Promoting Quality and Safety in Healthcare Organizations through Accreditation [Interview][Transcript]


Guest: Professor David Greenfield, PhD
Presenter: Wayne Bucklar
Guest Bio: Associate Professor Greenfield is a senior research scientist in the Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University. A/ Prof Greenfield is a Fellow of the Australasian Association for Quality in Health Care, a Fellow of the International Society for Quality in Health Care (ISQua), and recognised as an ISQua Expert. A/Professor David Greenfield research is at the intersection of improvement and implementation sciences. He is researching healthcare complex adaptive systems, health services and the organisation and delivery of clinical practice.

Segment overview: For our Health Academy Series today, we are joined by Associate Professor David Greenfield, PhD from the Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation at the Macquarie University. A/Prof Greenfield investigates what impacts on quality improvement and mechanisms to integrate research findings and evidence into healthcare policy and practice. This includes, for example, the formal or informal regulation of the organisation and delivery of care, via accreditation programs or interprofessional collaboration strategies. The purpose of this research is to derive evidence to improve organisational functioning, service delivery mechanisms and patient outcomes.


Health Professional Radio

Wayne Bucklar: You’re listening to Health Professional Radio. My name is Wayne Bucklar and this is the Health Academy, our regular opportunity to have a talk with academics involved in the health discipline. Today my guest is Associate Professor David Greenfield. David is with the Health Improvement Research Center for Healthcare Resilience and Implementation Science at the Australian Institute of Health Innovation at Macquarie University in Australia. David joins us from Sydney. David welcome to Health Professional Radio.

David Greenfield: Thank you very much, a pleasure to be here.

W: Now David that’s a long title: Health Improvement Research Center for Healthcare Resilience and Implementation Science, what happens there? Tell us a little bit about it.

D: Well quite simply our focus is about investigating how to improve quality and safety in the health care system. We do that by looking at how to improve and enhance the things that are going right, how can we identify those, look at what are the factors that are enabling things to occur in a positive sense, and enabling good care, and simultaneously also identifying those circumstances where there a challenges to providing good care, and how they can be overcome and improved so that patients and health providers are working in a positive environment and we get good care outcomes and effective care outcomes for people.

W: Now healthcare is a very old industry if I can call it an industry. Isn’t a quality something that they’ve just fixed years ago and have nailed then?

D: Quality is ongoing achievement, it’s not a destination. Quality is something that’s achieved at each moment that care is provided, each time a self-professional or somebody working health system, whether it’s one of the administration staff, whether it’s a front line clinician, whether it’s a manager of a ward or service interacts with a patient – that’s when quality and safety are enacted with it. Something that’s done in a moment by moment. And also has to be examined and introduced and monitored in a structural way as well to enable it to track things over the time and to look how things are improving and where the … are and where the challenges are.

W: And David what’s been the focus of your attention recently? What’s been drawing your attention?

D: Well a major project we’ve just been finishing, in fact within the last month, it’s a 5 years study which has been looking at accreditation of health services here in Australia and that’s looked at work in the general practice area, the aged care, and also acute services. So it’s about how you use accreditation schemes or external regulation schemes to identify and to monitor care. And through those schemes, engage staff, health professional providers and consumers in looking and reviewing care processes and trying to then work out how they can be enhanced and continued safely into the future.

W: And you’re saying it’s been a 5-year study?

D: That’s for 5 years study we’ve undertaking. It’s been a collaborative project with the accreditation agencies, in the aged care, general practices, and acute sector in Australia. It’s an Australian research council funded study.

W: Uh huh.

D: That’s I think we’ve been very successful over the period in helping us identify how those schemes work, their strengths and how they can be improved going forward.

W: And have you got any results from that study that you can share with us today?

D: Yeah, I think we can say that accreditation is a system that helps promote good organizational and clinical performance. It’s a system that promotes positive quality and safety cultures that cross and within organizations. So it helps give staff a chance to stop and think about what they’re doing, how they provide services, and how those services can be improved. It’s something that is challenging for staff and it’s clear that finding ways to simplify and to tag an accreditation system is important. But it’s also recognizing that they do help drive improvements in quality and safety and produce cultures in organizations that are focused on quality and safety and in improving care.

W: That’s interesting David. Have you been able to quantify in any way the value of accreditation?

D: We have been doing some studies, it’s part of this umbrella work we’ve been doing which have been looking at the economic cost of accreditation and the cost of that. That work has currently under peer review with a couple different journals and when that’s have been acceptable, we’ll be able to speak more about that.

W: uh huh.

D: But it has been looking at and been able to demonstrate, but … contrary to what many people think when you look at the overall cost of providing health services – it’s a very, very low percent involved. The challenge often I think that busy health professionals face and busy services face is creating time and space for their staff to stop and look at the quality and safety and look at the policy procedures, the systems around at what’s going on. So many services these days and providers these days that are so busy with delivering services that sometimes it can be seen as a bit of a luxury to stop and think about what’s going on or review how things that are appearing, when in fact I guess what we would argue is making time to do that and finding ways of doing that, structuring that in people’s work is essential if those services are gonna continue to be the best that they can.

W: You’re listening to the Health Academy on Health Professional Radio. My name is Wayne Bucklar and my guest is Professor David Greenfield. David is from the Australian Institute of Health and Innovation at Macquarie University and we’ve just been touching on the issue of time and space for workers in the health sector and I guess clinicians as well to contemplate and think about the value of accreditation in a busy day to day life. David it’s an interesting point that you raised because the constant money pressure on all health providers means that there’s a need to get the outputs and the outputs have written by a number of patients who come in and go out the door. Is there any solution that you see to the time and space problem with accreditation?

D: No, not really. I think it’s one of the continual struggle that services are gonna have and I don’t think that there’s any solution, easy solution to it. I think that it’s about recognizing that quality and safety requires time for health professionals to stop and look at what they’re looking to gather data about what the services they’re doing, opportunities to examine and reflect on that information, and how they work into professionally and work together so that they can then identify ways of making improvement on how the positive things that are ongoing, recognizing the strength that they currently have. There are short cuts for doing that, it’s providing people with the opportunity to do it, not to do it is to leave people in a position where they don’t have the information to demonstrate and to examine what their work is achieving which can leave them in positions where it doesn’t, they don’t have the right information to demonstrate the quality that they’re doing.

W: Has you’re work lead you to look at accreditation in other industries and its benefits? Has there been any comparative studies undertaken?

D: Well we’re focused on trying to examine accreditation in Healthcare and I guess what we’ve found through that is that across the different sectors within healthcare from aged care to general practice to acute services, well the accreditation programs are similar, external regulation programs are similar. There are also a very different ones you get into the specific cultures, to the specific dynamics of each sector, and that’s so much of the characteristics of those sector is very important to take into account, so the type of programs, the standards and the focus that they have. So in a sense, it’s getting really down to the details in each sector matters and the cultures that operate in those sectors.

W: Yes. It’s a I guess a perpetual problem that we have in that the way we do health these days pretty obvious means the money is not going to extend as the population does and we’re going to have to go in efficiencies rather than just volume in service. And I guess accreditation is one of the things that will lead to that efficiency.

D: Well I think that’s exactly right, that by making them and providing time to health professionals to review and examine their work, helping them gather data which helps them look at the outcomes of what they’re achieving and how they’re achieving that is a way of being able to drive efficiencies. And it’s only by spending a bit of time and resources in doing that, that you’re going to be able to identify other ways of providing services or more effective systems for doing that.

W: David, it’s been a pleasure chatting with you this afternoon. I look forward to the opportunity to have a chat with you when you’re 5 year project is published and we can discuss with you in detail more of the results of that research. Thank you for giving your time up for health professional radio.

D: It’s a pleasure. I’m happy to share results from our studies if people want to contact me via my contact details you have and we’ve already published a range of papers and presentations about that which are pretty available for people.

W: Thank you very much for that offer. So if you’d been listening and you’d like to get in touch with David, contact us here at the station and we’ll pass on the details to him. If you’ve just missed our interview, there’s a transcript on our website at Health Professional Radio, it’s And there’s also a SoundCould archive and you can hear the audio on YouTube as well. This has been the Health Academy. My name is Wayne Bucklar and you’re listening to Health Professional Radio.

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