Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis.

OBJECTIVES: The objectives of this review were to identify factors that influence implementation of hospital accreditation programmes and to assess the impact of the accreditation process on quality improvement in public hospitals. DATA SOURCES: Two electronic databases, Medline (OvidSP) and PubMed, were systematically searched. STUDY SELECTION: "Public hospital", "hospital accreditation", and "quality improvement" were used as the search terms. A total of 348 citations were initially identified. After critical appraisal and study selection, 26 articles were included in the review. DATA EXTRACTION: The data were extracted and analysed using a SWOT (strengths, weaknesses, opportunities, threats) analysis. DATA SYNTHESIS: Increased staff engagement and communication, multidisciplinary team building, positive changes in organisational culture, and enhanced leadership and staff awareness of continuous quality improvement were identified as strengths. Weaknesses included organisational resistance to change, increased staff workload, lack of awareness about continuous quality improvement, insufficient staff training and support for continuous quality improvement, lack of applicable accreditation standards for local use, and lack of performance outcome measures. Opportunities included identification of improvement areas, enhanced patient safety, additional funding, public recognition, and market advantage. Threats included opportunistic behaviours, funding cuts, lack of incentives for participation, and a regulatory approach to mandatory participation. CONCLUSIONS: By relating the findings to the operational issues of accreditation, this review discussed the implications for successful implementation and how accreditation may drive quality improvement. These findings have implications for various stakeholders (government, the public, patients and health care providers), when it comes to embarking on accreditation exercises.

Using bevacizumab in the fight against malignant glioma: first results in Asian patients.

OBJECTIVES: To investigate the efficacy and safety profile of bevacizumab in combination with irinotecan in Hong Kong Chinese patients with recurrent malignant glioma and to determine whether their response differed from that reported in other populations. DESIGN: Retrospective study. SETTING: Two private clinics and a public hospital in Hong Kong. PATIENTS: Fourteen individuals who presented with recurrent glioma presenting to the hospital between November 2005 and November 2009. INTERVENTION: Salvage therapy with bevacizumab (10 mg/kg) and irinotecan (125 mg/m(2) [340 mg/m(2) for those taking enzyme-inducing antiepileptic drugs]) on a 14-day schedule. RESULTS: A radiological response was observed in 12 (86%) of the patients, four (33%) of whom had a complete response. The median progression-free survival was 6 (range, 1-15) months; 71% remained progression-free at 6 months. The median overall survival was 18 (range, 9-61) months. The most common adverse events during the bevacizumab and irinotecan treatment period were haematological; five patients had grade 2/3 adverse events. Pulmonary embolism occurred in two patients, one of whom died. Intracranial haemorrhage was not detected in any of the 14 treated patients. CONCLUSIONS: Bevacizumab plus irinotecan was at least as effective at treating Chinese patients with recurrent glioma as previously reported in clinical trials in different patient populations.