Objective. This is the first systematic review aims to build the evidence for the impact of accreditation on quality improvement of healthcare services, as well as identify and develop an understanding of the contextual factors influencing accreditation implementation in the hospital setting through the lens of Normalisation Process Theory (NPT). Data sources. Data were gathered from five databases; MEDLINE, PUBMED, EMBASE, CINAHL, and the Cochrane Library. And supplemental sources. Study design. This systematic review is reported following PRISMA guidelines with a quality assessment. Data were analysed using a thematic analysis guided by the NPT theoretical framework. Data collection/extraction methods. Data were extracted and summarized using prespecified inclusion/exclusion criteria and a data extraction sheet encompassing all necessary information about the studies included in the review. Principal findings. There are inconsistent findings about the impact of accreditation on improving healthcare quality and outcomes, and there is scant evidence about its effectiveness. The findings also provide valuable insights into the key factors that may influence hospital accreditation implementation and develop a better understanding of their potential implications. Using the NPT shows a growing emphasis on the enactment work of the accreditation process and how this may drive improving the quality of healthcare services. However, little focus is given to accreditation’s effects on health professionals’ roles and responsibilities, strategies and ways for engaging health professionals for effective implementation, and ensuring that the goals and potential benefits of accreditation are made clear and transparent through ongoing evaluation and feedback to all health professionals involved in the accreditation process. Conclusions. While there are contradictory findings about the impact of accreditation on improving the quality of healthcare services, accreditation continues to gain acceptance internationally as a quality assurance tool to support best practices in evaluating the quality outcomes of healthcare delivered. Policymakers, healthcare organisations, and researchers should proactively consider a set of key factors for the future implementation of accreditation programmes if they are to be effectively implemented and sustained within the hospital setting.
Commentaire du Dr Marius Laurent (PAQS)
- Disons d’emblée que la première phrase de ce résumé doit être absolument lue jusqu’au dernier mot pour comprendre que ce n’est pas la première revue de la littérature sur l’impact de l’accréditation mais bien, sur cet impact et sur… une série d’autres points. Les quelques revues que j’ai pointées sont effectivement assez « anciennes », et n’apportent pas d’arguments définitifs, même si l’enthousiasme vis-à-vis de l’accréditation était sans doute plus vif plus près de son instauration [1-3]. L’accréditation est une démarche complexe, qui implique des acteurs dans l’hôpital et en dehors de celui-ci, qui joue sur les procédures et ceux qui les appliquent ou ceux qui les gèrent, de sorte qu’établir des liens de cause à effet entre l’accréditation dans son ensemble et la performance qualitative globale de l’hôpital et de son évolution est une gageure. Pour reprendre la conclusion ô combien prudente de la revue de Hussein, « Il existe des arguments raisonnables pour étayer l’idée que le respect des normes d’accréditation présente de multiples avantages plausibles ». Compte tenu du coût considérable (en honoraires pour les organismes qui accréditent, mais en temps, en énergie, en matériel, en personnel et en organisation pour les hôpitaux), on espère toujours des arguments plus convaincants pour maintenir ces derniers dans un processus d’accréditation ou de certification (à moins de l’imposer…)
Alhawajreh MJ, Paterson AS, Jackson WJ. Impact of hospital accreditation on quality improvement in healthcare: A systematic review. PLoS One. 2023;18(12):e0294180. Doi : 10.1371/journal.pone.0294180.
Notes :
1- Hussein M, Pavlova M, Ghalwash M, Groot W. The impact of hospital accreditation on the quality of healthcare: A systematic literature review. BMC Health Serv Res. 2021;21(1):1057.
2- Alkhenizan A, Shaw C. Impact of accreditation on the quality of healthcare services: A systematic review of the literature. Annals of Saudi medicine. 2011;31(4):407-416.
3- Greenfield D, Braithwaite J. Health sector accreditation research: A systematic review. Int J Qual Health Care. 2008;20(3):172-183.