Can Accreditation Work in Public Health? Lessons from Other Service Industries

Accreditation programs have developed for a wide variety of health and social service organizations over the past several decades in response to rising pressures for improving the quality and value of services and strengthening the viability and competitive position of organizations that provide these services. Many of the pressures that motivated the development of existing accreditation programs currently face the field of public health. These circumstances suggest that if accreditation programs have been successful in strengthening the delivery systems for other health and social services, they may hold promise for the field of public health. This paper reviews the literature on the experiences and outcomes of existing accreditation programs in health and social service industries in order to derive implications about the potential benefits and costs of accreditation for public health agencies. This review finds that existing accreditation programs have developed to achieve a variety of different goals and objectives, ranging from improving service quality and standardizing service offerings, to improving the competitiveness of the service industry and insulating the field from political influence. The governing structures and accreditation processes created for these programs initially reflected the interests of the program sponsors, but many programs have evolved over time to represent the interests of multiple stakeholders within the field of practice, including service providers, purchasers, consumers, and regulators. Relatively few accreditation programs rely on evidence-based performance standards that are tightly linked to desired service outcomes, but some programs have made recent progress in this direction. The degree of success experienced by accreditation programs in achieving widespread adoption and use of their programs hinges largely on the strength of the incentives faced by organizations within the industry to pursue and maintain accreditation. Limited but encouraging evidence exists to suggest that accreditation programs produce positive effects on service quality, service outcomes, and the operations of service providers. Although the volume and strength of this evidence is modest, the available studies provide a reasonably consistent picture of positive program effects. Moreover, we found no clear evidence suggesting that accreditation programs have had severe unintended and adverse effects on service providers and their communities. However, the sizable costs incurred by organizations that undergo accreditation have the potential to create significant barriers to accreditation for many organizations that perhaps could benefit most from the process— including organizations serving disadvantaged and under-resourced communities. This review of the experience with accreditation suggests several important conclusions and policy …