 2005 by the Danish Government and the five Danish regions (the regions run about 98% of all hospital services, financed over state taxes). The intention was to create a common national system for the assessment of quality in healthcare to promote better patient pathways, transparency of quality and continuous quality improvement (QI). At the outset, the programme covered only public hospitals, but step by step all publically financed healthcare has been included and now covers private hospitals, pharmacies, prehospital care, some aspects of municipality-based primary care as well as, from 2015 and onwards, programmes for all practice-based healthcare (GPs, physio-/ergotherapists, chiropractors) are being launched.
The two main components of the programme are the accreditation standards, setting the criteria against which the performance of the hospitals is assessed and the external survey conducted once every 3 years, where a team of surveyors assess the hospitals against the standards. The surveyors are hospital employees (senior clinicians or managers), trained for the purpose, and working as surveyors for 2–3 weeks per year. A large hospital will be assessed by a team of 6–8 surveyors for 5 days. The focus, in particular in the second cycle, has been on implementation of good working practices, judged by interviewing front-line staff and cross checking with documentation, such as patient records, and on a systematic approach to QI. Processes are assessed for their ability to deliver the expected outcome, rather than merely on compliance with formal specifications in written policies. The findings during the survey are presented in a published report and are the basis for the decision of which level of accreditation to award.
By the end of 2015, two cycles of accreditation had been completed for all public hospitals in Denmark and the programme for public hospitals was terminated. The Ministry of Health has indicated that the two cycles of accreditation have improved quality, especially organisational quality, and patient safety, but that the time has come to replace accreditation with other means of QI. Hospital accreditation is now perceived as entailing a burden of bureaucracy, excessive registration and documentation and a focus on detailed specification of processes, all of which are not meaningful to front-line staff (Danish Ministry of Health, 2015). Accreditation programmes will continue in private hospitals and pharmacies, GP practices and specialist physician practices.
