The Healthcare Unit (HU) accreditation Program of the Andalusian Agency for Health Care Quality aims to recognize that the HU is oriented and centered on both the supporting health actions and the needs and expectations of citizens and professionals. The purpose of this study is to analyze compliance patterns on the standards constituting the first two blocks, which are fundamentally focused on the participation of users and professionals and clinical leadership aspects.
Cross-sectional data was studied from 421 assessed HUs from 2011 to 2016. Latent class analysis was used to examine patterns of standard compliance and multinomial logistic regressions were performed to identify characteristics associated with these patterns.
A three-class model representing unique combination of the 15 non-compulsory standards from the HU Certification Program demonstrated the best fit (Bayesian Information Criterion = 4,617.906; Akaike Information Criterion = 4,407.159; Chi-square goodness of fit = 536.951.3). Class I (18.5% of units) and Class III (36.5% of units) were characterized by having a high rate of specialized units and belong to more recent certification projects. Class II (51.0% of units) presented the highest proportion of primary care units. When comparing standard compliance behavior, Class I had the best general performance on standards relating to the establishment of an individualized health management plan (100%), involvement of professionals on the agreed HU objectives (98%), the implantation of action lines according to comprehensive Health Plans (91%), the issuance a comprehensive activity report (87%), the assessment of the person needs to facilitate access to resources (74%), incorporation of the patients opinion on the organization (71%), promotion of citizen participation as an element of continuous improvement (57%) implementation of a Patient Safe Strategy (45%), or a Quality Plan implementation (41%) amongst others. There was only one quality standard where Class I did not show the best performance when compared with the other classes. The standard related to optimal information dissemination on health promotion activities to the citizen was more likely to be accomplished by class II (79%) that the Class I (70%). Class III showed similar o less compliance than class II, except for the standard related to the issuance a comprehensive activity report (68%), and the standard about the establishment of an individualized health management plan (86%).
Those units classified into the Class I, which also showed the highest overall compliance probability in all the standards, were more likely to be hospital units rather than primary care units. Comparing Class I to Class II and to Class III, significant differences were shown on standards about a proper Quality Plan implementation (40%, 4% and 0% respectively) and guaranteeing a Patient Safe Strategy (45%, 3% and 0%). The results suggest how these two items could be predictors of belonging to Class I, which is the one that shows the best overall compliance of patient centered care and governance/leadership standards. Leading Quality and Patient Safe strategies may drive to engage Healthcare Units in other quality initiatives in healthcare. Further analysis need to be performed to explore the reasons behind the compliance behavior on Patient Centered care and leadership related standards.