Examples of key subthemes regarding the five most common thematic categories explored within the health service accreditation literature
| Thematic categories (n) | Key subthemes (n) | Examples | Relevant references |
|---|---|---|---|
| Relationship to quality measures (n=65) | Performance levels (n=34) | Accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures, but these differences were found to have become more significant over the 5 years observed in this study51 | 25 36 37 39 42 44 45 51–77 |
| Effects on patient outcomes (n=9) | Patient outcome was systematically better when the transplantation centre was at a more advanced phase of accreditation22 | 22 44 58 61 74 76 78–80 | |
| Organisational impacts (n=62) | Standardisation of care processes (n=25) | Hospital accreditation was found to have had a significant impact on the infection control infrastructure and performance of hospitals in Japan42 | 3 28 37 42 44 51 54–57 59 61 63 71 73 81–90 |
| Compliance with external programmes or guidelines (n=22) | Accreditation helped encourage staff to conform to evidence-based stroke care delivery practices71 | 23 25 26 30 36 39 42 43 51 56 60 64 71 75 89–96 | |
| Organisational cultures conducive to quality and safety (n=18) | A mental health accreditation process was perceived as having improved communication, increased staff power to negotiate for resources and rewarded good practice81 | 3 6 21 28 30 32 33 38 39 49 75 81 90 94–98 | |
| Continuous quality improvement activities (n=17) | Accreditation was found to confer a greater likelihood that health centres have integrated specific quality improvement activities into their daily operations82 | 3 25 38 39 41 57 59 65 66 82 84 89 92 95 97–99 | |
| Leadership (n=8) | Accreditation results predicted greater organisational leadership6 | 6 38 39 41 49 53 95 98 | |
| Accreditation programme assessments (n=42) | Positive assessments (n=29) | Accreditation is perceived to have had a positive impact on the quality of care and the quality of life for residents in Australian Government subsidised aged care homes84 | 3 21 25 26 30 31 51 54 55 57 59–61 64 66 70 71 73 75 80–82 84 86 88 93 98 100 101 |
| Negative assessments (n=8) | Experienced surveyors failed to detect an error-prone medication usage system that was identified in an independent audit of a mental health institute, raising questions about the validity of accreditation survey scores as a measure of safety102 | 3 6 54 66 86 100–102 | |
| Neutral impacts (n=6) | Accreditation of a facility was not associated with a lower or higher medication error rate103 | 6 29 81 103–105 | |
| Programme development (n=7) | Serious deficiencies of financial and human resources had undermined the ongoing viability of the Zambia Hospital Accreditation Program30 | 21 30 31 106–109 | |
| Change mechanisms (n=41) | Commitment to implementing evidence-based quality systems of care (n=20) | Commitment to meeting national guidelines through the accreditation process appeared to be associated with improved patient outcomes after injuries43 | 3 22 25 28 31 41–43 56 59 60 71 73 81 84 87 90 93 110 111 |
| Engagement of staff in quality improvement (n=15) | Positive changes produced by accreditation were achieved through increased staff motivation and positive attitudes toward the use of continuous improvement processes39 | 28 37–39 41 42 71 81 84 85 89 90 111–113 | |
| Collation and use of data for internal and external benchmarking (n=12) | Accreditation reporting influenced how hospitals prioritised quality improvement goals and honed feedback and accountability mechanisms89 | 28 31 37 38 46 73 85 87 89 93 99 113 | |
| Professionals’ attitudes towards accreditation (n=38) | Improved processes of care (n=20) | Accreditation had a statistically significant improvement on the quality of patient care as perceived by hospital staff28 | 21 23 28 33 39 41 42 46 71 81 84 86 92 97 100 105 106 111 114 115 |
| Overly expensive bureaucratic burden (n=10) | Staff experienced that accreditation increased their paperwork and overall workload24 | 23 24 41 47 66 86 100 115–117 | |
| Improved patient safety (n=9) | Hospital administrators viewed accreditation as an effective intervention to reduce adverse events92 | 28 39 46 47 71 84 92 97 115 | |
| Impact on staff satisfaction (n=8) | Accreditation status was significantly positively associated with nurses’ intent to remain in their jobs32 | 21 27 32 39 41 97 114 115 | |
| Distraction from authentic quality improvement activities (n=4) | Mental health professionals believed that the focus on meeting a large number of accreditation and other regulatory standards can deter indepth efforts to fundamentally improve critical problems66 | 24 41 47 66 |