Sustaining quality accreditation in hospitals: a systematic review with narrative synthesis

Healthcare accreditation evaluates hospitals against established standards to promote continuous quality improvement. However, its long-term effectiveness on healthcare quality and patient satisfaction remains debatable, highlighting the need for enhanced standards and stakeholder support. This study evaluated the impact of healthcare accreditation on quality outcomes across diverse hospital settings. A systematic review of studies published between 2014 and 2024 was conducted across high-income and low- and middle-income countries. Thirteen studies met the inclusion criteria. Findings were synthesised narratively following the Synthesis Without Meta-analysis (SWiM) reporting guidance because included studies reported heterogeneous outcomes on incompatible scales that did not permit a methodologically defensible quantitative pooling. Healthcare accreditation is associated with improvements in patient safety, organizational performance, and quality of care across diverse settings. The magnitude of effect varied substantially across studies and could not be meaningfully pooled in a meta-analysis owing to outcome heterogeneity. The magnitude of impact varied across economic settings, with stronger effects in high-income countries compared to low- and middle-income countries, likely due to differences in resources and implementation capacity. The findings suggest that while accreditation contributes to quality improvement, its sustainability depends on contextual factors including governance, work-force capacity and system-level support.