Evaluating the Impact of Short-Notice Accreditation Assessment on Hospitals' Patient Safety and Quality Culture: Protocol for a Mixed Methods Study.

Background: Accreditation programs are used by hospitals and health services to be independently reviewed against established safety and quality standards and have been a feature of global health systems for over a century. While evidence that accreditation programs directly improve patient safety and quality outcomes exists, the findings of various researchers remain mixed. Inefficiencies and a culture of "gaming" the system have also been observed, raising questions about the overall effectiveness of accreditation programs and assessment processes. Consequently, exploration of other formats of accreditation assessment, such as short-notice accreditation assessment, has arisen. From July 1, 2023, the Australian Commission on Safety and Quality in Healthcare mandated that Australian public and private hospitals must engage in short-notice accreditation assessment. Objective: This study aims to explore the impact of short-notice accreditation assessment on hospitals, both in terms of safety and quality indicators, and organizational culture. A mixed methods design will be used to investigate these impacts. Methods: Quantitative safety and quality indicators will be drawn from a regional health service prior to and following its first short-notice accreditation assessment cycle. From the same site, staff will be invited to complete the Patient Safety Culture Survey and participate in semistructured interviews. Using Schein's Culture Framework as an organizational culture model, the study will examine observable outcomes (artifacts, behaviors, and indicators) alongside staff perceptions and experiences (norms and values) to form an understanding of underlying assumptions and beliefs about short-notice accreditation assessment processes. Quantitative data will be analyzed through cross-tabulation, trend analysis, and other statistical techniques, while qualitative data will be synthesized to provide a comprehensive understanding. Results: This protocol outlines the planned evaluation of short-notice accreditation assessment and its influence on patient safety and quality culture within a regional health service. Data collection is underway, with preintervention surveys being completed, and recruitment open for postintervention interviews. The study is expected to generate new knowledge on how this accreditation assessment process affects patient safety and quality culture of a regional and a rural hospital. Conclusions: The findings will inform health policy on the suitability and long-term viability of short-notice accreditation assessment as an approach to ensuring safe, high-quality health care.