Background Healthcare workers across the world are subjected to increasing workplace violence, mostly arising from patient interactions. Effective workplace violence prevention programs are urgently needed, but there is limited evidence supporting such programs in non-psychiatric inpatient units. Methods This prospective interventional study evaluated the effectiveness of a workplace violence prevention program. All patients admitted or transferred to four non-psychiatric inpatient units from November 2024 to August 2025 were included. Following a baseline observational period, Phase 1 interventions were implemented, consisting of screening patients with the 6-item Aggressive Behavior Risk Assessment Tool for Hospitalized Patients (ABRAT-H) and posting signage for patients with ABRAT-H scores ≥2. During the subsequent Phase 2 period, proactive rounding by a behavioral health response nurse was added to the Phase 1 interventions for patients with ABRAT-H scores ≥3. Results Of 7,625 evaluable patients, 340 had ≥ 1 violent event (overall rate = 4.46%), while 106 patients committed physical assaults (1.39%). Compared to the baseline observational period, violent event rate declined significantly during the Phase 2 period (5.30% vs 3.71%; Relative Risk [RR] = 0.69; 95% CI, 0.53–0.90; p = 0.007). Likewise, the physical assault rate decreased significantly between baseline and Phase 2 (1.89% vs 0.82%; RR = 0.43; 95% CI, 0.26–0.73; p = 0.001). However, the decreases in violent events and physical assaults were not statistically significant between baseline and Phase 1. Conclusion A workplace violence prevention program of screening patients with ABRAT-H combined with signage posting and proactive nurse rounding for high-risk patients achieved a 31% relative reduction in violent events and a 57% relative reduction in physical assaults.
Background Repeat blood pressure (BP) measurements help ensure accurate identification of controlled versus uncontrolled BP. Within the Department of Medicine (DOM), we aimed to improve the rate of repeat BP measurement when the initial reading was ≥140/90 mmHg from the baseline of 40% to 50% between September 2022 and August 2023. Methods A DOM Quality Committee, with representatives from each division, led a centralized improvement effort to create a common data infrastructure, electronic dashboard for local use, feedback of data to clinical leaders, and educational materials for clinic use. Control and run charts were used to analyze the impact of repeat BP measurements on the process and outcome measures. Results The 61 DOM clinics completed a total of 273,704 patient encounters between September 2022 and August 2023. A total of 74,614 encounters had an initial high BP reading ≥140/90 mmHg. In these encounters, the rate of repeat BP measurement increased from a mean 41% to 61% and the BP control (<140/90 mmHg) rate increased from a mean 74% to 78%. Similar improvements were seen in the subgroup with a known diagnosis of hypertension. In addition, the percentage of encounters reclassified from uncontrolled to controlled BP (<140/90 mmHg) upon repeating the BP remained relatively stable with a median reclassification rate of 38%. Conclusion This centralized, department-level intervention increased rates of repeat BP measurement. Improvement in BP control was observed prior to the implementation of interventions and continued to improve after. Using a system-level approach to quality improvement with centralized infrastructure, we facilitated changes in diverse clinics to improve clinical care.
Purpose To describe the design, implementation, and the results of a longitudinal multidisciplinary quality improvement (QI) initiative to improve length of stay (LOS) in elective neurosurgical patients at an academic satellite hospital. Methods A comprehensive quality improvement initiative to decrease LOS in elective neurosurgery patients. LOS was measured on a per-patient basis using an individualized LOS Index (LOSI), defined as an observed-to-expected LOS ratio. Interventions were identified and implemented using QI methodology and results were tracked in real-time using Shewhart control charts over a 12-month period. Bi-monthly meetings with a multidisciplinary working group enabled continuous and iterative development, review and implementation of effective interventions. Notable interventions include standardizing electronic medical record (EMR) order sets to include Extended Recovery After Surgery (ERAS) components, standardizing physical therapy, social work and case management processes, streamlining radiology workflows, and standardizing interdisciplinary communication. Results The initiative led to a sustained reduction in LOSI, with several consecutive months surpassing the institutional target of <1, accomplishing the project’s primary aim. Furthermore, at the completion of the project there was a statistically significant improvement in LOSI from the pre- to post-intervention groups (1.13 vs. 0.93, p=0.033). Conclusion This initiative demonstrates that longitudinal, multidisciplinary QI efforts based on realtime analysis and data-driven adjustments can lead to impactful, sustained reductions in LOS for elective neurosurgical patients. Our initiative provides a sustainable and adaptable framework that may serve as a model for other institutions seeking to improve perioperative efficiency and patient care outcomes.
Background Healthcare providers must understand indications and contraindications for percutaneous endoscopic gastrostomy (PEG) tube placement. Appropriate patient selection necessitates interdisciplinary collaboration and patient-centered decision-making. Guidelines recommend pre-procedural checklists for meticulous evaluation. This quality improvement initiative established a standardized workflow utilizing a novel checklist for proper PEG tube placement consultation. Aim We aimed to improve the PEG tube consult process by achieving ≥50% utilization of a standardized consult checklist within one year. Methods A novel electronic medical record-based checklist was employed to guide primary teams in patient optimization before consulting gastroenterology for PEG tubes. Teams received comprehensive education on indications, contraindications, techniques, and risks. Pre- (6/1/2021-7/31/22) and post-intervention (9/1/22-8/31/23) cohorts were compared. Outcome measures included checklist utilization, number of days between the initial consultation and PEG tube placement, reasons for delays in PEG tube placement, patient selection, total hospital length of stay (LOS), 30-day all-cause mortality, and complications related to PEG tube placement. Results Following implementation, the checklist was used in 69.2% of cases. The number of patients able to tolerate oral intake at discharge decreased significantly (24.6% pre- vs 10.8% post-intervention with checklist, p = 0.014), as did the mean total hospital length of stay (64.18±102.4 days pre- vs 48.52±27.02 days post-intervention, p = 0.01). Time from consult to placement, 30-day complication rate, and all-cause mortality also decreased post-intervention. However, these findings were not statistically significant. Conclusion This intervention achieved high adherence within one year and was associated with improved patient selection. These findings may provide a framework for other health systems seeking to implement similar initiatives, thereby supporting effective pre-consultation screening for PEG tube placement.
Background Launching a clinical service is a vulnerable phase in which latent risks may emerge before care processes stabilize. Hyperbaric oxygen therapy (HBOT) is a high-risk, technology-intensive service requiring infrastructure, equipment control, procedures, emergency preparedness, and cross-departmental coordination. The role of Failure Mode and Effects Analysis (FMEA) in supporting pre-launch implementation readiness has been less clearly described. Methods We conducted a prospective, multidisciplinary patient safety improvement project during pre-implementation of a hospital-based HBOT service in northern Israel. FMEA linked risk identification with mitigation planning, accountability, operational controls, readiness activities, and early post-launch review. Results The FMEA mapped 13 process stages and identified 114 failure modes. High-priority risks extended beyond in-chamber treatment to maintenance, patient preparation and transfer, discharge planning, equipment control, and fire and electrical safety. The highest RPN was 504 for use of a non-approved external electrical device; RPNs were prioritization aids rather than precise risk estimates. Of the 10 highest-priority failure modes, mitigation actions for 7 were implemented before launch, while 3 underwent additional reinforcement during early follow-up. All core launch-facing staff completed preparation, and 3 operational checklists were deployed. By February 2026, 347 treatment sessions had been completed, with no patient harm events identified in the reviewed top-risk categories. This was treated as an early operational observation, not evidence of reduced harm. Conclusions Prospective multidisciplinary FMEA helped structure implementation readiness by linking risk identification with mitigation ownership, operational controls, readiness review, and early post-launch learning. This single-center project did not evaluate whether FMEA reduced patient harm or improved clinical outcomes. FMEA or a comparable prospective hazard-assessment method may be considered in pre-launch planning for selected high-risk clinical services.
Context: Inter-ICU transfer of patients with acute respiratory failure occurs between hospitals to facilitate specialized care or treatment options. However, no uniform guidance exists to help clinicians decide why or when patients should be transferred. This lack of guidance contributes to inequities in transfers leading to negative impacts on quality of care and patient-centered outcomes. Objective: 1) To examine ICU clinicians’ perception on the transfer processes within a large health system, 2) To develop a novel Structured Transfer Escalation: Proactive and Unified Process (STEP-UP) for inter-ICU transfer of ARF patients, and 3) To gather feedback on the relevance of STEP-UP for future work. Methods: We employed Consolidated Framework for Implementation Research (CFIR) 2.0 as a framework throughout this mixed-methods study. Results: Eighty-six ICU clinicians from 7 hospitals responded to a survey about perceptions on inter-ICU transfers. 72% of participants felt that it was feasible to identify patients that would benefit from transfer and 91% felt that an earlier decision would be ideal for patient outcomes. An expert panel utilized the survey data to develop STEP-UP with two components (a) a time-based decision-making query regarding transfer and (b) a checklist of key tasks to facilitate shared decision-making, collaborative discussion, and standardized sign out to accomplish a transfer. Qualitative interviews of 19 clinicians revealed the lack of structure during transfers as a recurring theme and the majority of clinicians perceived STEP-UP as comprehensive and easy to apply. Conclusion: We identified facilitators (e.g. health system with a network of hospitals, positive clinician attitudes and hospital culture around transfers) and barriers (e.g. limited bed availability, asymmetric communication) to be considered in future work around a structured system for transfers.
BACKGROUND:Providing timely follow-up care after hospitalization reduces readmissions and improves patient outcomes, yet rates for follow-up within seven days of discharge are relatively low. METHODS:The authors implemented and evaluated a statewide collaborative (formed in 2018) to improve health outcomes for Ohio's Medicaid population, including a focus on timely follow-up after hospitalization for mental illness within seven days. Interventions (initiated in 2019) included developing new clinical services, completing follow-up phone calls after discharge, reserving dedicated appointment slots for hospital follow-up visits, expanding staffing, initiating collaborative care, convening predischarge planning groups, promoting warm handoffs, and using telehealth. A longitudinal analysis using binomial regression was conducted to retrospectively evaluate quarterly Medicaid claims and eligibility data from 2019 through 2023 to assess for improvement in the percentage of persons discharged who had timely follow-up after hospitalization. To compare annual changes observed for the statewide collaborative with national trends, changes were compared with publicly available data from the National Committee for Quality Assurance (NCQA). RESULTS:The number of eligible discharges totaled 9,041 across the statewide collaborative from 2019 through 2023. The available data demonstrated improvement in timely follow-up after hospitalization for mental illness, from 47.9% in 2019 to 57.0% in 2023 (quarterly median 51.8%, for 2019-2023). In binomial regression, there was a highly significant increase in the probability of follow-up over time (p < 0.001). Compared with publicly available national payer data from NCQA, the collaborative had higher rates of follow-up (by 7.5 percentage points across the study period, p = 0.015), and the difference in trends over time was statistically significant (difference in slope = 2.15 percentage points per year, p = 0.01). CONCLUSION:A statewide learning collaborative was associated with an increased percentage of Medicaid beneficiaries receiving timely follow-up after hospitalization for mental illness.
BACKGROUND:Aspiration events in hospitals are preventable yet difficult to systematically identify and mitigate. In high-risk environments such as the emergency department (ED), fragmented documentation and high clinician cognitive load create latent safety risks. Traditional strategies such as education or interruptive alerts have shown limited effectiveness. METHODS:A multisite quality improvement initiative across nine EDs within a large northeastern health system from July 2022 through May 2025 was conducted on timely implementation of aspiration precaution and "nothing by mouth" (NPO) orders. The intervention progressed through three phases: an initial interruptive pop-up alert, a revised interruptive alert, and an automated standing order. Primary outcomes were the proportion of ED encounters in which aspiration precautions and NPO orders were placed and time from ED arrival to order placement. RESULTS:During the preintervention period, aspiration precautions and NPO orders were placed in 37 of 550,621 ED encounters (0.007%), with median time to order placement of 597 minutes (interquartile range [IQR] 346-1,973) for NPO orders and 704 minutes (IQR 479-2,115) for aspiration precautions. During the initial and revised interruptive alert phases, orders were placed in 438 of 54,407 encounters (0.81%) and 918 of 182,434 encounters (0.50%), respectively. After implementation of the automated standing order system, orders were placed in 16,393 of 559,744 encounters (2.93%), and median time decreased to 24 minutes (IQR 11-53) for both NPO and aspiration precautions. No aspiration-related ED safety events were reported during the one-year post-automation period. CONCLUSION:An automated, standing order workflow was associated with decreased duration of latent aspiration risk. This approach transformed a low-reliability, human-dependent process into a high-reliability system-level safeguard and offers a scalable model for addressing safety risks in emergency care.
Transparency has become a central governance strategy for strengthening accountability, quality, and patient safety in healthcare systems. In high-income countries, this principle is often operationalized through the public reporting of standardized healthcare performance indicators, enabling comparability, organizational learning, and continuous improvement. In Brazil, however, although the availability of health data has advanced substantially, standardized public reporting of healthcare performance remains fragmented and uneven. Although hospitals are subject to extensive regulatory reporting requirements and the country has developed a robust health information infrastructure, Brazil still lacks a unified national framework for risk-adjusted, validated, and publicly reported hospital performance indicators. National information systems primarily disseminate aggregated data, limiting hospital-level comparability and public accountability. Private-sector initiatives led by the National Supplementary Health Agency and the Brazilian National Association of Private Hospitals have advanced benchmarking and outcomes measurement; however, access to comprehensive and comparable performance data remains limited in scope, coverage, and public accessibility across the Brazilian healthcare system. This article analyzes transparency as a governance principle in Brazilian healthcare, with a specific focus on public reporting of hospital performance as an essential operational mechanism to strengthen accountability and quality improvement. It identifies critical policy gaps, including the lack of standardized national indicators, limited use of risk adjustment, insufficient independent data validation, the absence of an integrated national public reporting system encompassing both public and private hospitals, and the limited integration of public-sector hospitals into existing reporting frameworks. The authors argue that establishing a unified, methodologically robust, and publicly accessible national hospital performance platform is a critical step toward strengthening governance, improving accountability, and advancing patient safety and high-quality healthcare in Brazil.
BACKGROUND:Emergency department (ED) boarding of patients awaiting inpatient admission is a widespread challenge. Patients presenting for psychiatric reasons face disproportionate rates and durations of boarding. Prior literature suggests higher occupancy levels on inpatient medical units increases ED boarding, but this relationship has not been examined in psychiatry. The goal of this study was to examine the association between inpatient psychiatry occupancy levels and psychiatric ED boarding. METHODS:This was a retrospective operational data analysis in an integrated healthcare delivery system. The study population included patients presenting to EDs requiring inpatient psychiatry placement. Separate analyses were conducted for adult, child/adolescent, and geriatric populations. Data were obtained from operational dashboards created from electronic health record data. Generalized additive models were used to assess the relationship between inpatient psychiatry unit occupancy and ED boarding volume. RESULTS:Among the adult population, higher inpatient psychiatry unit occupancy was associated with higher psychiatric ED boarding volume (for example, daily predicted boarding volume was 31.6 (95% confidence interval [CI] 27.6-35.6) at < 80% occupancy and 41.0 (95% CI 37.3-44.8) at ≥ 90% occupancy. For the child/adolescent population, higher occupancy was also associated with higher boarding volume, but at a lower occupancy threshold (≥ 60%). There was not a significant association between boarding and occupancy for the geriatric population. CONCLUSION:Higher inpatient psychiatry occupancy levels were associated with greater ED boarding, with the relationship best explained by boarding volume rather than duration. This possibly reflects dynamics in boarding and placement specific to psychiatry, including challenges of finding appropriate units for complex patients. In addition, health system factors that block beds (for example, staffing or infection status) likely influence the relationship between occupancy and boarding and should be incorporated into operational analyses aimed at reducing ED boarding.
BACKGROUND:Access to healthcare and timely patient scheduling are essential for early diagnosis, effective treatment, enhanced operational efficiency, and patient satisfaction in healthcare systems. METHODS:This study examined five access initiatives at a tertiary oncological center: redesigned scheduling algorithms, expedited appointment-offering protocols (same-day/next-day [SD/ND] scheduling), optimization of four-hour patient contact workflows, developing a patient-facing access tracking tool (My Referral Status), and a workforce redesign that empowered access leaders with data analytics, process improvement skills, and career advancement strategies. The authors analyzed new patient referrals from January 2023 to December 2024, focusing on three domains: appointment scheduling, operational performance, and patient experience. RESULTS:Median time to appointment creation decreased from five to two calendar days. The four-hour patient contact rate increased by nearly 40 percentage points, reaching 90%. Press Ganey scheduler courtesy scores exceeded the 97th percentile nationally (an improvement from the 41st percentile). SD/ND scheduling improved from 38% to 62% across all patient cohorts and from 48% to 74% within the target population. Use of the My Referral Status tool contributed to a 5% increase in Press Ganey Top Box communication scores. Workforce stability improved substantially, with turnover declining from approximately 30% to below 5%, vacancy rates falling below 5%, and engagement scores increasing across multiple institutional survey domains. CONCLUSION:Coordinated, data-driven access strategies reduced structural barriers, improved scheduling timeliness, enhanced transparency, and strengthened workforce stability. This integrated model provides a replicable framework for healthcare systems seeking to expand access, improve patient experience, and support sustainable oncology operations.
BACKGROUND:Anticoagulant-associated bleeding is an important patient safety concern in hospitalized patients. These events may be underdetected in routine clinical practice. The authors developed and validated a trigger-based surveillance approach to support anticoagulation-associated bleeding detection in hospitalized adult general medicine patients. METHODS:The trigger tool for identifying anticoagulation-associated bleeding was developed through a systematic review and a two-round modified Delphi consensus. A retrospective observational study was conducted in hospitalized adult patients receiving anticoagulants at a tertiary care hospital between March and June 2024 to evaluate performance and feasibility of the trigger tool. The tool was applied to identify potential bleeding events, which were then assessed by pharmacists for causality, severity, and preventability. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of individual triggers and the overall tool were evaluated. RESULTS:Fourteen triggers were included in the Delphi consensus process, resulting in 11 candidate triggers for validation. Among 395 admissions, 50 in-hospital bleeding events were identified in 43 patients (10.9%) on anticoagulation therapy. Most bleeding events caused temporary harm (60.0%), while 40.0% were serious (prolonged hospital stay or life-threatening situation). Overall, 40.0% of events were considered preventable. The trigger tool showed a sensitivity of 62.8% (95% confidence interval [CI] 46.7%-77.0%), specificity of 90.9% (95% CI 87.4%-93.7%), PPV of 45.8% (95% CI 32.7%-59.2%), and NPV of 95.2% (95% CI 92.4%-97.3%). CONCLUSION:This anticoagulation-associated bleeding trigger tool is a promising approach to enhance the identification of potential bleeding events in hospitalized adult patients. Further evaluation is needed to assess its applicability across broader patient populations and clinical settings.
For organizations using range orders, Joint Commission requires the standardization of range order interpretation, utilization, and nurse training. The aim of this work was to create a tool outlining the standard approach applied by postanesthesia care unit (PACU) registered nurses (RNs) treating patient pain using as needed intravenous opioid range orders. Engaging PACU RNs in the development of the tool and using scenario-based training demonstrated standardized interpretation and utilization, which was validated in Joint Commission's on-site surveys. Appropriate use of this tool demonstrates that RNs can use opioid range orders to safely and effectively meet individual patients' pain management goals.
BACKGROUND:Enhanced Recovery After Surgery (ERAS®) guidelines in the pediatric population recommend appropriate multimodal analgesia to limit opioid exposure, with the goal of preventing deleterious effects. Acetaminophen offers an alternative to opioids in neonatal surgical patients, but oral and rectal administrations cannot always be used. The authors used quality improvement methodology to implement a perioperative intravenous (IV) acetaminophen protocol for neonates undergoing gastrointestinal surgery. METHODS:A multidisciplinary stakeholder team was created that included pediatric surgeons, neonatal intensive care physicians and nurses, nurse practitioners, pharmacists, and information technologists. Special approval was issued for IV acetaminophen in neonatal surgical patients. The first Plan-Do-Study-Act (PDSA) cycle implemented a standardized perioperative dosing protocol accompanied by training. The second PDSA cycle involved implementation of an online order set for ease of administration and compliance. The primary process measure was protocol compliance. The primary balancing measure was postoperative pain, measured by the Neonatal Pain, Agitation, and Sedation Scale (NPASS). RESULTS:Fifty prospective cases were included. The overall rate of compliance was 43.9%, with 46.0% preoperative compliance and 90.2% postoperative compliance. Compliance was greater when the order set was used, though the preoperative order set was used less frequently than the postoperative order set (67.7% vs. 77.4%). Median NPASS scores at 24 and 48 hours were 2.4 (interquartile range [IQR] 1.5-3.3) and 2.3 (IQR 1.0-3.5), respectively, indicating adequate analgesia. CONCLUSION:This project provides a model for implementing perioperative IV acetaminophen as an analgesic for neonates undergoing gastrointestinal surgery. Continuing education and sustainability efforts are required to ensure ongoing compliance to the protocol.
BACKGROUND:CommonSpirit Health, a leading nonprofit health system in the United States, provides care to 20 million patients across 158 hospitals and more than 2,200 care sites in 24 states. Achieving large-scale clinical excellence amid inherent variation requires a disciplined approach that is firmly rooted in performance improvement science. METHODS:CommonSpirit developed an innovative eight-step performance improvement approach. This framework includes (1) identifying opportunities via internal/external scans and leadership collaboration; (2) establishing cascaded targets with robust data and benchmarks; (3) ensuring clinical and operational governance; (4) scaling evidence-based standards systemwide; (5) providing comprehensive toolkits and education; (6) implementing performance improvement cycles; (7) multilevel performance feedback; and (8) fostering engagement and accountability. RESULTS:This approach accelerated evidence into practice, achieving top-quartile national performance across numerous quality measures. Systemwide, risk-adjusted hospital mortality significantly declined from 0.93 (28th percentile nationally) in 2021 to 0.64 (66th percentile) in 2024 across 99 acute care hospitals. This translates to thousands of lives saved annually and improved care for more than 400,000 patients in three years. CONCLUSION:CommonSpirit's standardized eight-step performance improvement approach is key to consistently scaling improvement across diverse clinical areas and populations. This replicable model empowers teams to identify, intervene, measure, and achieve substantial, sustainable gains in the quality and safety of care provided. Critical success factors include strong clinical leadership, trained multidisciplinary teams, and consistent, accurate feedback.
BACKGROUND:When a patient and clinician do not speak the same language, the absence of language-concordant care necessitates professional interpretation to ensure safety. However, many clinicians proceed without a professional interpreter, often relying on informal interpreters such as family members or other methods, which may increase the risk of medical errors and incomplete communication. Understanding factors that influence interpreter use is necessary to improve language access. This study sought to quantify the trade-offs clinicians consider when deciding whether to request a professional medical interpreter for patients with non-English language preferences. METHODS:The authors conducted an electronic discrete choice experiment at a large urban academic medical center. Participants evaluated choice sets describing theoretical clinical encounters characterized by seven attributes. Data were analyzed using Hierarchical Bayesian modeling to estimate relative importances of attributes. RESULTS:Ninety-three clinicians (attending physicians, residents/fellows, nurse practitioners, and physician assistants) from various specialties (49.5% from Medicine) participated. The most important attribute driving clinicians' decision to request a professional medical interpreter was whether the patient's "English proficiency is good enough for the encounter" (27.1%), followed by clinical complexity of the encounter (19.4%) and having a bilingual family member present (18.8%). CONCLUSION:Decisions to request professional interpreters are primarily driven by clinicians' subjective perception of their patient's English proficiency, followed by the clinical complexity of the encounter and the availability of untrained or informal interpretation. Interventions should promote interpreters whenever patients report a non-English language preference and simplify interpreter access.
BACKGROUND:Accreditation is widely used to improve healthcare quality and patient safety; however, staff experiences during accreditation preparation and survey activities remain inadequately understood, particularly in Middle Eastern healthcare settings. The objective of this study was to examine healthcare staff experiences during Joint Commission International (JCI) accreditation and identify organizational factors associated with positive accreditation experiences and perceived outcomes. METHODS:A cross-sectional survey was conducted among clinical and nonclinical staff at a tertiary academic medical center in Dubai, United Arab Emirates, following a JCI accreditation survey. Descriptive statistics, bivariate analyses, and multivariable logistic regression were used to evaluate associations between organizational factors and staff-reported experiences. RESULTS:A total of 304 staff responses were analyzed. Overall perceptions of accreditation were highly favorable, with more than 90% of respondents reporting positive perceptions of patient safety, quality of care, teamwork, and leadership engagement. Leadership engagement (adjusted odds ratio [AOR] 2.45), perceived improvements in patient safety (AOR 2.89), and quality of care (AOR 2.63) were independently associated with positive accreditation experiences. Workload manageability (AOR 0.61) and psychological safety (AOR 0.68) were negatively associated with positive experience. Nurses and allied health professionals reported more favorable perceptions than physicians, although differences were small. Qualitative findings highlighted the need for continuous readiness, protected time for accreditation activities, improved coordination, and ongoing training. CONCLUSION:Healthcare staff generally perceived JCI accreditation positively and associated it with improvements in patient safety and quality of care. Leadership engagement emerged as a key facilitator of positive accreditation experiences, whereas workload burden and psychological safety represented important challenges. Organizations implementing accreditation programs should prioritize continuous readiness, workforce support, psychological safety, and targeted physician engagement strategies to sustain accreditation benefits.
