Table 4

Examples of key subthemes regarding the five most common thematic categories explored within the health service accreditation literature

Thematic categories (n)Key subthemes (n)ExamplesRelevant 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 study5125 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 accreditation2222 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 Japan423 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 practices7123 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 practice813 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 operations823 25 38 39 41 57 59 65 66 82 84 89 92 95 97–99
Leadership (n=8)Accreditation results predicted greater organisational leadership66 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 homes843 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 safety1023 6 54 66 86 100–102
Neutral impacts (n=6)Accreditation of a facility was not associated with a lower or higher medication error rate1036 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 Program3021 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 injuries433 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 processes3928 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 mechanisms8928 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 staff2821 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 workload2423 24 41 47 66 86 100 115–117
Improved patient safety (n=9)Hospital administrators viewed accreditation as an effective intervention to reduce adverse events9228 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 jobs3221 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 problems6624 41 47 66