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Unannounced or announced periodic hospital surveys: a study protocol for a nationwide cluster-randomized controlled trial

Authors Beltoft Simonsen K, Olesen AV, Jensen MB, Rasmussen GS, Ehlers LH

Received 17 April 2015

Accepted for publication 29 May 2015

Published 1 September 2015 Volume 2015:5 Pages 57—63

DOI https://doi.org/10.2147/CER.S86740

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Katherina Beltoft Simonsen,1 Anne Vingaard Olesen,1 Morten Berg Jensen,1,2 Gitte Sand Rasmussen,3 Lars Holger Ehlers1

1Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark; 2Center for Research in Econometric Analysis of Time Series, Department of Economics and Business, Aarhus University, Aarhus, Denmark; 3Danish Institute for Quality and Accreditation in Healthcare, Aarhus, Denmark

Purpose: Accreditation programs for health care systems have been implemented in more than 70 countries to stimulate high-quality organizational performance. Several Danish health care institutions are covered by the Danish Healthcare Quality Program (DDKM), and all Danish public hospitals have been accredited according to the DDKM since 2010. The dates of each survey are currently announced beforehand. Announcing surveys has been criticized for creating an “arranged reality”. It was therefore suggested that a national intervention be conducted to evaluate the effect of unannounced hospital surveys. The objective is to evaluate the effect of unannounced hospital surveys compared to the conventional announced hospital surveys by conducting a cluster-randomized controlled trial.
Methods: All public somatic and psychiatric hospitals in Denmark (n=30) were invited to participate. Twenty-three hospitals (77%) agreed to participate and to be randomized to one of the trial clusters. Eleven hospitals received announced surveys (control group) and 12 hospitals received unannounced surveys (intervention group). We hypothesized that hospitals receiving unannounced surveys would be rated as less successful than hospitals receiving announced surveys, defined as meeting less compliance with accreditation standards and performance indicators. Surveyors employed and educated by the Danish Institute for Quality and Accreditation in Health Care (IKAS) were responsible for conducting the surveys according to an abbreviated version of the current Danish Healthcare Quality Program (DDKM). The outcome is compliance with indicators reflecting organizational performance. Compliance was analyzed using binomial regression analyses with bootstrapped standard errors.
Discussion: Unannounced hospital surveys are expected to reveal less compliance with performance indicators compared to the announced hospital surveys. These study results may facilitate a validation of the effect of unannounced periodic hospital surveys influencing the decision of whether or not unannounced surveys should be implemented as a new method of conducting accreditation programs in Danish hospitals.

Keywords: accreditation, quality improvement, quality indicators, health care

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