The Influence of Accreditation on Patient Safety Culture

Patient safety culture is a pivotal aspect of healthcare quality, necessitating a collective, interdisciplinary approach rather than relying solely on individual effort.[1] The study by de Oliveira Lima and colleagues[2] offers timely insights from a large Brazilian cohort, highlighting subtle yet meaningful differences between accredited and nonaccredited hospitals.

The study, recently published in the Global Journal on Quality and Safety in Healthcare, found that accredited hospitals scored marginally higher in domains such as communication openness, frequency of event reporting, and overall perception of patient safety than nonaccredited hospitals.[2] Importantly, both groups shared similar strengths and weaknesses across other dimensions, indicating that accreditation alone may not be a panacea for improving all facets of patient safety culture.[2]

This finding is congruent with the study by Oweidat et al,[3] who reported that there are no significant differences between accredited and nonaccredited hospitals regarding nurses’ perceptions of patient safety culture. Such findings challenge the presumption that accreditation status universally translates into enhanced safety culture perceptions.

It is well recognized that patient safety culture is a multifaceted phenomenon influenced by both organizational and individual factors, including values, attitudes, and teamwork across disciplines.[4] Accreditation processes can standardize procedures, but instilling a deeply rooted safety culture demands more than compliance; it requires continuous leadership engagement, empowerment of healthcare workers, and the promotion of a nonpunitive environment.

Several studies support the notion that accreditation positively influences safety culture. Al-Awa et al[5] demonstrated that accreditation significantly improved patient safety culture perceptions at King Abdulaziz University Hospital. Similarly, El-Jardali et al[6] identified higher safety culture and incident reporting in accredited hospitals.

A systematic review concluded that accreditation fosters a positive patient safety culture, but sustained improvements require organizational commitment and continuous evaluation.[7] Survey results indicate that accreditation significantly improves hospital quality and patient safety; it has an essential role in promoting a culture focused on patient safety.[8]

On the other hand, some studies have highlighted that the impact of accreditation varies depending on the context. For instance, research on Jordanian hospitals found no significant link between accreditation and incident reporting practices.[9] This finding emphasizes the importance of broader cultural changes rather than depending on accreditation status.[9,10]

Hwang[11] noted that nurses’ patient safety competence is influenced more by education and empowerment than by accreditation. The Brazilian study also highlights that nonpunitive response to errors remains a weak area across both accredited and nonaccredited hospitals, consistent with global trends reported.[12,13]

It is important to note that variations exist across different healthcare systems. In Saudi Arabia, Al-Surimi et al[12] observed that although certain safety culture dimensions improved post accreditation, issues such as blame culture persisted. In Kuwait, dimensions of patient safety culture significantly influenced accreditation compliance in primary healthcare centers.[13] Thus, there is a growing body of evidence suggesting that accreditation is a supportive but insufficient driver for cultivating a mature patient safety culture. Leadership, continuous learning, psychological safety, and system-wide engagement are equally, if not more, critical.

In conclusion, the Brazilian multicenter study offers valuable confirmation that accreditation is associated with improvements of patient safety culture, but the overall effect may be modest. Healthcare organizations should view accreditation not as an endpoint but as a catalyst for broader, sustained cultural transformation. Future efforts should prioritize building a resilient safety culture that transcends accreditation cycles, emphasizing teamwork, open communication, and a nonpunitive approach to errors.