Since 2009, hospital quality policy in Flanders, Belgium, is built around a Quality-of-Care Triad, which encompasses accreditation, public reporting and inspection. Policy makers are currently reflecting on the added value of this Triad.
We performed a narrative review of the literature published between 2009 and 2020 to examine the evidence-base of the impact accreditation, public reporting and inspection, both individually and combined, has on patient processes and outcomes. The following patient outcomes were examined: mortality, length-of-stay, readmissions, patient satisfaction, adverse outcomes, failure-to-rescue, adherence to process measures and risk aversion. The impact of accreditation, public reporting and inspection on these outcomes was evaluated as either positive, neutral (i.e. no impact observed or mixed results reported) or negative.
We identified 69 studies, of which 40 on accreditation, 24 on public reporting, three on inspection and two on accreditation and public reporting concomitantly. Identified studies reported primarily low-level evidence (level-IV, n=53) and were heterogenous in terms of implemented programs and patient populations (often narrow in public reporting research). Overall, a neutral categorization was determined in 30 papers for accreditation, 23 for public reporting and 4 for inspection. Ten of these recounted mixed results. For accreditation, a high number (n=12) of positive research on adherence to process measures was discovered.
The individual impact of accreditation, public reporting and inspection, the core of Flemish hospital quality, was found to be limited on patient outcomes. Future studies should investigate the combined effect of multiple quality improvement strategies.