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.
Accreditation is usually a voluntary program, sponsored by a non-governmental organization (NGO), in which trained external peer reviewers evaluate a healthcare organization's compliance and compare it with pre-established performance standards.1 Quality standards for hospitals and other medical facilities were first introduced in the United States in the “Minimum Standard for Hospitals” developed by the American College of Surgeons in 1917. After World War II, increased world trade in manufactured goods led to the creation of the International Standards Organization (ISO) in 1947.2 Accreditation formally started in the United States with the formation of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 1951. This model was exported to Canada and Australia in the 1960s and 1970s and reached Europe in the 1980s. Accreditation programs spread all over the world in the 1990s.3 There are other forms of systems used worldwide to regulate, improve and market the services of healthcare providers and organizations, including Certification and Licensure. Certification involves formal recognition of compliance with set standards (e.g., ISO 9000 standards) validated by external evaluation by an authorized auditor. Licensure involves a process by which governmental authority grants permission, usually following inspection against minimal standards, to an individual practitioner or healthcare organization to operate in an occupation or profession.3 Although the terms accreditation and certification are often used interchangeably, accreditation usually applies only to organizations, while certification may apply to individuals, as well as to organizations.2
The aim of this study was to evaluate the impact of accreditation programs on the quality of healthcare services. Another recently published review of the literature related to accreditation had several limitations.4 It was not limited to health services accreditation, but also included heterogeneous types of accreditation programs, including medical education accreditation programs. In our review, we limited our search to health services accreditation. Second, the period covered in the search in the other review was only up to May 2007 and several important publications have been published since May 2007. Third, several important papers relevant to accreditation were missed in the other review.