The Effect of Joint Commission International (JCI) Accreditation on Healthcare Quality: A Study of Hospitals in Saudi Arabia

Abstract

Purpose: Investing in hospital accreditation by external accreditation bodies is costly in time and resources. I aimed to identify the effect of accreditation on the health service quality. Methods: To understand what effect the accreditation process had on quality of patient care, firstly I conducted a systematic review on studies that measured accreditation impact by comparing accredited and non-accredited hospitals worldwide. Then, I carried out four studies investigating the impact of the Joint Commission International (JCI) accreditation on healthcare quality by comparing accredited and non-accredited hospitals in Saudi Arabia. In both accredited and non-accredited Saudi hospitals, I studied staff perceptions, patients’ experience, and hospitals’ existing data on infection rates and patient falls; and finally conducted interviews with managers working in accredited hospitals. Results: Regarding the systematic review, I found limited and conflicting evidence on the value of accreditation. Only a small number of articles were of high quality and only one of eight of these articles showed any convincing difference between accredited and nonaccredited hospitals. Similarly, the findings from the four different studies for my research varied, with some supporting and some not supporting accreditation impact on quality of care. The difference in mean scores between accredited and non-accredited hospitals was 0.198 with a 95% CI (0.133, 0.262) in favour of better patient experience in non-accredited hospitals (p < .0001). Accredited hospitals’ staff indicated a higher overall rating of the perceived quality of care than did those working in non-accredited hospitals with a mean difference of 0.22 and 95% CI (0.15, 0.28) at p = .0001. The results of pre- and post-accreditation comparison from two accredited hospitals showed changes in only one hospital before and after engaging in the JCI accreditation. There was a lower rate of falls per 1,000 patient days in non-accredited hospitals, (M) = 0.55 with 95% CI (0.46, 0.64), than in accredited hospitals, M = 1.60 with 95% CI (1.35, 1.85). The findings of the qualitative study of interviews with managers revealed varying and conflicting views, both in favour of and against accreditation programmes. Although some stated that accreditation was a valid tool for improvement, many cast doubts on its benefits and reported that it was a costly exercise and put pressure on employees. Conclusion: This thesis failed to show conclusive evidence on accreditation impact on quality of care. The findings of the systematic review, patients’ experience, clinical quality measures and managers’ views were inconclusive, with only staff perception supporting the accreditation process. As has become clear in reviewing the literature, the impact of accreditation is difficult to study. However, lack of evidence to support it is not the same thing as evidence that accreditation has no value or is harmful.