Impact of hospital accrediation on organizational culture and in-patient satisfaction

Abstract

Introduction: The Australian Council on Healthcare Standards (ACHS) is commissioned by the Hospital Authority (HA) of the Hong Kong Special Administrative Region (HKSAR) to pilot test hospital accreditation at selected public hospitals in Hong Kong. This study sets out to explore ways in which hospital accreditation influenced quality of care by looking at organizational culture profiles and in-patient satisfaction. Methods: Full-time clinical staffs of Queen Mary Hospital (QMH) were surveyed nine months before the implementation of accreditation, and followed up twice at one-year interval, to profile organizational culture using the Quality Improvement Implementation Survey II (QIIS II). Four culture dimensions (group, developmental, rational and hierarchical) were computed into culture strength indicators and tested for changes over time. Adult in-patients (age 18-80) hospitalized at QMH were invited to participate in a post discharge survey on patient satisfaction using the Picker Patient Experience (PPE15) survey. Simple additive scoring was used to compute the PPE-15 domain and summary scores. Linear models were used to assess influence of culture change on satisfaction scores. Results: Culture strength scores improved across the three time-points despite hierarchical culture remained persistent and higher than that reported by similar studies overseas. With no significant differences in patient demographic characteristics amongst three cross-sections, PPE-15 scores continued to go down, suggesting better patient experience in most domains with the exception of ‘continuity’ (‘not told about medication side effects’). Scores by last measurements were lower than 2005 Thematic Household Survey for all HA clusters. Conclusions: Organizational culture and patient satisfaction improved after implementation of accreditation.