Unannounced or announced periodic hospital surveys: a study protocol for a nationwide cluster-randomized controlled trial

Abstract

Purpose:

Accreditation programs for health care systems have been implemented in more than 70 countries to stimulate high-quality organizational performance. Several Danish health care institutions are covered by the Danish Healthcare Quality Program (DDKM), and all Danish public hospitals have been accredited according to the DDKM since 2010. The dates of each survey are currently announced beforehand. Announcing surveys has been criticized for creating an “arranged reality”. It was therefore suggested that a national intervention be conducted to evaluate the effect of unannounced hospital surveys. The objective is to evaluate the effect of unannounced hospital surveys compared to the conventional announced hospital surveys by conducting a cluster-randomized controlled trial.

Methods:

All public somatic and psychiatric hospitals in Denmark (n=30) were invited to participate. Twenty-three hospitals (77%) agreed to participate and to be randomized to one of the trial clusters. Eleven hospitals received announced surveys (control group) and 12 hospitals received unannounced surveys (intervention group). We hypothesized that hospitals receiving unannounced surveys would be rated as less successful than hospitals receiving announced surveys, defined as meeting less compliance with accreditation standards and performance indicators. Surveyors employed and educated by the Danish Institute for Quality and Accreditation in Health Care (IKAS) were responsible for conducting the surveys according to an abbreviated version of the current Danish Healthcare Quality Program (DDKM). The outcome is compliance with indicators reflecting organizational performance. Compliance was analyzed using binomial regression analyses with bootstrapped standard errors.

Discussion:

Unannounced hospital surveys are expected to reveal less compliance with performance indicators compared to the announced hospital surveys. These study results may facilitate a validation of the effect of unannounced periodic hospital surveys influencing the decision of whether or not unannounced surveys should be implemented as a new method of conducting accreditation programs in Danish hospitals.

Keywords::

• accreditation
• quality improvement
• quality indicators
• health care

Acknowledgments

This C-RCT is funded by IKAS. The authors would like to thank the hospitals for their participation. In addition, thanks go to the surveyors for their engagement and great work in preparing and conducting the surveys. In closing, thanks go to IKAS for contributing to the conception of the study and the overall study design. The abstract in this paper is presented according to the CONSORT Extension for Abstracts checklist. This trial is registered at ClinicalTrials.gov (NCT02348567).

Author contributions

All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.