Festival Fiasco: Unveiling the Illusion of Quality

In this 10-article series, I will critically examine the transient nature of quality improvement efforts surrounding accreditation assessments in hospitals and unearth root causes.

This series seeks to move beyond the temporary "festival" of quality to establish a sustainable culture of quality and continuous improvement. Recommendations, measures, and continuing quality systems in hospitals will be covered.

The articles are in three subsets – ‘Deconstructing the Situation’, ‘Measures to adopt’ and ‘Continuing Quality systems in the Hospitals’.

DECONSTRUCTING THE SITUATION

1. The Quality Mirage: Understanding the Yo-Yo Effect in Hospital Accreditation

Hospital accreditation is a hallmark of excellence, showcasing an institution's commitment to high standards of patient care and safety. Yet, beneath this esteemed recognition, a troubling pattern emerges. I call it “Festivals of Quality” or the "Yo-Yo Effect".? It’s a cycle where hospitals temporarily enhance their practices for accreditation, only to revert to old ways rapidly after the assessment gets done. This phenomenon is a significant challenge in the sustainability of quality improvements and its real impact on patient care.

Over past 15 years I have assessed hundreds of hospitals for accreditation and consulted with several dozens. I have observed that most hospitals fall into this trap of “Festivals”. In this article I will deconstruct the phenomenon.

A Surge of Quality The path to accreditation is exhaustive, demanding hospitals to align with a comprehensive set of standards. In preparation, institutions may undergo dramatic transformations, from infrastructural upgrades to the implementation of advanced healthcare technologies and safety protocols. These efforts are aimed at securing a favorable assessment, showcasing a temporary peak in quality and operational excellence.

The Reality Unfolds However, the aftermath of accreditation often reveals a concerning trend. A relaxation in the rigor of maintaining these newly implemented standards is not uncommon, attributed to the unsustainable resource allocation during the preparation phase, lack of continuous monitoring, the pressure to revert to cost-saving yet potentially compromising measures and pressures to ‘ease’ the work.

The Re-surge

Very soon the re-survey knocks the door, and the “festival” begins. In most hospitals key people may have changed during the intervening period and the trained staff moved to greener pastures, the quality gets relegated to ‘entrusted’ to a “junior” staff - usually a ‘Quality Manager” (often with no clinical background and little training). The ‘Quality Manager’ has the onerous task of maintaining “Quality” with ‘minimal’ cooperation from the clinical teams, nursing and support staff who are all involved in ‘providing care’ to the patients and consider quality as a burden and a ‘necessary evil’ at best.

The results are not surprising. The re-survey shows improved quality with a lot of key indicators showing ‘0’ or ‘100%’ achievement! In the absence of cooperation from clinical teams and staff, then Quality manager actually ‘manages’ the quality system and ‘puts out’ the results. ?

And another “festival” gets over! I have seen this “Yo-Yo” repeats over and over again for periods, sometimes lasting over a decade.

Implications of “Festivals”: Undermined Patient Care This Yo-Yo Effect fundamentally undermines the purpose of accreditation. While aimed at ensuring consistent high-quality care, the cycle of improvement followed by regression creates a false sense of security, potentially leading to compromised patient safety and care quality.

Root Causes and Moving Forward Addressing this phenomenon requires a cultural shift in healthcare institutions towards continuous improvement and embracing accreditation standards as a permanent operational philosophy. It also calls for accrediting bodies to refine assessment methodologies, focusing on the sustainability of practices and incorporating unannounced visits and patient outcomes data into the evaluation process.

Beyond the Mirage The Yo-Yo Effect in hospital accreditation unveils a mirage of quality — temporary excellence that masks the challenge of sustaining high standards. Overcoming this issue is critical for truly enhancing patient care and ensuring accreditation serves its role as a beacon of trust and excellence in healthcare.