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FACTORS RELATED TO HOSPITAL ACCREDITATION OF COMMUNITY HOSPITAL DURING COVID-19 OUTBRAKE
PATCHARIN WONGTA1, WARINMAD KEDTHONGMA2*,WUTTIPHONG PHAKDEEKUL2*, CHALARD
JUKPIM3
1.Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Thailand.
Email: [email protected]
2.Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Thailand.
3.Faculty of Liberal Arts and Management Science, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Thailand. Email: [email protected] *Corresponding Author:
Warinmad Kedthongma, Email: [email protected]; ÜRCID:https://orcid.org/0000-0002-5135-9254 Wuttiphong Phakdeekul, Email:[email protected] ; ÜRCID:https://orcid.org/0000-0002-5091-9600
Abstract: Background: The health system is responsible for providing services as well as providing services for everyone to access that are safe and good quality. Currently, health problems are changeable and complex, especially the COVID-19 pandemic, which is also related to health legislation. Therefore, a good quality health system is critical.
Methods: This Cross-sectional survey study was conducted from July 2021 - March 2023 using a sample of 384 of 11 community hospitals. Spearman's rank correlation coefficient was used to analyze.
Results: The results showed that the samples had an average age of 39 years (S.D. = 10.15), an average time of work 13 years (S.D. = 10.19), with a bachelor's degree of 73.18%, while 38.80% were a nurse. In addition, samples had knowledge and attitude on the hospital accreditation (HA) at a high level of 68.49%, and 47.92% (=.85 S.D.=.11; = 4.05, S.D.= .40 respectively). But organization, process, and outcomes are at a moderate level of 54.17%,55.47%, and 58.85% (=3.93, S.D.=.55, 3.96 S.D.=.54, =3.85 S.D.=.57 respectively). Most hospitals had HA at level 3 (81.82%). Furthermore, the knowledge factors related to HA level (significance at .01 level; rs= .161). The factors affecting HA development results were attitude, organization, and process factors (p< 0.01).
Conclusions: The majority of hospital had moderate levels of HA. Knowledge, attitude, organization, and method with health legislation being the key elements. These elements can be used to get HA information during COVID-19 outbrake.
Keywords: Hospital accreditation, Quality development, Quality Service, Community Hospitals, Factors, COVID-19 Outbrake
Background:
The health system is responsible for providing services for everyone to access that are safe and of good quality.1 Currently, health problems are changeable and complex. Therefore, a good quality of health system is very important.2 According, Constitution of the kingdom of Thailand (2007) has stipulated the duty of the state to provide public health services to the public. Chapter 5 duties of the state section 55. The State shall ensure that the people receive efficient public health services universally, ensure that the public has the basic knowledge in relation to health promotion and disease prevention. The public health services shall cover health promotion, control and prevention of diseases, medical treatment and rehabilitation. The State shall continuously improve the standard and quality of public health services. The Ministry of Public Health requires hospitals to have quality standards that meet HA quality certification assessment,3 to enable all citizens to have appropriate access to and receive necessary medical and public health services.4 From the results of the HA quality certification assessment in 2021, only 56.51% of Thailand's hospitals achieved level 3 certification, with Health region 8 having a score of 88.04 %.5
Nakhon Phanom Provincial Public Health Office has required hospitals to achieved HA certification.6 The HA certification process is external certification to encourage hospitals to improve the quality and safety of patient care. This approach relies on international-based standards as a framework for development by using cooperation of personnel in the organization to determine whether the organizational structure7,8 and process factors influence service quality improvement.9,10,11 Personality factors.12'13'14 and cognitive and attitude factors15,16 affect the development and accreditation of hospitals.
In addition, the Nakhon Phanom Provincial Public Health Office, HA quality development is a strategic indicator of Nakhon Phanom Province that can support driving the continual development of the hospital through the network to improve the quality of the hospital with nanny system. However, only 83.33% of hospitals are certified for HA level 3.17,18 The report on the renewal of HA accreditation indicated that most of the issues had to be resolved and revisited .19,20 Furthermore, it occurred during 2021 and 2022, especially in Thailand, during the COVID-19 pandemic. It has an impact on both the patient's visit and the hospital's services. Patients are unable to access services as a result. This is so that hospitals can respect government-instituted safety rules. The national health security act (2002) Chapter 1 Right to receive public health services every person has the right to receive standard public health services. As a result, it affects the creation of quality management systems for hospital services.21,22,23,24 Therefore, a study of factors related to the development of community hospital accreditation in Nakhon Phanom Province should provide important information that will be useful in the development and certification of quality hospital in Nakhon Phanom Province.
Methods:
A Cross-sectional survey study was conducted during July 2021 - August 2022 based on 384 samples in 11 community hospitals from a population of 1,732 personnel working in hospitals.27 Sampling used the simple logistic regression formula of Hsieh Bloch & Larson ,17 with multistage sampling. Data were collected based on answers to a questionnaire with a reliability of 0.98 and index of item objective congruence of 0.97, The questionnaire had 117 items in 6 parts (Personal data, Knowledge, Attitude, Organizational, Process, and Outcome).
Part 1: Personal data: Data collected consisted of: age, status, time of work, education, and job position.
Part 2: Knowledge : There were two choice responses (1 for correct answer, 0 for wrong answer, 24 full scores, and 3 interpretation criteria according to Bloom,14 defined as low level knowledge (score 0.42 - 0.61), moderate knowledge (score 0.62 - 0.81), and high-level knowledge (score 0.82 - 1).
Part 3: Attitude: There were 24 questions with replies based on 5 options (strongly agree, agree, indifferent, disagree, strongly disagree, having a 5, 4, 3, 2, 1 score, respectively, for the positive questions and 1, 2, 3, 4, 5 score into 3 levels were based on Bloom's criteria,14 defined as high-level (score 4.11 - 4.83), moderate (score 3.37 - 4.10), and low-level (score 2.36 - 3.36).
Part 4: Organizational: There were 23 questions, with replies based on 5 options (most, very, moderate, less, least, having scores of 5, 4, 3, 2, 1 respectively). Criteria for interpreting organizational scores into 3 levels, levels were based on Bloom's criteria.14 defined as high-level (score 4.07 - 5), moderate (score 3.12 - 4.06),
low- level (score 2.17 - 3.11)
Part 5: Process: There were 24 questions, with replies based on 5 options options (most, very, moderate, less, least, having scores of 5, 4, 3, 2, 1 respectively). Criteria for interpreting process scores into 3 levels, were based on Bloom's criteria.14 defined as high-level (score 4.02 - 5), moderate (score 3.04 - 4.01), low-level (score 2.04 - 3.03).
Part 6: Outcome: There were 17 questions, with replies based on 5 options options (most, very, moderate, less, least, having scores of 5, 4, 3, 2, 1 respectively). Criteria for interpreting outcome scores into 3 levels, were based on Bloom's criteria .14 defined as high-level (score 4.05 -5), moderate (score 3.09 - 4.04), low-level (score 2.12 - 3.08).
All data were analyzed by descriptive statistics percentages, means, standard deviation (S.D.), and inferential statistics (Spearman's rank correlation coefficient).
The researchers collected data collection based on questionnaires. The process involved distributing the questionnaires to the sample group personally and having the sample group completed the questionnaire, checking for completeness and reliability of information, with quality control of data recording by duplicating the recordings, reviewing, and then storing data in 2 files.
Ethical Issues/Statement
The study was conducted with the approval of the Research Ethics Committee, Nakhon Phanom Province (COE No. 014/65, Date 7 August 2022).
Results:
Demographic characteristics of the sample
The results showed that samples had average age of 39 years (S.D.=10.15), most of the samples were aged 30-34 years 19.27%, the majority were married (50.52%), with an average time of work 13 years (S.D.=10.19), a bachelor's degree (73.18%), and the most common profession was nurse (38.80%). as shown in Figure 1.
Level of knowledge, attitude, organization, process and results of quality development of community hospitals in Nakhon Phanom Province.
The results showed that the samples had knowledge, and attitude on the HA at high level at 68.49% % ( X =.85 S.D.=.11 ) and 47.92 ( X = 4.05, S.D.= .40), respectively.
However, organization, process, and outcome were at the moderate level at 54.17% (^=3.93 S.D.=.55), 55.47% (X 3.96 S.D. =.54), and 58.85% (^=3.85 S.D.=.57), respectively, as show in Figure 2.
Spearman's rank correlation coefficient analysis results between variables and results
The factors related to level HA were knowledge (significance at .01 level; rs=. 161). In addition, factors related to HA development result were attitude, organizational,process, and health legislation (significance at .01 level; rs = .434, rs = .804, rs = .814, and rs =680**respectively), as shown in Table 1.
Spearman's rank correlation coefficient analysis with HA accreditation level outcomes of community hospitals in Nakhon Phanom province.
The result of the Spearman's rank correlation coefficient analysis with level HA. showed that the knowledge factor had a very low positive correlation with the level of hospital accreditation (significance at .01 level; rs=161), as show in Table 2. Correlation coefficient for HA outcomes
The results showed that attitude factors at the low level were positively associated with hospital accreditation development outcomes (significance at .01 level; rs = 434). Organizational and process factors at the high level had a positive relationship with the hospital accreditation development outcomes (significance at .01 level; rs = .804, and rs = .814, respectively), as shown in Table 3.
Factors Affecting Hospital Accreditation of Community Hospitals During COVID-19 Outbrake
The factors affecting the variables and the outcomes of community hospital quality development. Initially, the distribution was tested using the Kolmogorov-Smirnov test and found that the distribution was not normal. Logistic Regression Analysis was used to analyze the data by establishing the initial and dependent variables. It was found that the factors affecting the quality
development of community hospitals were organizational, the process, and health legislation factor (P< 0.001). In addition, the percentage of correct prediction (Hite rate) was 93.23% as shown in Table 4. Moreover, health legislation had been controlled the public health services which were l cover health promotion, control and prevention of diseases, medical treatment and rehabilitation.
Discussion
The results of a study on factors related to the development of community hospital accreditation in Nakhon Phanom Province revealed that knowledge factors were significantly associated with HA accreditation results at the .01level (rs = 161). This corresponds with the study results of Tippawan Ketsaeng,7 regarding the factors related to the participation of professional nurses in hospital quality development work. There was a moderate positive correlation with participation in hospital quality improvement (significant at .01 level; r = 0.44) that corresponds with the results of the study by Nuttakit Thammakawinwong and Civilize Wanaratwijit,4 in community hospitals were the factors influencing continuous quality improvement were significant at the 0.05 level was a cognitive factor.
The results found that the attitude related to hospital quality improvement outcomes (significance at .01 level; rs= .434), which corresponds with the study results of Tippawan Ketsaeng,7 who report that attitudes in hospital quality development had a moderate positive correlation with participation in hospital quality development (significant at .01 level; rs = 0.39), as well as with the result of the study Oramanee Pattapakorn and Siriphan Hongsappinyo,13 on the success of factors in hospital quality development, where they found that the factors affecting the success of quality development including the attitude factor of personnel towards quality development (significant at 0.01 level; R=23. 50). This also corresponded with the results of the study by Nuttakit Thammakawinwong and Civilize Wanaratwiit,4 on the factors influencing the continuous quality improvement of community hospitals. They report that attitude factors influenced continuous quality improvement (significance at .05 level).
The result showed that organizational factors related to hospital quality improvement outcomes (significant at 0.01 level; rs = .804), corresponded with the results of Kannikar Kewheung.1 Regarding administration affecting the development of hospital quality according to hospital standards, the organizational structure was a factor affecting the operation at a high level. This corresponded with the result of the study by Nuttakit Thammakawinwong and Civilize Wanaratwijit,4 who investigated the factors influencing the continuous quality improvement of community hospitals and found that structural factors of quality improvement were relevant (significance at the 0.05 level).
In addition, the results showed that the process factors were significantly related to the hospital quality improvement outcomes at the 0.01 level (rs = .814), which was consistent with Thaksin Chaodon.6 Factors affecting service quality Improvement of community hospitals were process factors that had the greatest effect and influence on the improvement of service quality. This was consistent with the results of the study by Yosapat Sri-Ngam,9 on the factors influencing the quality of community hospitals, which indicated process factors influencing the quality of community hospitals. Furthermore, the study of Correa et al,15 found that process focus is linked to the development of health organizations and has a direct influence on the quality assurance process.
Hospitals that have quality developed and received hospital quality certification. It will help patients and service users receive standardized services. And safety. Therefore, the leader and the organization should support the development of hospital quality to continuously improve the quality25 26 27 28. In this study, it was found that knowledge, attitude, organization and process were related to the development of the quality hospitals. Therefore, leaders should establish policies for hospitals to be accredited. as well as supporting necessities such as training,
knowledge, support, materials, budget, stimulation, monitoring, as well as solving important problems29 30 31. However, health legislation must also be taken into account32 33.
Conclusions
The hospital's quality development is still at a moderate level despite the COVID-19 pandemic. There were important factors involved, namely the knowledge, attitude, organizational process and health legislation factors. These factors may be used as Key information to improve the quality of hospital to ensure they receive certification.
Acknowledgements: This research was successfully accomplished. We would like to thank the contributors for their supports as follows Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Nakhon Phanom Provincial Public Health Office, and community hospitals at Nakhon Phanom province, Thailand.
References:
1. Kannikar Kewheung. (2014). Administrative factors affecting hospital quality development according to hospital standards (HA) of Phichai Dab Hak Camp Hospital. (Master's thesis). Uttaradit Rajabhat University, Uttaradit.
2. Ministry of public health. (2016). Thailand global health strategic framework 2016 - 2020. Nonthaburi: Ministry of public health
3. Strategy and Planning Division. (2018). 20-Year National Strategic Plan, FiscalYear 2018. Office of the Permanent Secretary, Ministry of Public Health: Nonthaburi.
4. Nuttakrit Thammakawinwong and Civilize Wanaratwijit. (2016). Factors Influencing the continuous quality improvement of community hospitals, Health area 3 Phutthachinnaratwetsan, 33 (2), 178-186.
5. Tuenjai Saesin. (2013). Factors related to participation in hospital quality development of professional nurses. in the community hospital Sisaket Province. (Master's thesis). Sukhothai Thammathirat University, Nonthaburi.
6. Thaksin Chaodr. (2018). Factors affecting service quality development of community hospitals accredited for service quality in Udon Thani Province. (Master's thesis). Sukhothai Thammathirat University, Nonthaburi.
7. Tippawan Ketsaeng. (2019). Factors related to participation of registered nurses. in the development of hospital quality Chaiya Hospital Surat Thani Province. Journal of health research and innovation , 2 (4), 91-105.
8. Watee Direksri. (2018). Factors related to continuous quality improvement in community hospitals in Chaiyaphum Province. (Master's thesis). Sukhothai Thammathirat University, Nonthaburi.
9. Yospat Sri-Ngam. (2016). Factors influencing quality development of community hospitals in Phra Nakhon Si Ayutthaya Province. (Master's Thesis). Chulalongkorn University, Bangkok.
10. Healthcare accreditation institute (Public Organization). (2020). Summary of the results of the survey to renew the quality process accreditation according to the hospital and health service standards No. 4. Healthcare accreditation institute (Public Organization).
11. Healthcare accreditation institute (Public Organization). (2020). Summary of the status of quality accreditation of hospitals. Nonthaburi.
12. Nakhon Phanom Provincial Public Health Office. (2019). Strategic plan for health development of Nakhon Phanom Province. Nakhon Phanom Provincial Public Health Office: Nakhon Phanom.
13. Ormanee Phatthiphakon and Siriphan Hongsappinyo. (2020). Factors of success in hospital quality development. TUH Journal, 5(1), 19-24.
14. Bloom, B. S. (1975). Taxonomy of education. New York: David McKay Company.
15. Correa, J. E., Turrioni, J. B., Mello, C. H. P., Santos, A. C. O., da Silva, C. E. S., & de Almeida, F. A. (2018).
Development of a system measurement model of the Brazilian hospital accreditation system. Int J Environ Res Public Health, 15(11)
16. Cronbach, L. J., & Shavelson, R. J. (2004). My current thoughts on coefficient alpha and successor
Procedures. Educational and psychological measurement, 64(3), 391-418.
17. Hsieh Bloch & Larson. (1998). A simple methodof sample size calculation for linear and logistic regression (Vol.17). Statistics in Medicine statist.
18. Turner, R. C., & Carlson, L. (2003). Indexes of item objective congruence for multidimensional items. International Journal of Testing, 3(2), 163-171.
19. World Health Organization (WHO). (2022). Health services delivery.
https://www. euro.who.int/en/health-topics/Health-systems/health-servicesdelivery/health-services-del ivery#
20. Office of Policy and Strategy. (2016). 20-year National strategic plan (Ministry of public health). Ministry of public health, Nonthaburi.
21. Phakdeekul W, Thongkrajai T., Eiamprapai P, Kanato, M. (2011). Risk Factors to Alcohol Law Violations in the Community: Quasi-Experimental Study. American Journal of Applied Sciences. 8(12): 1343-48.
22. Kedthongma, W., & Phakdeekul, W. (2022). The intellectually developed model for community participatory management of child care centers during the COVID-19 Outbreak. European Journal of Contemporary Education, 11(1), 81-88.
23. Kedthongma W, Phakdeekul W. (2022). Oral Health and Well-being of Elderly During and Post COVID-19 Outbrake. J Int Dent Med Res. 2022; 15(4): 1672-1677.
24. Chaiyapet, C., Phakdeekul, W., & Kedthongma, W. (2023). Risk Factors of Severity of Road Accident Injury Incidence at Kut Bak district Sakon Nakhon Province, Thailand. Social Science Journal: Res Militaris,
12(5), 835-845.
25. Tashayoei, N., Raeissi, P., & Nasiripour, A. A. (2020). Challenges of implementation of hospital accreditation
in Iran: an exploratory factor analysis. J Egypt Public Health Assoc, 95( 1), 1-10.
26. Correa, J. E., Turrioni, J. B., de Paiva, A. P., Paes, V. C., Balestrassi, P. P., Papandrea, P. J., & Goncalves, E. D. C. (2018). The influence of accreditation on the sustainability of organizations with the Brazilian accreditation methodology. J Healthc Eng,28(6), 1-11.
27. Pasinringi, S. A., Rivai, F., Arifah, N., & Rezeki, S. F. (2021). The relationship between service quality perceptions and the level of hospital accreditation. Gac Sanit, 35 (2), 116-119.
28. Juthasinee Sammanont. (2019). Factors affecting the development and accreditation of hospital quality in a case study. One hospital in Nonthaburi province. Nonthaburi: Faculty of business administration Thammasat University
29. Kittisak Nuanchum, Wuttiphong Phakdeekul, and Warinmad Kedthongma. (2023). Factors Related to Preventive Behavior towaeds Covid-19 among People in Rural Area of Thailand, Neuroquantology. 21(5), 216-225. doi: 10.48047/nq.2023.21.5.NQ?22021.
30. Siam Chinpong. (2016). Factors affecting personnel participation in service quality development according to hospital quality standards. Ron Phibun Hospital Nakhon Si Thammarat Province (Master's Thesis). Sukhothai Thammathirat Open University, Nonthaburi.
31. Human Resource Management Group. (2021). Information of staff who actually work. Nakhon Phanom: Nakhon Phanom Provincial Public Health Office.
32. Office of the Council of State. (2007). Constitution of the kingdom of Thailand B.E.2560. Bangkok:
Office of the Council of State.
33. Office of the Council of State. (2002). The National Health Security Act B.E. 2545. Bangkok: Office
of the Council of State.
Figures
Figures1. The hospital's quality development is still at a good level despite the COVID-19 pandemic.
Figures2. Level of knowledge, attitude, organization, process and results of quality development of community hospitals in Nakhon Phanom Province.
Tables
Table 1 Spearman's rank correlation coefficient results between variables regarding quality development of community hospitals in Nakhon Phanom Province.
Variables Age Time work of Knowledg e Attitude Organi zationa l Proces s health legislation Outcom e
Age 1
Time of work .813** 1
Knowledge .123* .115* 1
Attitude .031 .044 . 190** 1
Organizational -.017 .004 .037 .399** 1
Process .003 .034 .088 .404** .814** 1
health -.052 -0.49 1.61** .049 -.002 .011 1
legislation
Outcome -.017 .028 .029 .434** .804** .814** .680** 1
Significant at .05 level * Significant at .01 level
Table 2. Spearman's rank correlation coefficient analysis with HA accreditation level of community
hospitals in Nakhon Phanom province. Results of HA accreditation level of community hospitals in Nakhon Phanom Province
Correlation coefficient w , Relationship level
p-Value
(rs)
Age -.052 .306 No correlation
Time of work -.049 .337 No correlation
Knowledge .161** .002 Very low
Attitude .049 .335 No correlation
Organizational -.002 .971 No correlation
Process .011 .829 No correlation
health legislation .351** .001 low
* Significant at .05 level ** Significant at .01 level
Table 3. Spearman's rank correlation coefficient analysis for HA outcomes of community hospitals
in Nakhon Phanom Province
HA outcome
Variables
Correlation
(rs)
coefficient
p-Value
Relationship level
Age
Time of work
Knowledge
Attitude
Organizational
Process
health
legislation
-.017 .028 .029 .434** .804** .814** .842**
.737 .588 .573 <.001 <.001 <.001 <.001
No correlation
No correlation
No correlation
low
high
high
high
Significant at .05 level * Significant at .01 level
Table 4. Factors Affecting Hospital Accreditation of Community Hospitals During COVID-19 Outbrake
Variables b S.E Wald P
Constant -13.13 3.90 11.37 .001
Age -.39 .58 .46 .50
Status -1.9 .51 .14 .71
Operational period .78 .65 1.43 .23
education level -.05 .72 .00 .95
job position .13 .59 .05 .83
knowledge 1.00 1.18 .71 .40
attitude .35 .56 .40 .53
organization 2.31 .62 14.04 .001
process 4.33 .83 27.48 .001
health legislation 4.64 .72 28.82 .001
