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This paper aims to investigate how health care accreditation surveyors enact their role with a view to identifying a surveyor styles typology.

This study was conducted in two phases. First, observational research was used to examine the conduct of a small survey team during the 2005 accreditation survey of a rural health service in Australia. The survey team was from the Australian Council on Healthcare Standards (ACHS), the major health care accreditation agency in Australia. Second, the emerging typology was reviewed by an expert panel of ACHS surveyors.

A typology comprising three unique surveyor styles is identified – interrogator; explorer; and discusser. Additionally, a further style, the questioner, is hypothesised.

The typology has application for development by accreditation agencies to be used with surveyors as a self‐reflection tool to improve learning and development. The knowledge gained about surveyors' styles can be used to match more effectively survey teams to organisations seeking accreditation. Further research is necessary to confirm these styles and examine whether other styles are apparent.

This study is an important step in examining the conduct of surveyors and opening up health care accreditation surveyor inter‐rater reliability for further investigation.

Health systems are changing at variable rates. Periods of significant change can create new challenges or amplify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability.

Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards.

Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy; accrediting agency management of the accreditation process, including the program’s framework; survey coordinators; survey team dynamics; individual surveyors; and healthcare organizations’ approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain.

Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.

Inquiries into healthcare organisations have highlighted organisational or system failure, attributed to poor responses to early warning signs. One response, and challenge, is for professionals and academics to build capacity for quality and safety research to provide evidence for improved systems. However, such collaborations and capacity building do not occur easily as there are many stakeholders. Leadership is necessary to unite differences into a common goal. The lessons learned and principles arising from the experience of providing distributed leadership to mobilise capacity for quality and safety research when researching health care accreditation in Australia are presented.

A case study structured by temporal bracketing that presents a narrative account of multi‐stakeholder perspectives. Data are collected using in‐depth informal interviews with key informants and ethno‐document analysis.

Distributed leadership enabled a collaborative research partnership to be realised. The leadership harnessed the relative strengths of partners and accounted for, and balanced, the interests of stakeholder participants involved. Across three phases, leadership and the research partnership was enacted: identifying partnerships, bottom‐up engagement and enacting the research collaboration.

Two principles to maximise opportunities to mobilise capacity for quality and safety research have been identified. First, successful collaborations, particularly multi‐faceted inter‐related partnerships, require distributed leadership. Second, the leadership‐stakeholder enactment can promote reciprocity so that the collaboration becomes mutually reinforcing and beneficial to partners.

The paper addresses the need to understand the practice and challenges of distributed leadership and how to replicate positive practices to implement patient safety research.

The purpose of this article is to test whether healthcare accreditation survey processes are reliable.

The study uses multiple methods to document stakeholder experiences and views on accreditation survey reliability. There were 29 research activities, comprising 25 focus groups, three interviews and a survey questionnaire. In total, 193 stakeholders participated; 134 in face‐to‐face activities and 56 via questionnaire. All were voluntary participants. Using open‐ended questioning, stakeholders were asked to reflect upon accreditation survey reliability.

Stakeholders perceived healthcare accreditation surveys to be a reliable activity. They identified six interrelated factors that simultaneously promoted and challenged reliability: the accreditation program, including organisational documentation and surveyor accreditation reports; members' relationship to the accrediting agency and survey team; accreditation agency personnel; surveyor workforce renewal; surveyor workforce management; and survey team conduct including coordinator role. The six factors realised shared expectations and conduct by accreditation stakeholders; that is, they enabled accreditation stakeholder self‐governance.

Knowledge gained can be used to improve accreditation program reliability, credibility and ongoing self‐governance.

The paper is a unique examination of healthcare accreditation surveys the reliability. The findings have potential application to reliability in other healthcare areas.

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.

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.

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.

Few studies into health systems change employ wide‐ranging research methods and metrics. This study helps to fill this gap.