Improvement Motivation, Communication, And Engagement Human Resources For Accreditation Hospitals With “Photovoice”

. Hospital accreditation is an effort to improve the quality of hospitals. All employees in the hospital must support these efforts. To increase employees' motivation, communication, and involvement in carrying out accreditation. One way to achieve it is done by Photovoice, which is a participatory research method by involving all employees in the hospital in one activity by "identifying, representing, and strengthening communication through photographic techniques". This study aims to provide a communication space for the members of RSUD Dr. Soedono Madiun to express the circumstances, strengths, and problems they face related to Accreditation and facilitate the hospital community to express their views, thoughts, and ideas about accreditation. The research method used Participatory Action Research (PAR) with 5 stages of implementation, namely: 1) Recruiting photovoice participants and introducing photovoice through FGD; 2) Taking and collecting photos; 3) Discussing the photos; 4) Holding photo exhibition; and 5) Evaluating the activities. The subjects in this study were the members of RSUD Dr. Soedono Madiun. As a result of this community service activity, 16 working groups contributed to Hospital Accreditation. The response from all working groups was very positive. They felt that their contribution to accreditation was indispensable. All groups displayed photos of their struggles to carry out the accreditation. In conclusion, Photovoice can increase motivation, communication, and attachment both physically and mentally for the employees in hospitals in carrying out accreditation on an ongoing basis to improve the quality of hospitals and the quality of reliable human resources.


Introduction
Hospital accreditation programs, defined as the 'systematic assessment of hospitals against accepted standards' are conducted by independent bodies, external to the hospital structure, usually comprising nongovernmental and nonprofit organizations.The process includes staff training, the establishment of a team project, the selection of standards to be followed, and the implementation of specified requirements.It also comprises survey visits by a multidisciplinary healthcare team, leading to a detailed report of identified areas of improvement and the next cycle of follow-up visits.(1) The planning stage was perceived as the easiest component of JCI accreditation.Implementing and maintaining changes postaccreditation that demonstrably promote patient safety and quality of care was perceived as a more difficult stage.When planning for accreditation, institutions need to incorporate strategies to ensure that improvements to care continue after the accreditation period.(Al Mansour et al., 2022).The accreditation model is comprehensive and has been implemented to improve the quality of services and patients' safety.The basic philosophy of hospital accreditation does not fully comply with the underlying conditions of the hospitals.The hospital staff consider accreditation as the ultimate goal rather than a means for achieving quality of service (3).
Photovoice is a visual research methodology that provides cameras for the participants to help them document, reflect upon, and communicate issues of their concern while stimulating social change.A Photovoice research project taking place in an underserved urban community shows positive individual empowerment results (4).Photovoice is a method to reduce stigma (5); The perspective of Photovoice; (6) Reviews and aims of photovoice (7); Photovoice in evaluating a community (8); and Nurses perception of individual and organizational changes with photovoice (9).
The accreditation process is a critical aspect of healthcare that aims to ensure the quality and safety of hospitals' services.However, the accreditation process can sometimes overlook the experiences and perspectives of patients, families, and healthcare staff.
To address this gap, Photovoice, a participatory research method, can be used to provide a platform for patients, families, and healthcare staff to share their experiences and insights related to healthcare quality and safety.By using Photovoice, participants can capture and share their experiences through photographs, which can lead to better understanding and communication of issues related to healthcare quality and safety.
This article aims to explore the potential of using Photovoice to improve motivation, communication, and engagement of human resources for hospital accreditation.By engaging in Photovoice activities, human resources can be motivated to actively participate in the accreditation process, communicate more effectively with patients, families, and other stakeholders, and ultimately, improve the quality and safety of healthcare services provided by the hospital.
Through Photovoice activities, human resources can also engage with patients and families, listen to their feedback, and gain insights into their experiences.This can help human resources to identify and address any gaps in service delivery and ultimately enhance patient satisfaction.Photovoice offers a unique and innovative approach to improving motivation, communication, and engagement of human resources for hospital accreditation.By enabling participants to share their experiences through photographs and engage in meaningful discussions, Photovoice can help human resources to better understand the perspectives and needs of patients, families, and other stakeholders.Ultimately, this can lead to the provision of safer and higher-quality healthcare services in accredited hospitals.

Methodology
The study was conducted using the Participatory Action Research approach, utilizing focus group discussions and Photovoice activities.Participants in this study were human resources from a hospital in Indonesia that was in the process of having accreditation.Participants were recruited through purposive sampling, based on their roles and responsibilities in the accreditation process, including healthcare providers, quality improvement officers, and administrators.
The study was conducted in three stages: First, participants were introduced to Photovoice and trained on how to use photography as a means of capturing and sharing their experiences related to healthcare quality and safety.Participants were then instructed to take photographs that represented their experiences and perspectives related to the accreditation process.Second, participants were engaged in focus group discussions to reflect on the photographs they had taken, share their experiences, and identify common themes related to motivation, communication, and engagement in the accreditation process.The focus group discussions were facilitated by a trained moderator who encouraged participants to share their thoughts and feelings openly and provided guidance as needed.Third, the data collected from the focus group discussions and Photovoice activities were analyzed using content analysis.The photographs taken by participants were used to support the analysis of the focus group discussions, and themes related to motivation, communication, and engagement were identified.
The study's ethical considerations included obtaining informed consent from participants, maintaining confidentiality, and ensuring the privacy of the photographs taken by participants.The study also followed the ethical guidelines for research involving human participants.
The material and methods used in this study demonstrated the potential of Photovoice as a participatory research method to improve motivation, communication, and engagement of human resources for hospital accreditation.The combination of focus group discussions and Photovoice activities allowed for a deeper understanding of participants' experiences and perspectives, which can be used to inform the accreditation process and ultimately improve the quality and safety of healthcare services.
Community service using the means of "Photovoice" while the method used was Participatory Action Research (PAR) where all employees were given the opportunity to show the results of photos related to the implementation of accreditation that has been carried out.Then, the employees presented the results of the photos they collected to explain to all employees the achievements they have made during the implementation of accreditation.
Photos taken by hospital staff during the preparation and implementation of hospital accreditation showed many experiences both pleasant and sad experiences.The employees presented and showed the results of the photographs and they were asked to explain all activities that have a lot of information."Photovoice" aims to provide photographic images that represent the feelings and voices of healthcare workers facing hospital accreditation with all the difficulties they face.The photos are to communicate their experiences to the audience, including managers, leaders, and the community visiting the hospital.The stages of Photovoice implementation are as shown below:

Figure 2. Accreditation process in the hospital
This community service was carried out at RSUD dr.Soedono Madiun which was held in December 2022 with the participation of an accreditation team consisting of 48 people.The inclusion criteria of these community service participants were all hospital accreditation teams, while the exclusion criteria were the accreditation teams who were not willing to participate in this activity.The results of the community service were kept confidential so that it allowed participants to follow this community service stage by expressing their views honestly and openly.
The material prepared in the implementation of this Photovoice is a standing frame to put photos from various working groups in the implementation of hospital accreditation.

Figure 3. Standing Frame for showing the Photovoice
The number of photos shown was 16 photos from the working groups of the accreditation.

Results and Discussion
The result of this community service is to provide a communication space for the members of RSUD dr.Soedono Madiun to express the circumstances, strengths, and problems they face related to the accreditation and facilitate the hospital community to express their views, thoughts, and ideas.
The Photovoice activity was attended by the entire Hospital Community, the Director, the Deputy Director of the Hospital as well as the community service groups from the UMY MARS Study Program.The exhibition activity provides facilities for health workers who have undergone accreditation activities to share all their feelings when explaining the photos to the audience.
This Community Service Team has facilitated each working group to explain and convey the meaning of the photos displayed.During the photo exhibition, the representatives from 16 (sixteen) Accreditation Working Groups expressed their views on the photos displayed."Foto ini menggambarkan saat expo, kami satu-satunya Kelompok Kerja yang paperless, karena dokumen belum sempat di print.Foto lain menggambarkan saat kami melakukan kegiatan penyuluhan TB HIV bekerja sama dengan LSM.Kami juga bekerja sama dengan posyandu, untuk pembinaan locus stunting di daerah Madiun.Foto lain menggambarkan saat kami dan DSOG melakukan skrining ibu dengan resiko tinggi di puskesmas" The best photographs presented by the Working Group are as follows: This community service in hospitals ensures that the experiences and perspectives of patients, families, and healthcare staff are included in the accreditation process.By using Photovoice, participants can capture and share their experiences through photographs, leading to a better understanding and communication of healthcare quality and safety issues.
Photovoice can potentially improve motivation, communication, and engagement of human resources in the accreditation process.By engaging in Photovoice activities, human resources can be motivated to actively participate in the accreditation process, communicate more effectively with patients, families, and other stakeholders, and ultimately, improve the quality and safety of healthcare services provided by the hospital.
The study's material and methods demonstrate how Photovoice can be used as a participatory research method to explore the potential of using photographs to capture and share experiences related to healthcare quality and safety.The study used a qualitative research approach, utilizing focus group discussions and Photovoice activities to gather data from human resources at a hospital in Indonesia that was in the process of accreditation.
Photovoice can be a powerful tool for hospital accreditation as it allows a visual representation of the hospital's facilities, processes, and services.The reasons are as follows: 1. Transparency: Accreditation bodies require hospitals to meet certain standards of quality and safety.Photovoice can provide an objective and transparent assessment of whether these standards are met.Photos can show the physical condition of the hospital, equipment, and facilities, as well as the level of cleanliness and hygiene.This transparency can help accreditation bodies to make informed decisions about the hospital's compliance with the standards.2. Documentation: Photovoice can serve as a valuable documentation tool, capturing hospitals' progress, and improvement over time.Hospitals can use Photovoice to document the implementation of new policies and procedures, and the results of quality improvement initiatives.This documentation can provide evidence of the hospital's commitment to continuous quality improvement and can be used to demonstrate compliance with accreditation standards.3. Communication: Photovoice can also be used to communicate the hospitals' strengths and areas for improvement to stakeholders, including patients, staff, and accreditation bodies.Photos can provide a visual representation of the hospital's facilities and services as well as help to create a more engaging and informative experience for stakeholders.This communication can help to build trust and confidence in hospitals and their services.

Conclusions
Photovoice serves as a participatory research method to improve motivation, communication, and engagement of human resources in the accreditation process of hospitals.By including the experiences and perspectives of patients, families, and healthcare staff, hospitals can ensure that the accreditation process leads to the provision of safer and higher-quality healthcare services.The study's results suggest that Photovoice activities can lead to improved motivation, communication, and engagement of human resources in the accreditation process.Participants could share their experiences and perspectives through photographs and engage in meaningful discussions identifying common themes related to motivation, communication, and engagement.

Figure 4
Figure 4 The Community Service Team and Deputy Director of Soedono Hospital and The Atmosphere of the Photovoice Exhibition The Photovoice exhibition was opened by the Deputy Director of Soedono Hospital and was attended by the entire hospital community who prepared for the accreditation of Soedono Madiun Hospital.The exhibition activity provides facilities for health workers who have undergone accreditation activities to share all their feelings when explaining the photos to the audience.This Community Service Team has facilitated each working group to explain and convey the meaning of the photos displayed.During the photo exhibition, the representatives from 16 (sixteen) Accreditation Working Groups expressed their views on the photos displayed.