• Lars Holger Ehlers, Katherina Beltoft Simonsen, Morten Berg Jensen, Gitte Sand Rasmussen, and Anne Vingaard Olesen.
• Danish Center for Healthcare Improvements, Department of Business and Management, Fibigerstraede 11, DK-9220, Aalborg University, Aalborg, Denmark.
• Int J Qual Health Care. 2017 Jun 1; 29 (3): 406-411.

ObjectiveTo evaluate the effectiveness of unannounced versus announced surveys in detecting non-compliance with accreditation standards in public hospitals.DesignA nationwide cluster-randomized controlled trial.Setting And ParticipantsAll public hospitals in Denmark were invited. Twenty-three hospitals (77%) (3 university hospitals, 5 psychiatric hospitals and 15 general hospitals) agreed to participate.InterventionTwelve hospitals were randomized to receive unannounced surveys (intervention group) and eleven hospitals to receive announced surveys (control group). We hypothesized that the hospitals receiving the unannounced surveys would reveal a higher degree of non-compliance with accreditation standards than the hospitals receiving announced surveys. Nine surveyors trained and employed by the Danish Institute for Quality and Accreditation in Healthcare (IKAS) were randomized into teams and conducted all surveys.Main Outcome MeasureThe outcome was the surveyors' assessment of the hospitals' level of compliance with 113 performance indicators-an abbreviated set of the Danish Healthcare Quality Programme (DDKM) version 2, covering organizational standards, patient pathway standards and patient safety standards. Compliance with performance indicators was analyzed using binomial regression analysis with bootstrapped robust standard errors.ResultsIn all, 16 202 measurements were acceptable for data analysis. The risk of observing non-compliance with performance indicators for the intervention group compared with the control group was statistically insignificant (risk difference (RD) = -0.6 percentage points [-2.51-1.31], P = 0.54). A converged analysis of the six patient safety critical standards, requiring 100% compliance to gain accreditation status revealed no statistically significant difference (RD = -0.78 percentage points [-4.01-2.44], P = 0.99).ConclusionsUnannounced hospital surveys were not more effective than announced surveys in detecting quality problems in Danish hospitals.Trial Registration NumberClinicalTrials.gov NCT02348567, https://clinicaltrials.gov/ct2/show/NCT02348567?term=NCT02348567.© The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care.

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