title: Examining challenges to reliability of health service accreditation during a period of healthcare reform in Australia.
abstract: OBJECTIVE
  Health systems are changing at variable rates. Periods of significant change can create new challenges or amplify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability.
  
  
  METHODS
  Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards.
  
  
  RESULTS
  Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy; accrediting agency management of the accreditation process, including the program's framework; survey coordinators; survey team dynamics; individual surveyors; and healthcare organizations' approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain.
  
  
  CONCLUSIONS
  Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.
authors.affiliation: Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Greenfield
authors.forename: Deborah
authors.initials: D
authors.lastname: Debono
authors.forename: Anne
authors.initials: A
authors.lastname: Hogden
authors.forename: Reece
authors.initials: R
authors.lastname: Hinchcliff
authors.forename: Virginia
authors.initials: V
authors.lastname: Mumford
authors.forename: Marjorie
authors.initials: M
authors.lastname: Pawsey
authors.forename: Johanna
authors.initials: J
authors.lastname: Westbrook
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Braithwaite
mesh_terms: D000068:Accreditation / Q000592:standards*; D001315:Australia; D005260:Female; D017144:Focus Groups; D018166:Health Care Reform; D006296:Health Services / Q000592:standards*; D006801:Humans; D008297:Male; D036301:Qualitative Research; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Accreditation; Challenges; Change; Healthcare; Healthcare reform; Survey reliability