An international comparison of hospital accreditation systems across five countries: applying a holistic relationship model

Providing quality services has become a vital part of the healthcare sector globally. Governments worldwide have committed to achieving this goal and thus have supported the establishment of accreditation systems and more recently quality measurement systems, as an effective means for continuous quality improvement and one way of attaining health system strengthening. Yet there is an on-going debate with regards to the effectiveness of accreditation for continuous quality improvement. Research pertaining to accreditation has also increased, but significant gaps still persist and few researches have been conducted from a systems theory perspective.
Therefore, this study aimed to highlight the similarities and differences and the potential patterns of integrating the accreditation system and quality measurement systems of five prominent hospital accreditation systems
The study was comparative, qualitative and cross-sectional in nature; and used the Holistic Healthcare Systems Relationship Model as a reference model. This model consists of four relationships: P1, P2, P3 and P4; three of which were investigated in this study. These are P1, P2 and P4. They exist among the sub-systems of the accreditation system: accreditation system, quality measurement and reporting system (QMS) and hospital-level delivery system. P1 exists between the accreditation system and hospital-level delivery system, P2 is found between the quality measurement system and the hospital-level delivery system, and P4 exists between the output of the quality measurement system and accreditation system.
According to the reference model, data relevant to the attributes associated with the three relationships were systematically collected for each of the five hospital accreditation systems. These attributes were determined based on an accreditation-related literature review. The resources utilized included: grey literature, accreditation manuals, other published documents, conference proceedings and experts’ e-mail correspondences. All data were organized, analyzed and synthesized based on the principles of systems theory.
Five types of implementation patterns were determined based on the findings of the international comparison of the five hospital accreditation systems. They include: TYPE I, which is a basic, stand-alone accreditation system that can have government, autonomous or mixed ownership and can be linked to insurance payment or not; TYPE II, is the collaboration with only the clinical measurement and reporting system. The clinical indicators are collected either manually or electronically by surveyors. TYPE III is similar to TYPE II; however, it represents the collaboration of the accreditation system with more than the clinical measurement and reporting system. TYPE IV is an accreditation system that integrates the reports of clinical measurement and reporting system with the accreditation system. The clinical measurement and reporting system may be owned by the accreditation agency, an independent agency, the hospital-level delivery system or a combination of all three. TYPE V, is similar to TYPE IV, except that more than just the clinical measurement and reporting system are integrated with the accreditation system.
Therefore, stakeholders wishing to establish a new hospital accreditation system or improve an existing one for continuous quality improvement may consider these findings in future health system and accreditation reforms, respectively, in order to improve the effectiveness of the accreditation results.