title: Staff perceptions of change resulting from participation in a European cancer accreditation programme: a snapshot from eight cancer centres.
abstract: BACKGROUND
  Healthcare accreditation is considered to be an essential quality improvement tool. However, its effectiveness has been critiqued.
  
  
  METHODS
  Twenty-four interviews were conducted with clinicians (five), nurses (six), managers (eight), and basic/translational researchers (five) from eight European cancer centres on changes observed from participating in a European cancer accreditation programme. Data were thematically analysed and verified with participants and checked against auditor's feedback.
  
  
  RESULTS
  Four change categories emerged: (i) the growing importance of the nursing and supportive care field (role change). Nurses gained more autonomy/clarity on their daily duties. Importance was given to the hiring and training of supportive care personnel (ii) critical thinking on data integration (strategic change). Managers gained insight on how to integrate institutional level data (iii) improved processes within multidisciplinary team (MDT) meetings (procedural change). Clinical staff experienced improved communication between MDTs (iv) building trust (organisational change). Accreditation improved the centre's credibility with its own staff and externally with funders and patients. No motivational changes were perceived. Researchers perceived no changes. The auditor's feedback included changes in 13 areas: translational research, biobanks, clinical trials, patient privacy and satisfaction, cancer registries, clinical practice guidelines, patient education, screening, primary prevention, role of nurses, MDT, supportive care, and data integration. However, our study revealed that staff perceived changes only in the last four areas.
  
  
  CONCLUSIONS
  Staff perceived changes in data integration, nursing and supportive care, and in certain clinical aspects. Accreditation programmes must pay attention to the needs of different stakeholder groups, track changes, and observe how/why change happens.
authors.affiliation: The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands.
authors.forename: Abinaya
authors.initials: A
authors.lastname: Rajan
authors.affiliation: The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands.
authors.forename: Anke
authors.initials: A
authors.lastname: Wind
authors.affiliation: Institut Gustave Roussy, 14 rue Edouard-Vaillant, Villejuif 94805, France ; Organisation of European Cancer Institutes (OECI-EEIG) c/o Fondation Universitaire, 11 Rue d'Egmont, Brussels B-1000, Belgium.
authors.forename: Mahasti
authors.initials: M
authors.lastname: Saghatchian
authors.affiliation: Institut Gustave Roussy, 14 rue Edouard-Vaillant, Villejuif 94805, France.
authors.forename: Frederique
authors.initials: F
authors.lastname: Thonon
authors.affiliation: Organisation of European Cancer Institutes (OECI-EEIG) c/o Fondation Universitaire, 11 Rue d'Egmont, Brussels B-1000, Belgium ; Integraal Kankercentrum Nederland, Griffeweg 97, Groningen 9723 DV, The Netherlands.
authors.forename: Femke
authors.initials: F
authors.lastname: Boomsma
authors.affiliation: The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands.
authors.forename: Wim H
authors.initials: WH
authors.lastname: van Harten
keywords: accreditation; comprehensive health care; health care; perception; quality assurance; quality improvement