title: Determinants of impact of a practice accreditation program in primary care: a qualitative study.
abstract: BACKGROUND
  Practice accreditation is a widely used method to assess and improve the quality of healthcare services. In the Netherlands, a practice accreditation program was implemented in primary medical care. We aimed to identify determinants of impact of a practice accreditation program, building on the experiences of primary care professionals who had participated in this program.
  
  
  METHODS
  An interview study was done to document the experiences of 33 participating primary care professionals and used to identify determinants of outcomes. The Consolidated Framework for Implementation Research (CFIR) was used as framework for the qualitative analysis.
  
  
  RESULTS
  After analyzing 23 interviews saturation was reached. The practice accreditation program is based on structured quality improvement, but only some of its elements were identified as determinants of impact. Factors that were perceived to facilitate implementation of the program were: designating one person responsible for the program, ensuring clear lines of communication within the whole practice team and having affinity with or stimulate enthusiasm for improving quality of care. Contextual factors such as participation in a care group and being connected to the GP educational institute were important for actual change. The accreditation program was perceived to have positive effects on team climate and commitment to quality of care in the practice team. The perception was that patient care was not directly influenced by the accreditation program. Receiving a certificate for completing the accreditation program seemed to have little added value to participants.
  
  
  CONCLUSIONS
  Practice accreditation may have positive outcomes on quality of care, but not all planned elements may contribute to its outcomes. Both factors in the accreditation process and in the context were perceived as determinants of quality improvement. The challenge is to build on facilitating factors, while reducing the elements of accreditation that do not contribute to its impact.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, P.O. Box 9101 , 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands. elvira.nouwens@radboudumc.nl.
authors.forename: Elvira
authors.initials: E
authors.lastname: Nouwens
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, P.O. Box 9101 , 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands. jan.vanlieshout@radboudumc.nl.
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, P.O. Box 9101 , 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands. michel.wensing@radboudumc.nl.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000068:Accreditation; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009426:Netherlands; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D015397:Program Evaluation; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*