Beyond Accreditation Status: Mapping the Hospital Accreditation - Clinical Appropriateness Gap Through a Systematic Review

Abstract

This study synthesises evidence on the relationship between hospital accreditation compliance and the appropriateness of clinical care and maps the accreditation–appropriateness gap. A systematic literature review was conducted using a Scopus search, the authors’ reference corpus, and citation snowballing centred on Hussein et al. (2021) and Bergholt et al. (2021). Study selection followed PRISMA 2020, and the findings were synthesised narratively and thematically. Bergholt et al. (2021) found that recommended care remained below 50% before and after first-time accreditation; the opportunity-based composite score increased by 4.4 percentage points without statistical significance, whereas the all-or-none score improved significantly (RR = 2.32; 95% CI: 2.03–2.67). Hussein et al. (2021) reported mixed effects across 76 studies, with more consistent benefits for safety culture and process measures than for patient outcomes. The evidence base was heterogeneous, and few primary studies jointly measured accreditation compliance and patient-level appropriateness. Nevertheless, the review cautions policymakers and hospital managers against treating accreditation status as a proxy for guideline-adherent care. Its contribution and novelty lie in explicitly conceptualising and mapping the accreditation–appropriateness gap across organisational, process, and patient-level outcomes.