From policy prescription to health professional compliance: Implementation of a hospital quality and patient safety accreditation system

Abstract

Hospitals are facing increased legal pressure to implement a quality and patient safety accreditation system to govern professional practice. Often, however, accreditation systems are considered to be ineffective and run the risk of unintended consequences such as lower intrinsic motivation of health professionals. Therefore, insights are needed on how these systems can be applied more effectively. This dissertation contributes to the knowledge on effective implementation of a quality and patient safety accreditation system. The starting point is that, even in the case of external pressure for accreditation, hospitals and their managers can enforce an accreditation system in different ways. More specifically, this book considers the effectiveness of two different enforcement approaches: punishment (based on monitoring and threats of penalties) and persuasion (based on dialogue and suggestion). This book focuses on whether and how these enforcement approaches are related to health professional compliance. The results of this study show that an accreditation system is indeed enforced in different ways and that persuasion is the main enforcement approach used by managers. More importantly, only persuasive enforcement actions are effective in ensuring health professional compliance. In addition, the results of this dissertation also highlight the importance of enforcement actions by management at all levels of the organization. The findings of this study imply that a quality and patient safety accreditation system can be effectively implemented if managers use persuasive enforcement actions.