Impact of Accreditation on the Quality of Healthcare Services: A Systematic Review of the Literature

Alkhenizan, Abdullah; Shaw, Charles

doi:10.4103/0256-4947.83204

Cited by 425Healthcare Quality and ManagementPrimary Care and Health OutcomesPatient Satisfaction in Healthcare

Impact of Accreditation on the Quality of Healthcare Services: A Systematic Review of the Literature

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Alkhenizan, Abdullah, Shaw, Charles·2011·Annals of Saudi Medicine

DOI 10.4103/0256-4947.83204PMC PMC3156520

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Abstract

BACKGROUND AND OBJECTIVE: Accreditation is usually a voluntary program in which trained external peer reviewers evaluate a healthcare organization's compliance and compare it with pre-established performance standards. The aim of this study was to evaluate the impact of accreditation programs on the quality of healthcare services METHODS: We did a systematic review of the literature to evaluate the impact of accreditation programs on the quality of healthcare services. Several databases were systematically searched, including Medline, Embase, Healthstar, and Cinhal. RESULTS: Twenty-six studies evaluating the impact of accreditation were identified. The majority of the studies showed general accreditation for acute myocardial infarction (AMI), trauma, ambulatory surgical care, infection control and pain management; and subspecialty accreditation programs to significantly improve the process of care provided by healthcare services by improving the structure and organization of healthcare facilities. Several studies showed that general accreditation programs significantly improve clinical outcomes and the quality of care of these clinical conditions and showed a significant positive impact of subspecialty accreditation programs in improving clinical outcomes in different subspecialties, including sleep medicine, chest pain management and trauma management. CONCLUSIONS: There is consistent evidence that shows that accreditation programs improve the process of care provided by healthcare services. There is considerable evidence to show that accreditation programs improve clinical outcomes of a wide spectrum of clinical conditions. Accreditation programs should be supported as a tool to improve the quality of healthcare services.

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Accreditation is typically a voluntary program sponsored by a non-governmental agency using external peer reviews to assess whether healthcare organizations adhere to pre-established standards.
“Accreditation is typically a voluntary program sponsored by a non-governmental agency using external peer reviews to assess whether healthcare organizations adhere to pre-established standards [346].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [346]

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BackgroundInfluential
An Innovative Framework for Sustainable Development in Healthcare: The Human Rights Assessment
Moldovan, F., Blaga, P., Moldovan, L., & Bățagă, T. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19042222 · Cited by 44 · see citing works
“Lack of accreditation has been independently associated with suboptimal management of sleep medications [25].”
BackgroundInfluential
Hospital accreditation: staff experiences and perceptions.
Bogh, S. B., Blom, A., Raben, D. C., Braithwaite, J., Thude, B., Hollnagel, E., & von Plessen, C. (2018) · International Journal of Health Care Quality Assurance · doi:10.1108/ijhcqa-06-2017-0115 · Cited by 35
Is the hospital decision to seek accreditation an effective one?
Grepperud, S. (2015) · International Journal of Health Planning and Management · doi:10.1002/hpm.2263 · Cited by 35
Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability
Moldovan, F., Moldovan, L., & Bataga, T. (2023) · Medicina · doi:10.3390/medicina59040796 · Cited by 35 · see citing works
“Labor practice quality in different medical specialties such as orthopedics-traumatology, together with survival rates in trauma [18], surgery and infection control [19], laboratory investigations, and acute myocardial infarction [20] are improved as a result of the hospital accreditation.”
Background
DUQuE quality management measures: associations between quality management at hospital and pathway levels
Wagner, C., Groene, O., Thompson, C., DerSarkissian, M., Klazinga, N., Arah, O., & Suñol, R. (2014) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzu020 · Cited by 33 · see citing works
“The impact of these forms of external assessment has been described in various articles [20–23].”
Background
Medical negligence in healthcare organizations and its impact on patient safety and public health: a bibliometric study
Dahlawi, S. M. A., Menezes, R., Khan, M., Waris, A., Saifullah, & Naseer, M. M. (2021) · F1000Research · doi:10.12688/f1000research.37448.1 · Cited by 32 · see citing works
Evaluating the impact of accreditation on Brazilian healthcare organizations: A quantitative study
Saut, A. M., Berssaneti, F., & Moreno, M. (2017) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzx094 · Cited by 32
The use of on-site visits to assess compliance and implementation of quality management at hospital level
Wagner, C., Groene, O., DerSarkissian, M., Thompson, C., Klazinga, N., Arah, O., & Suñol, R. (2014) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzu026 · Cited by 32
“As a recent review suggests, audits seem to lead to improved structure and process of care and even clinical outcomes [6].”
Background
Hospital accreditation: an umbrella review
Lewis, K., & Hinchcliff, R. (2022) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzad007 · Cited by 30 · see citing works
“Seventeen reviews provided results related to effectiveness, with 10 proposing positive links [12, 19, 24, 26, 33, 36, 37, 39, 49, 50], citing accreditation’s promotion of evidence-based practice [19, 33], guideline development [37, 39], and increased use of clinical indicators [39] and data [33].”
BackgroundInfluential
The need of international Islamic standards for medical tourism providers: a Malaysian experience
Kamassi, A., Manaf, N. H. A., & Omar, A. (2020) · Journal of Islamic marketing · doi:10.1108/jima-03-2019-0051 · Cited by 30 · see citing works
“For example, hospital accreditation is considered as a good tool for improving quality of health care (El-Jardali et al., 2008; Alkhenizan and Shaw, 2011).”
Method
Is compliance with hospital accreditation associated with length of stay and acute readmission? A Danish nationwide population-based study.
Falstie-Jensen, A. M., Nørgaard, M., Hollnagel, E., Larsson, H., & Johnsen, S. (2015) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzv070 · Cited by 30
Developing a hospital accreditation model: a Delphi study
Mosadeghrad, A., & Ghazanfari, F. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06904-4 · Cited by 29 · see citing works
“Moreover, accreditation results in the development of hospital capacity [9] and its equipment [10], optimal use of hospital resources [10], higher quality of care [11, 12], safety [13, 14], effectiveness of hospital care [15, 16], reduction of medical errors [17–19], lower mortality rate [19], higher patient satisfact…”
Background
Benefits of Applying Hospital Accreditation: The Perspective of Staff.
Algunmeeyn, A., Alrawashdeh, M., & Alhabashneh, H. (2020) · Journal of Nursing Management · doi:10.1111/jonm.13066 · Cited by 29
Quality analysis of the clinical laboratory literature and its effectiveness on clinical quality improvement: a systematic review
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“…in Table 3 highlight the significance of accreditation in clinical laboratories, which conforms with the findings of research by Alkhenizan et al. (30) One of the main restrictions to implementing accreditation programs is the skepticism of healthcare profes‐ sionals, particularly physicians,…”
Pioneering quality assessment in European cancer centers: a data analysis of the organization for European cancer institutes accreditation and designation program.
Saghatchian, M., Thonon, F., Boomsma, F., Hummel, H., Koot, B., Harrison, C., Rajan, A., de Valeriola, D., Otter, R., Pontes, J. L., et al. (2014) · Journal of Oncology Practice · doi:10.1200/jop.2013.001331 · Cited by 28
Assessing Patients’ Perception of Health Care Service Quality Offered by COHSASA-Accredited Hospitals in Nigeria
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Hospital accreditation: The good, the bad, and the ugly
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“Some evidences suggest that accreditation is an effective strategy for improving the quality of healthcare services [7], reducing hospitals’ infections and medical errors [8], and improving patient safety [9].”
Compliance with accreditation and recommended hospital care—a Danish nationwide population-based study
Falstie-Jensen, A. M., Bogh, S. B., Hollnagel, E., & Johnsen, S. (2017) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzx104 · Cited by 26
Assessing consumer preferences on halal service: the emergence of Sharia hospitals for Muslim consumer
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Accrediting private providers with National Health Insurance to better serve low-income populations in Kenya and Ghana: a qualitative study
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Effect of accreditation on the quality of chronic disease management: a comparative observational study
van Doorn-Klomberg, A. L., Braspenning, J. C. C., Wolters, R. J., Bouma, M., & Wensing, M. (2014) · BMC Family Practice · doi:10.1186/s12875-014-0179-4 · Cited by 35 · see citing works
“central mechanism, embedded in a continuous quality improvement process that aims to enhance a culture that fosters quality and safety of healthcare [4,28].”
Background
Effects of Hospital Accreditation on Medical Students: A National Qualitative Study in Taiwan
Ho, M., Chang, H.-H., Chiu, Y., & Norris, J. L. (2014) · Academic medicine : journal of the Association of American Medical Colleges · doi:10.1097/acm.0000000000000481 · Cited by 25
Iran hospital accreditation standards: challenges and solutions.
Ghazanfari, F., Mosadeghrad, A., Jaafaripooyan, E., & Mobaraki, H. (2021) · International Journal of Health Planning and Management · doi:10.1002/hpm.3144 · Cited by 23 · see citing works
Evaluation results of national hospital accreditation program in Iran: The view of hospital managers.
Yousefinezhadi, T., Mosadeghrad, A., Hinchcliff, R., & Akbari-Sari, A. (2020) · Journal of Healthcare Quality Research · doi:10.1016/j.jhqr.2019.08.008 · Cited by 23
Attitudes and practices of nurses toward oral care of hospitalized patients – A cross-sectional survey in Riyadh, Saudi Arabia
al-Rababah, D., Nassani, M., Baker, O., Alhelih, E., Almomani, S., & Rastam, S. (2018) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_88_18 · Cited by 23
“Furthermore, hospitals have been encouraged by Saudi Ministry of Health to be enrolled in accreditation programs as a sign of quality health care.[21] Such growing environment in Saudi hospitals may affected nursing staff and created this constructive attitude.”
Background
Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities.
Bernardes, A., Gabriel, C. S., Cummings, G., Zanetti, A. C. B., Leoneti, A., Caldana, G., & Maziero, V. (2020) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2019-0732 · Cited by 22
Factors Affecting Quality of Health Service and Patient Satisfaction in Community Health Centers in North Lampung, Sumatera
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“is important to recognize interpersonal and quality technical qualities in accordance with medical standards in the provision of health services, the balance will be felt by patients so that patients will prove the benefits and feel the existing health system even though in general accreditation program will be able t…”
BackgroundResult
Facebook Reviews as a Supplemental Tool for Hospital Patient Satisfaction and Its Relationship with Hospital Accreditation in Malaysia
Rahim, A. I. A., Ibrahim, M., Musa, K., & Chua, S.-L. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18147454 · Cited by 20 · see citing works
“While a focus on patient outcomes is unquestionably beneficial, it is possible that the accreditation process places a greater emphasis on organizational structure, patient safety, and clinical qualities [1,64,65].”
Background
Nurses’ Perceptions of Joint Commission International Accreditation on Patient Safety in Tertiary Care in South Korea: A Pilot Study
Despotou, G., Her, J., & Arvanitis, T. N. (2020) · Journal of Nursing Regulation · doi:10.1016/s2155-8256(20)30011-9 · Cited by 20
Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape
van Rensburg, R. J., van der Merwe, A. S., & Crowley, T. (2020) · Health SA = SA Gesondheid · doi:10.4102/hsag.v25i0.1392 · Cited by 19
Accreditation is not a stand-alone solution.
Shaw, C. (2015) · Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit · doi:10.26719/2015.21.3.226 · Cited by 19
Self-citation
Accreditation of primary health care centres in the KSA: Lessons from developed and developing countries
Alotaibi, S. Y. (2023) · Journal of Taibah University Medical Sciences · doi:10.1016/j.jtumed.2022.12.012 · Cited by 16 · see citing works
“Accreditation started more than 100 years ago and was first introduced by the American College of Surgeons who set quality standards for surgical training called the “Minimum Standard for Hospitals”.(18,27,28) These standards were developed into a multidisciplinary programme of standardization that led to the formatio…”
Background
The Different Classification of Hospitals Impact on Medical Outcomes of Patients in China
Li, L., Du, T., & Zeng, S. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.855323 · Cited by 21 · see citing works
The perceptions of healthcare professionals about accreditation and its impact on quality of healthcare in Kuwait: a qualitative study.
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Exploring staff perspectives of the barriers to the implementation of accreditation in Jordanian hospitals: Case study
Algunmeeyn, A., El-Dahiyat, F., Alfayoumi, I., & Alrawashdeh, M. (2020) · International Journal of Healthcare Management · doi:10.1080/20479700.2020.1763233 · Cited by 18
“a public recognition by a national healthcare accreditation body of the achievement of accreditation standards by a healthcare organization, demonstrated through an independent external peer assessment of that organization’s level of performance in relation to the standards [1].”
Background
Challenges facing healthcare leadership in attaining accreditation of teaching hospitals.
Kuwaiti, A. A., & Almuhanna, F. (2019) · Leadership in Health Services · doi:10.1108/lhs-01-2018-0002 · Cited by 18
Surveyor Management of Hospital Accreditation Program: A Thematic Analysis Conducted in Iran
Teymourzadeh, E., Ramezani, M., Arab, M., Foroushani, A. R., & Sari, A. A. (2016) · Iranian Red Crescent Medical Journal · doi:10.5812/ircmj.30309 · Cited by 18
“The program was then extended to Canada and Australia in the 1960s and 1970s, to Europe in 1980, and finally to the entire world in 1990 (12-16).”
BackgroundMethod
Acreditação hospitalar como estratégia de melhoria: impactos em seis hospitais acreditados
Mendes, G. H. D. S., & Mirandola, T. B. D. S. (2015) · doi:10.1590/0104-530x1226-14 · Cited by 18
“As visões positivas associam a acreditação como uma estratégia eficaz para a qualidade e melhoria do desempenho organizacional (Davis et al., 2007; Alkhenizan & Shaw, 2011).”
Background
Defining clinical pharmacy and support activities indicators for hospital practice using a combined nominal and focus group technique
Lopes, H., Lopes, A., Farinha, H., & Martins, A. (2021) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-021-01298-z · Cited by 17 · see citing works
“1 3 organizations is the first step of healthcare quality cycle [49], only one study from Brazil referred to the importance of measuring the existence of updated written operational procedures for all clinical pharmacy activities [34].”
Background
Explaining Inequity in the Use of Institutional Delivery Services in Selected Countries
Mai, D., Soelaeman, R. H., & Hotchkiss, D. (2015) · Maternal and Child Health Journal · doi:10.1007/s10995-014-1561-5 · Cited by 17 · see citing works
A Mixed-Methods Study to Explore the Impact of Hospital Accreditation
Al-alawy, K., Moonesar, I. A., Obaid, H. A. M., Gaafar, R., & Bawadi, E. I. A.-A. (2021) · Inquiry : a journal of medical care organization, provision and financing · doi:10.1177/0046958020981463 · Cited by 16 · see citing works
Accreditation as a management tool: a national survey of hospital managers’ perceptions and use of a mandatory accreditation program in Denmark
Ellis, L., Nicolaisen, A., Bogh, S. B., Churruca, K., Braithwaite, J., & von Plessen, C. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05177-7 · Cited by 16
The perception of healthcare employees and the impact of healthcare accreditation on the quality of healthcare in Korea
Park, I., Jung, Y., & Suk, S. (2017) · Journal of Hospital Administration · doi:10.5430/jha.v6n6p20 · Cited by 16 · see citing works
Challenges in the Implementation Accreditation Process in the Hospitals: a Narrative Review
Salehi, Z., & Payravi, H. (2017) · doi:10.29252/ijn.30.106.23 · Cited by 16
Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?
Maina, R. N., Mengo, D. M., Mohamud, A. D., Ochieng, S., Milgo, S. K., Sexton, C., Moyo, S., & Luman, E. (2014) · African Journal of Laboratory Medicine · doi:10.4102/ajlm.v3i2.222 · Cited by 16
Factors influencing the establishment of hospital accreditation programs in low- and middle-income countries: a scoping review
Dharmagunawardene, D., Bowman, P., Avery, M., Greenfield, D., & Hinchcliff, R. (2025) · Health Policy and Planning · doi:10.1093/heapol/czaf011 · Cited by 15 · see citing works
“…reviews highlighted the importance of the supportive and educational role of accreditation (Ammar et al. 2007, Greenfield and Braithwaite 2008, Alkhenizan and Shaw 2011, Lewis and Hinchcliff 2022, Alhawajreh et al. 2023) rather than authoritative inspection processes (Becker 1995, Bateganya…”
Factors that influence the implementation of (inter)nationally endorsed health and social care standards: a systematic review and meta-summary
Kelly, Y., O’Rourke, N., Flynn, R., O’Connor, L., & Hegarty, J. M. (2023) · BMJ Quality & Safety · doi:10.1136/bmjqs-2022-015287 · Cited by 23 · see citing works
“An example of minor edits included: ‘Poor or patchy QS11[Quality Standard 11] implementation was often attributed to weak communication between health-care professionals in different sectors or settings’ 30 (p272) was edited to read: Poor or patchy implementation was often attributed to weak communication between heal…”
Effectiveness of Improvement Plans in Primary Care Practice Accreditation: A Clustered Randomized Trial
Nouwens, E., van Lieshout, J., Bouma, M., Braspenning, J., & Wensing, M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0114045 · Cited by 15 · see citing works
“Although the terms accreditation and certification are often used interchangeably, accreditation usually applies to healthcare organizations, while certification applies to practitioners and organizations [2].”
Background
Saudi regulations for the accreditation of sleep medicine physicians and technologists
Bahammam, A. S., al-Jahdali, H., Alharbi, A. S., Alotaibi, G., Asiri, S., & Al-Sayegh, A. (2013) · Annals of Thoracic Medicine · doi:10.4103/1817-1737.105710 · Cited by 15
“Specialty care has been shown to improve outcomes in several settings.[4] For example, a number of studies in intensive care units have demonstrated that the management of critically ill patients by qualified critical care medicine specialists reduces mortality rates, length of hospital stay, and health care utilizati…”
Impacts of accreditation on the performance of primary health care centres: A systematic review
Tabrizi, J., Ashabi, A., Nazari, M., Tavani, M. E., Haghi, M., & Gharibi, F. (2023) · Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia · doi:10.51866/rv.274 · Cited by 14 · see citing works
“24 Accordingly, the understanding of the nature, acceptance and associated outcomes of accreditation in PHC settings is limited.”
Background
Levers for change: an investigation of how accreditation programmes can promote consumer engagement in healthcare.
Hinchcliff, R., Greenfield, D., Hogden, A., Sarrami-Foroushani, P., Travaglia, J., & Braithwaite, J. (2016) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzw074 · Cited by 14 · see citing works
“Programmes involve HSOs applying performance standards to demonstrate effective organizational and clinical practices [11, 12].”
Background
Effect of accreditation on length of stay in psychiatric inpatients: pre-post accreditation medical record comparison
Al-Sughayir, M. (2016) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0090-6 · Cited by 14 · see citing works
Promoting patients’ rights through hospital accreditation
Sperling, D., & Pikkel, R. B. (2020) · Israel Journal of Health Policy Research · doi:10.1186/s13584-020-00405-1 · Cited by 13
“All about the money?” A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States
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“At the same time, legal requirements for quality improvement strategies and adoption of accreditation programs are known drivers of change [39, 40].”
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Quality of care in accredited and nonaccredited hospitals: perceptions of nurses in the Eastern Province, Saudi Arabia.
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A systematic review of the profile and density of the maternal and child health workforce in China
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The impact of hospital accreditation in selected Middle East countries: a scoping review.
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Healthcare professionals’ perceptions about implementing accreditation as a strategy to improve healthcare quality and organisational performance: a cross-sectional survey study
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Mapping the landscape of sleep medicine training across Asia
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Infection prevention and control staffing and programs in Middle Eastern Countries.
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“the world, and follow the recommendations of Western accreditation agencies [29].”
Background
Testing the Strength of Hospital Accreditation as a Signal of the Quality of Care in Romania: Do Patients’ and Health Professionals’ Perceptions Align?
Druică, E., Wu, B., Cepoi, V., Mihăilă, V., & Burcea, M. (2020) · Healthcare · doi:10.3390/healthcare8030349 · Cited by 12 · see citing works
“Their findings suggest that the increased requirements of accreditation programs in hospitals’ managerial processes may burden employees’ workloads and sacrifice the quality of medical services, indicating that the incompatibility between accreditation standards and patients’ needs might contribute to the negative ass…”
Background
Long-term effectiveness of infection and antibiotic control programs on the transmission of carbapenem-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex in central Taiwan
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“Accreditation programs improve the management provided by healthcare services [18, 19] .”
Background
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Authors: Alkhenizan, A., & Shaw, C.
Affiliations: King Faisal Specialist Hospital & Research Centre (SA)
European Society for Quality in Healthcare, Limerick, Ireland
Corresponding author: Alkhenizan, Abdullah
ORCID: Alkhenizan, Abdullah
Shaw, Charles
Venue: Annals of Saudi Medicine
Publisher: King Faisal Specialist Hospital and Research Centre
Published: 2011-07
Volume: 31
Issue: 4
Pages: 407-416
ISSN: 0256-4947 (ISSN-L)
0975-4466
DOI: 10.4103/0256-4947.83204
PMC: PMC3156520
OpenAlex: W2128099173
Cited by: 425
References: 34
Citations by year: 2026: 31 · 2025: 24 · 2024: 26 · 2023: 32 · 2022: 25 · 2021: 49 · 2020: 44 · 2019: 25 · 2018: 22 · 2017: 24 · 2016: 20 · 2015: 21 · 2014: 73 · 2013: 3 · 2012: 4
FWCI: 3.92
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by-nc-sa
Locations: Annals of Saudi Medicine (publishedVersion, cc-by-nc-sa)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
PubMed Central (publishedVersion, cc-by-nc-sa)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: American College of Surgeons
Topics: Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
Keywords: healthcare accreditation, quality of healthcare services, clinical outcomes, process of care, acute myocardial infarction, trauma care, outpatient surgery, infection control, pain management, sleep medicine, chest pain management
MeSH terms: Accreditation, Delivery of Health Care, Humans, Peer Review, Quality of Health Care, Outcome Assessment, Health Care

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Impact of Accreditation on the Quality of Healthcare Services: A Systematic Review of the Literature

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