Attitudes of hospital staff and surveyors
towards unannounced hospital surveys:
Primary reporting of survey results
Katherina Beltoft Simonsen1, Morten Berg Jensen1, 2 Gitte Sand Rasmussen3, and Lars Holger
Ehlers1
1
Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health
Sciences, Aalborg University, Denmark, 2Department of Economics and Business - Center for
Research in Econometric Analysis of Time Series, Aarhus University, Denmark, and 3The Danish
Institute for Quality and Accreditation in Healthcare, Aarhus, Denmark.
Email addresses: Katherina Beltoft Simonsen kbs@id.aau.dk, Morten Berg Jensen
mbj@econ.au.dk, Gitte Sand Rasmussen gr@ikas.dk, and Lars Holger Ehlers lehlers@id.aau.dk
Background: Hospital accreditation in Denmark is currently based on The Danish Health Care
Quality Programme version 2 (DDKM version 2) and is conducted through announced surveys
every third year including a periodic hospital survey conducted one and a half year +/- six months
after an external survey.
Objective: To evaluate the attitudes of clinicians, quality-staff, surveyors and hospital managers
towards the implementation of unannounced hospital surveys.
Methods: This survey is the second sub-project of the nationwide research project “Unannounced
surveys on public hospitals” designed by the Institute for Quality and Accreditation in Healthcare
(IKAS) and the Danish Center for Healthcare Improvements (DCHI).
Twenty-five out of 30 hospitals in Denmark represent the survey population. The study sample
comprises hospital managers, quality-staff (quality-managers and quality-employees), doctors and
nurses within selected specialties, and hospital surveyors. The questionnaire was administered by
surveyXact the 11 August 2014 and closed the 1 September 2014. The questionnaire was delivered
to 17.646 unique email addresses.
Questionnaire responses were analysed in STATA/v13 using contingency tables. Qualitative survey
data (free comments) were applied for content analysis in Nvivo/v10.
Results: Included for analysis were 5.208 responses (response rate 30%). The overall attitudes
indicate that unannounced surveys will facilitate the daily work with quality of care (61%) and will
provide a more accurate picture of the quality of care compared to announced surveys (65%). The
resources consumed during an accreditation process are expected to be unchanged (35%) or reduced
(27%) by changing the process to unannounced surveys.
Table 1 Breakdown of questionnaire responses for the use of unannounced surveys as a part of the accreditation process.
Frequency
Percent %
Unannounced surveys should replace
announced surveys
848
16.3
Unannounced and announced surveys should
be used in combination
2018
38.7
Unannounced surveys should only replace the
periodic hospital survey
607
11.7
Unannounced surveys should not be
implemented
561
10.8
Don’t know
926
17.8
missing
248
4.8
Total
5208
100
Of 5.208 responses, 254 respondents (5%) provided free text comments on the topic of
unannounced surveys. They responded that unannounced surveys will provide a more accurate
picture of the hospitals’ daily care process supporting survey results. Of negative attitudes, the main
part argued that unannounced surveys could imply more control and mistrust, to a higher degree
than announced surveys. Several respondents indicated that a combination of unannounced and
announced surveys would be preferable which supports the survey result (38.7%), see table 1.
Conclusion: This study demonstrates mainly positive attitudes towards changing the practice of
announced hospital surveys to unannounced hospital surveys or implementing a combination of
both methods.
Conflict of interest: None.
Abbreviations: DCHI: Danish Center for Healthcare Improvements; DDKM version 2: The Danish
Health Care Quality Programme version 2; IKAS: Institute for Quality and Accreditation in Health
Care.