Healthcare accreditation programs have been adopted internationally to maintain quality and safety of services. Accreditation assesses compliance of organisations to a series of standards. The evidence base supporting benefits of accreditation is mixed, potentially influenced by differences in local implementation and operationalisation of standards. Successful implementation is associated with optimising regulation, funding and government commitment. Implementation of accreditation is a complex intervention that needs to be tailored to meet contextual differences across settings. Comparing why and how accreditation is implemented across countries supports effective implementation of new programs and refinements to existing systems.
This article presents four case studies from Australia, Botswana, Denmark and Jordan to consider a geographic spread and mix of high- and upper-middle-income countries. The data were derived from a review of accreditation program documents and follow-up discussions with directors of the accrediting bodies in the countries of interest. Each case study was summarised according to a standardised framework for comparison: 1) goals (why); 2) program implementation (how); 3) outcomes based on pre-post measures (what); and 4) lessons learned (enablers, barriers).
The accreditation programs were all introduced in the 2000s to improve quality and safety. Documents from each country outlined motivations for introducing an accreditation program, which were predominantly initiated by government. The programs were adopted in demarcated healthcare sectors (e.g., primary care and hospital settings) with a mix of mandatory and voluntary approaches. Implementation support centred on interpretation and operationalisation of standards and follow-up on variation in compliance with standards, after announced surveys. Most standards focused on patient safety, patient-centeredness, and governance, but differed between using standard sets on quality management or supportive processes for patient care. Methods for evaluation of program success and outcomes measured varied. Frequently reported enablers of successful implementation included strong leadership and ownership of the process. A lack of awareness of quality and safety, insufficient training in quality improvement methods and transfer of staff represented the most common challenges.
This case analysis of accreditation programs in a variety of countries highlights consistent strategies utilised, key enabling factors, barriers, and the influence of contextual differences. Our framework for describing why, how, what, and lessons learned demonstrates innovation and experimentation in approaches used across high- and upper-middle-income countries, hospital and primary care and specialist clinics.