BACKGROUND: Hospital accreditation is widely adopted as a visible measure of an organisation's quality and safety management standards compliance. There is still inconsistent evidence regarding the influence of hospital accreditation on hospital performance, with limited studies in developing countries. This study aims to explore the association of hospital characteristics and market competition with hospital accreditation status and to investigate whether accreditation status differentiate hospital performance. METHODS: East Java Province, with a total 346 hospitals was selected for this study. Hospital characteristics (size, specialty, ownership) and performance indicator (bed occupancy rate, turnover interval, average length of stay, gross mortality rate, and net mortality rate) were retrieved from national hospital database while hospital accreditation status were recorded based on hospital accreditation report. Market density, Herfindahl-Hirschman index (HHI), and hospitals relative size as competition indicators were calculated based on the provincial statistical report data. Logistic regression, Mann-Whitney U-test, and one sample t-test were used to analyse the data. RESULTS: A total of 217 (62.7%) hospitals were accredited. Hospital size and ownership were significantly associated with of accreditation status. When compared to government-owned, hospital managed by ministry of defense (B = 1.705, p = 0.012) has higher probability to be accredited. Though not statistically significant, accredited hospitals had higher utility and efficiency indicators, as well as higher mortality. CONCLUSIONS: Hospital with higher size and managed by government have higher probability to be accredited independent to its specialty and the intensity of market competition. Higher utility and mortality in accredited hospitals needs further investigation.

Department of Community and Occupational Medicine University Medisch Centrum University of Groningen Antonius Deusinglaan 1 9713 AV Groningen The Netherlands

Department of Health Policy and Management Faculty of Medicine Public health and Nursing Universitas Gadjah Mada Jalan Farmako Sekip Utara Yogyakarta 55281 Indonesia

Department of Social Medicine and Public Health Faculty of Medicine and Dentistry Palacký University Hněvotínská 3 775 15 Olomouc Czech Republic

Doctoral Program in Medicine and Health Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Jalan Farmako Sekip Utara Yogyakarta 55281 Indonesia

Post Graduate Program in Hospital Management Faculty of Medicine Universitas Brawijaya East Java Jalan Veteran No 1 Malang 65145 Indonesia

Zobrazit více v PubMed

Scrivens E. Putting continuous quality improvement into accreditation: improving approaches to quality assessment. Qual Heal Care. 1997;6:212–218. doi: 10.1136/qshc.6.4.212. PubMed DOI PMC

Pomey M, Lemieux-charles L, Champagne F, Angus D, Shabah A. Does accreditation stimulate change ? A study of the impact of the accreditation process on Canadian healthcare organizations. Implement Sci. 2010;5:2–14. doi: 10.1186/1748-5908-5-31. PubMed DOI PMC

Nicklin W, Fortune T, van Ostenberg P, O’Connor E, McCauley N. Leveraging the full value and impact of accreditation. Int J Qual Heal Care. 2017;29:310–312. doi: 10.1093/intqhc/mzx010. PubMed DOI

Sheingold BH, Hahn JA. The history of healthcare quality: the first 100 years 1860-1960. Int J Africa Nurs Sci. 2014;1:18–22. doi: 10.1016/j.ijans.2014.05.002. DOI

Marjoua Y, Bozic KJ. Brief history of quality movement in US healthcare. Curr Rev Musculoskletal Med. 2012;5:265–273. doi: 10.1007/s12178-012-9137-8. PubMed DOI PMC

Wardhani V, Utarini A, van Dijk JP, Post D, Groothoff JW. Determinants of quality management systems implementation in hospitals. Health Policy. 2009;89:239–251. doi: 10.1016/j.healthpol.2008.06.008. PubMed DOI

Wagner C, Mannion R, Hammer A, Groene O, Arah OA, Dersarkissian M. The associations between organizational culture , organizational structure and quality management in European hospitals. Int J Qual Heal Care. 2014;26:74–80. doi: 10.1093/intqhc/mzu027. PubMed DOI PMC

Al-Awa B, de Wever A, Melot C, Devreux I. An overview of patient safety and accreditation: a literature review study. Res J Med Sci. 2011;5:200–223. doi: 10.3923/rjmsci.2011.200.223. DOI

Shaw CD, Groene O, Botje D, Sunol R, Kutryba B, Klazinga N, et al. The effect of certification and accreditation on quality management in 4 clinical services in 73 European hospitals. Int J Qual Heal Care. 2014;26:100–107. doi: 10.1093/intqhc/mzu023. PubMed DOI PMC

Brubakk K, Vist GE, Bukholm G, Barach P, Tjomsland O. A systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health Serv Res. 2015;15:280. doi: 10.1186/s12913-015-0933-x. PubMed DOI PMC

Feng Y, Pistollato M, Charlesworth A, Devlin N, Propper C, Sussex J. Association between market concentration of hospitals and patient health gain following hip replacement surgery. J Health Serv Res Policy. 2015;20:11–17. doi: 10.1177/1355819614546032. PubMed DOI PMC

Saleh SS, Sleiman JB, Dagher D, Sbeit H, Natafgi N. Accreditation of hospitals in Lebanon: is it a worthy investment? Int J Qual Heal Care. 2013;25:284–290. doi: 10.1093/intqhc/mzt018. PubMed DOI

Gowrisankaran G, Town RJ. Competition , payers , and hospital. Health Serv Res. 2003;38:1403–1422. doi: 10.1111/j.1475-6773.2003.00185.x. PubMed DOI PMC

Gobillon L, Milcent C. Competition and hospital quality : evidence from a French natural experiment. Paris; 2017.

Cheng SH, Wei YJ, Chang HJ. Quality competition among hospitals: the effects of perceived quality and perceived expensiveness on health care consumers. Am J Med Qual. 2006;21:68–75. doi: 10.1177/1062860605283618. PubMed DOI

Sack C, Lütkes P, Günther W, Erbel R, Jöckel K-H, Holtmann GJ. Challenging the holy grail of hospital accreditation: a cross sectional study of inpatient satisfaction in the field of cardiology. BMC Health Serv Res. 2010;10:120. doi: 10.1186/1472-6963-10-120. PubMed DOI PMC

Wong HS, Goldfarb MG. The effects of hospital competition on inpatient quality of care. Inquiry. 2008;45:263–279. doi: 10.5034/inquiryjrnl_45.03.263. PubMed DOI

Broughton E, Achadi A, Latief K, Nandiaty F, Qomariyah SN, Rianty T, et al. Indonesia hospital accreditation process impact evaluation : midline report. Washington DC; 2015.

Braithwaite J, Shaw CD, Moldovan M, Greenfield D, Hinchcliff R, Mumford V, et al. Comparison of health service accreditation programs in low- and middle-income countries with those in higher income countries: a cross-sectional study. Int J Qual Heal Care. 2012;24:568–577. doi: 10.1093/intqhc/mzs064. PubMed DOI

Smits H, Supachutikul A, Mate KS. Hospital accreditation: lessons from low- and middle-income countries. Glob Health. 2014;10:1–8. doi: 10.1186/s12992-014-0065-9. PubMed DOI PMC

Ng GKB, Leung GKK, Johnston JM, Cowling BJ. Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals : a SWOT analysis. Hongkong Med J. 2013;19:434–446. doi: 10.12809/hkmj134063. PubMed DOI

Hort K, Djasri H, Utarini A. Regulating the quality of health care : lessons from hospital accreditation in Australia and Indonesia. Melbourne; 2013.

Bahadori M, Sadeghifar J, Hamouzadeh P, Hakimzadeh SM, Nejati M. Combining multiple indicators to assess hospital performance in Iran using the Pabon lasso model. Australas Med J. 2011;4:175–179. doi: 10.4066/AMJ.2011.620. PubMed DOI PMC

Broughton E, Achadi A, Latief K, Nandiaty F, Rianty T, Wahyuni S, et al. Hospital accreditation process impact evaluation. 2018.

Das J, Woskie L, Abbasi K, KT Ki AJ. Rethinking assumptions about delivery of healthcare: implications for universal health coverage. BMJ. 2018;361:1–5. doi: 10.1136/bmj.k1716. PubMed DOI PMC

Reich MR, Harris J, Ikegami N, Maeda A, Cashin C, Araujo C, et al. Moving towards universal health coverage: lessons from 11 country studies. Lancet Heal Policy. 2016;387:811–816. doi: 10.1016/S0140-6736(15)60002-2. PubMed DOI

Nicklin W. The value and impact of health care accreditation : a literature review. Accredit Canada. 2015:1–14.

Hinchcliff R, Greenfield D, Moldovan M, Westbrook JI, Pawsey M, Mumford V, et al. Narrative synthesis of health service accreditation literature. BMJ Qual Saf. 2012;21:979–991. doi: 10.1136/bmjqs-2012-000852. PubMed DOI

Shaw C. How can hospital performance be measured and monitored ? Copenhagen, WHO regional Office for Europe. 2003.

Goshtasebi A, Vahdaninia M, Gorgipour R, Samanpour A, Maftoon F, Farzadi F, et al. Assessing hospital performance by the Pabon lasso model. Iran J Public Health. 2009;38:119–124.

Dimick JB, Welch HG, Birkmeyer JD. Surgical mortality as an indicator. J Am Med Assoc. 2004;292:847–851. doi: 10.1001/jama.292.7.847. PubMed DOI

Groene O, Kringos DSR. Seven ways to improve quality and safety in hospitals an evidence based guide. 2014.

Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W. Addressing access barriers to health services: an analytical framework for selectingappropriate interventions in low-income Asian countries. Health Policy Plan. 2012;27:288–300. doi: 10.1093/heapol/czr038. PubMed DOI

Statistics Indonesia. Indonesia demographic and health survey 2012. National Population and Family Planning Board, Ministry of Health; 2013.

Hort K, Patchararanarumol W. The Republic of Indonesia health system review Asia Pacific observatory on health systems and policies. vol. 7. 2017.

Heywood P, Choi Y. Health system performance at the district level in Indonesia after decentralization. Int Heal Hum Right. 2010;10:1–12. doi: 10.1186/1472-698X-10-3. PubMed DOI PMC

Pitriyan P, Siregar AY, Siregar AY. Health inequity in Indonesia: is it declining? 2013.

Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the sustainable development goals: development and baseline data for an index of essential health services. Lancet Glob Heal. 2018;6:e152–e168. doi: 10.1016/S2214-109X(17)30472-2. PubMed DOI

Fullman N, Lozano R. Towards a meaningful measure of universal health coverage for the next billion. Lancet Glob Heal. 2018;6:e122–e123. doi: 10.1016/S2214-109X(17)30487-4. PubMed DOI

Irawan A. Regional Income Disparities in Indonesian: Measurement, convergence process and decentralization: University of Illnois; 2014.

Ministry of Health. Online hospitals database. Online Hosp Database n.d. http://sirs.yankes.kemkes.go.id/rsonline/data_list.php (accessed January 15, 2015).

ICAH. List of Accredited Hospitals n.d. http://akreditasi.kars.or.id/accreditation/report/report_accredited.php (accessed January 20, 2015).

Phibbs CS, Robinson JC. A variable-radius measure of local hospital market structure. Health Serv Res. 1993;28:313–324. PubMed PMC

Succi MJ, Lee SY, J a A. Effects of market position and competition on rural hospital closures. Health Serv Res. 1997;31:679–699. PubMed PMC

Pongpirul K, Sriratanaban J, Asavaroengchai S, Thammatach-Aree J, Laoitthi P. Comparison of health care professionals’ and surveyors; opinions on problems and obstacles in implementing quality management system in Thailand: a national survey. Int J Qual Heal Care. 2006;18:346–351. doi: 10.1093/intqhc/mzl031. PubMed DOI

Nandraj Sunil, Khot Anagha, Menon Sumita, Brugha Ruairí. A stakeholder approach towards hospital accreditation in India. Health Policy and Planning. 2001;16(suppl_2):70–79. doi: 10.1093/heapol/16.suppl_2.70. PubMed DOI

Badrick T, Preston A. Influences on the implementation of TQM in health care organisations : professional bureaucracies , ownership. Aust Health Rev. 2001;24:166–175. doi: 10.1071/AH010166. PubMed DOI

Li LX. Relationships between determinants of hospital quality management and service quality performance—a path analytic model. Omega. 1997;25:535–545. doi: 10.1016/S0305-0483(97)00017-0. DOI

Shen Y, Eggleston K, Lau J. NBER working paper series hospital ownership and quality of care: what explain the different result? Natl Buraeau Econ Res. 2006.

Braithwaite J, Shaw C, Moldovan M, Greenfield D, Hinchcliff R, Mumford V, et al. Comparison of health service accreditation programs in low-and middle-income countries with those in higher income countries: a cross-sectional study. Int J Qual Heal Care. 2012;24:568–577. doi: 10.1093/intqhc/mzs064. PubMed DOI

Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL, et al. Health in Southeast Asia 5 human resources for health in Southeast Asia : shortages , distributional challenges , and international trade in. Lancet. 2011;377:769–781. doi: 10.1016/S0140-6736(10)62035-1. PubMed DOI

Mukamel DB, Zwanziger J, Bamezai A. Hospital competition, resource allocation and quality of care. BMC Health Serv Res. 2002;2:10. doi: 10.1186/1472-6963-2-10. PubMed DOI PMC

Propper C, Gossage D. Competition and quality : evidence from the NHS internal market 1991-1999. News Rep. 2003;44:138–170.

Greenfield D, Braithwaite J. Health sector accreditation research : a systematic review. Int J Qual Heal Care. 2008;20:172–183. doi: 10.1093/intqhc/mzn005. PubMed DOI

Falstie-Jensen AM, Larsson H, Hollnagel E, Norgaard M, Svendsen MLO, Johnsen SP. Compliance with hospital accreditation and patient mortality: a Danish nationwide population-based study. Int J Qual Heal Care. 2015;27:165–174. doi: 10.1093/intqhc/mzv023. PubMed DOI

Devkaran S, O’Farrell PN. The impact of hospital accreditation on quality measures: an interrupted time series analysis. BMC Health Serv Res. 2015;15:137. doi: 10.1186/s12913-015-0784-5. PubMed DOI PMC

Groene O, Mora N, Thompson A, Saez M, Casas M, Suñol R. Is the maturity of hospitals’ quality improvement systems associated with measures of quality and patient safety? BMC Health Serv Res. 2011;11:344. doi: 10.1186/1472-6963-11-344. PubMed DOI PMC

World Health Organization. Quality and accreditation in health care: a global review. Geneva; 2003.

Booth M, James P, Stevanovic V. Benchmarking of hospital activity data: an international comparison. Benchmarking An Int J. 2005;12:515–522. doi: 10.1108/14635770510628654. DOI

Maier AM, Moultrie J, Clarkson PJ. Assessing organizational capabilities: reviewing and guiding the development of maturity grids. IEEE Trans Eng Manag. 2012;59:138–159. doi: 10.1109/TEM.2010.2077289. DOI

Jacobs R, Mannion R, Davies HTO, Harrison S, Konteh F, Walshe K. The relationship between organizational culture and performance in acute hospitals. Soc Sci Med. 2013;76:115–125. doi: 10.1016/J.SOCSCIMED.2012.10.014. PubMed DOI

Sollecito WA, Johnson JK. Factors influencing the application and diffusion of CQI in health care. Implement Contin Qual Improv Heal Case A Glob Caseb. 2012:49–74.

Canaway R, Bismark M, Dunt D, Kelaher M. Perceived barriers to effective implementation of public reporting of hospital performance data in Australia: a qualitative study. BMC Health Serv Res. 2017;17:391. doi: 10.1186/s12913-017-2336-7. PubMed DOI PMC

Devkaran S, O ‘farrell PN, Dhabi U. The impact of hospital accreditation on clinical documentation compliance: a life cycle explanation using interrupted time series analysis. BMJ Open. 2014;4:1–9. doi: 10.1136/bmjopen-2014-005240. PubMed DOI PMC