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Accreditation of health organisations, occurring in over 70 countries, is predicated upon the reliability of survey teams judgements, but we do not know the extent to which survey teams are reliable. To contribute evidence to this issue, we investigated the reliability of two survey teams simultaneously assessing an organisation. The setting was a large Australian teaching hospital, and data were derived from interviews, observations and survey documents. Participants were from four groups: hospital staff, accreditation agency personnel and surveyors, and research staff. Thematic analysis was employed to identify significant factors that influenced the study. The two survey teams ratings and recommendations demonstrated high levels of agreement. However, while a common understanding of the study existed, the research was compromised. There were difficulties enacting the study. Contrary to negotiated arrangements, the pressure of the study resulted in surveyors discussing evidence and their interpretation of standards. Uncontrollable circumstances (late changes of personnel), and unexpected events (a breakdown of working relationships), challenged the study. The twin lessons learnt are that a consistent survey outcome is likely to be reached when reliability of process and consistent application of standards are pursued, and research requires negotiating challenges and relationships.

Purpose: The purpose of this study is to evaluate the effects of a health system-wide safety improvement program (SIP) three to four years after initial implementation., Design/methodology/approach: The study employs multi-methods studies involving questionnaire surveys, focus groups, in-depth interviews, observational work, ethnographic studies, documentary analysis and literature reviews with regard to the state of New South Wales, Australia, where 90,000 health professionals, under the auspices of the Health Department, provide healthcare to a seven-million population. After enrolling many participants from various groups, the measurements included: numbers of staff trained and training quality; support for SIP; clinicians' reports of safety skills acquired, work practices changed and barriers to progress; RCAs undertaken; observation of functioning of teams; committees initiated and staff appointed to deal with adverse events; documentation and computer records of reports; and peak-level responses to adverse events., Findings: A cohort of 4 per cent of the state's health professionals has been trained and now applies safety skills and conducts RCAs. These and other senior professionals strongly support SIP, though many think further culture change is required if its benefits are to be more fully achieved and sustained. Improved information-handling systems have been adopted. Systems for reporting adverse incidents and conducting RCAs have been instituted, which are co-ordinated by NSW Health. When the appropriate structures, educational activities and systems are made available in the form of an SIP, measurable systems change might be introduced, as suggested by observations of the attitudes and behaviours of health practitioners and the increased reporting of, and action about, adverse events., Originality/value: Few studies into health systems change employ wide-ranging research methods and metrics. This study helps to fill this gap.