The impact of hospital accreditation on the quality of healthcare: a systematic literature review

Abstract

Background Accreditation is viewed as a reputable tool to evaluate and enhance the quality of health care. However, its effect on performance and outcomes remains unclear. This review aimed to identify and analyze the evidence on the impact of hospital accreditation. Methods We systematically searched electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, MEDLINE (OvidSP), CDSR, CENTRAL, ScienceDirect, SSCI, RSCI, SciELO, and KCI) and other sources using relevant subject headings. We included peer-reviewed quantitative studies published over the last two decades, irrespective of its design or language. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers independently screened initially identified articles, reviewed the full-text of potentially relevant studies, extracted necessary data, and assessed the methodological quality of the included studies using a validated tool. The accreditation effects were synthesized and categorized thematically into six impact themes. Results We screened a total of 17,830 studies, of which 76 empirical studies that examined the impact of accreditation met our inclusion criteria. These studies were methodologically heterogeneous. Apart from the effect of accreditation on healthcare workers and particularly on job stress, our results indicate a consistent positive effect of hospital accreditation on safety culture, process-related performance measures, efficiency, and the patient length of stay, whereas employee satisfaction, patient satisfaction and experience, and 30-day hospital readmission rate were found to be unrelated to accreditation. Paradoxical results regarding the impact of accreditation on mortality rate and healthcare-associated infections hampered drawing firm conclusions on these outcome measures. Conclusion There is reasonable evidence to support the notion that compliance with accreditation standards has multiple plausible benefits in improving the performance in the hospital setting. Despite inconclusive evidence on causality, introducing hospital accreditation schemes stimulates performance improvement and patient safety. Efforts to incentivize and modernize accreditation are recommended to move towards institutionalization and sustaining the performance gains. PROSPERO registration number CRD42020167863.

The evidence base for US joint commission hospital accreditation standards: cross sectional study

“…Even if enforcement of recommendations unsupported by evidence does not directly harm patients, it might lead to regulatory fatigue that diverts clinicians and facilities from their primary missions. 21 25 26 27 28 29 Efforts to comply could distract workers from implementing policies that are essential, and possibly result in patient harm. 25 Time and resources could also be wasted.…”

Perceived accreditation benefits, participation and organizational commitment in hospital accreditation performance

“…The relation between perceptions of accreditation, participation and commitment has an important role to play in the continuity of the implementation of accreditation and employees' performance in improving quality health services. The results of previous studies show the impact of the perceived benefits of accreditation on the performance of employees mediated by participation and organizational commitment [5]- [8]. Other research findings also show a partially significant effect between participation, organizational commitment and perceptions in correlations to employee performance [9]- [13].…”

“…The high levels of support and dedication among the respondents describes employees who are generally good but who need to improve to remain in the accreditation organization and to participate in giving opinions. The effect of participation in accreditation showed a high standard compliance, adherence to guidelines and sustained changed [8]. Research assessing these two variables in hospital settings was tested in Taiwan which examined nurses to assess their participation and commitment and was shown to have a positive impact with a high incidence of 16% [28].…”

Accreditation in Interventional Radiology: Why it Matters and Why we Sought IASIOS Certification

“…The process is complex and multifaceted, and the evidence supporting the impact of accreditation on clinical outcomes is inconsistent [3]. A recent systematic review revealed that accreditation does have a net positive effect on improving hospital performance in terms of patient safety, culture, and efficiency [4]. However, when appropriately applied, accreditation can enhance institutional and clinical performance [4].…”

“…A recent systematic review revealed that accreditation does have a net positive effect on improving hospital performance in terms of patient safety, culture, and efficiency [4]. However, when appropriately applied, accreditation can enhance institutional and clinical performance [4].…”