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Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study
  1. Jeffrey Braithwaite1,
  2. David Greenfield1,
  3. Johanna Westbrook2,
  4. Marjorie Pawsey1,
  5. Mary Westbrook1,
  6. Robert Gibberd3,
  7. Justine Naylor1,4,
  8. Sally Nathan1,
  9. Maureen Robinson1,5,
  10. Bill Runciman1,6,
  11. Margaret Jackson1,7,
  12. Joanne Travaglia1,
  13. Brian Johnston1,7,
  14. Desmond Yen1,7,
  15. Heather McDonald7,
  16. Lena Low1,7,
  17. Sally Redman1,8,
  18. Betty Johnson9,
  19. Angus Corbett1,10,
  20. Darlene Hennessy7,
  21. John Clark7,
  22. Judie Lancaster1,10
  1. 1University of New South Wales, Sydney, Australia
  2. 2The University of Sydney, Sydney, Australia
  3. 3University Newcastle, Newcastle, Australia
  4. 4Liverpool Hospital, Liverpool, Australia
  5. 5Communio Pty Ltd, Sydney, Australia
  6. 6University of South Australia, Adelaide, Australia
  7. 7Australian Council on Healthcare Standards, Sydney, Australia
  8. 8The Sax Institute, Sydney, Australia
  9. 9Consumers' Health Forum of Australia, Canberra, Australia
  10. 10University of Technology, Sydney, Australia
  1. Correspondence to Professor Jeffrey Braithwaite, University of New South Wales, Level 1 AGSM Building, Randwick, Sydney, NSW 2052, Australia; j.braithwaite{at}


Background Despite the widespread use of accreditation in many countries, and prevailing beliefs that accreditation is associated with variables contributing to clinical care and organisational outcomes, little systematic research has been conducted to examine its validity as a predictor of healthcare performance.

Objective To determine whether accreditation performance is associated with self-reported clinical performance and independent ratings of four aspects of organisational performance.

Design Independent blinded assessment of these variables in a random, stratified sample of health service organisations.

Settings Acute care: large, medium and small health-service organisations in Australia.

Study participants Nineteen health service organisations employing 16 448 staff treating 321 289 inpatients and 1 971 087 non-inpatient services annually, representing approximately 5% of the Australian acute care health system.

Main measures Correlations of accreditation performance with organisational culture, organisational climate, consumer involvement, leadership and clinical performance.

Results Accreditation performance was significantly positively correlated with organisational culture (rho=0.618, p=0.005) and leadership (rho=0.616, p=0.005). There was a trend between accreditation and clinical performance (rho=0.450, p=0.080). Accreditation was unrelated to organisational climate (rho=0.378, p=0.110) and consumer involvement (rho=0.215, p=0.377).

Conclusions Accreditation results predict leadership behaviours and cultural characteristics of healthcare organisations but not organisational climate or consumer participation, and a positive trend between accreditation and clinical performance is noted.

  • Accreditation
  • organisational culture
  • organisational climate
  • consumer involvement
  • leadership
  • clinical performance
  • clinical indicators
  • culture
  • organisation

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  • Funding The research was supported under Australian Research Council's Linkage Projects funding scheme (project number LP0560737).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the University of New South Wales' Human Research Ethics Committee (HREC), approval 05081.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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