TY - JOUR T1 - Accreditation in health care: does it make any difference to patient outcomes? JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 845 LP - 847 DO - 10.1136/bmjqs-2020-012533 VL - 30 IS - 11 AU - Natalie Bracewell AU - David E Winchester Y1 - 2021/11/01 UR - http://qualitysafety.bmj.com/content/30/11/845.abstract N2 - Over the past few decades, a growing number of organisations have begun offering accreditation and certification services to healthcare facilities. As an example, in the USA, a comprehensive and facility-wide accreditation with a designated organisation is required to contract with Medicare and Medicaid, two large government-sponsored health insurance programmes and often the largest single payers for any given facility. In addition, facilities have the option to pursue voluntary specialty-specific accreditations for nursing excellence, radiology and imaging, trauma, chest pain and more. However, one of the perennial questions about these accolades is, does accreditation mean that patient outcomes are better? Accreditation methods are heterogeneous, typically rely on facility-generated documentation of processes and policies and do not guarantee best practices will be followed on a day-to-day basis. As a result, the published literature shows mixed evidence on its effectiveness.1 What remains unclear at this point is how accreditation achieves improved outcomes. A classic analysis found nearly 300 potential barriers to physicians following clinical practice guidelines.2 Some of these barriers may be reduced by accreditation. For example, lack of awareness and inertia from previous practice may be overcome through agreement to adopt new practices, and external barriers may be removed with facility leadership commitment of resources. Another systematic review showed that the external inspection process alone may mediate change.3 Two papers in this edition of BMJ Quality & Safety further our understanding of how accreditation may improve outcomes. In the first, Sun and colleagues4 conducted a large-scale evaluation of patients in accredited chest pain centres. The authors compared outcomes in hospitals with and without accreditation, and then observed changes in outcomes as centres went through the accreditation process. The specific details of the accreditation process are not provided; however, facilities were expected to adopt best clinical practices for chest … ER -