Does accreditation improve quality of care and patient safety in a Low- and Middle-Income Country? An observational study in healthcare organizations of India

In the vast and complex world of healthcare, hospitals are constantly searching for ways to ensure that every patient receives safe, effective, and high-quality treatment. To help them achieve this, many countries have developed systems of accreditation. Think of accreditation as a rigorous, independent inspection where a team of experts visits a hospital to check if its buildings, staff, and daily routines meet a specific set of high standards. It is not just about having shiny equipment; it is about proving that the organization has clear rules for patient safety, that staff are properly trained, and that the hospital can handle emergencies correctly. While these systems are common in wealthy nations, their impact in lower-income countries, where resources are often tighter and challenges are greater, has been less clear. The question remains: does going through this demanding process actually make care better and safer for patients, or is it simply a costly exercise in paperwork?

A team of researchers from the All India Institute of Medical Sciences in New Delhi set out to answer this question by looking directly at hospitals across India. They focused on three different types of accreditation systems used in the country: the National Accreditation Board for Hospitals & Healthcare Providers, which is the main domestic standard; the National Quality Assurance Standards, a government program designed specifically for public health facilities; and the Joint Commission International, a global standard often sought by hospitals that treat international patients. The researchers did not run a clinical trial or change how the hospitals operated. Instead, they conducted a large observational study, sending a detailed questionnaire to the leaders and quality managers of 91 different healthcare organizations. These hospitals ranged from small community clinics to massive tertiary care centers, and they were located in 14 different states and union territories across India. The goal was to gather the real-world experiences of the people running these facilities regarding how accreditation changed their daily work, their costs, and their ability to keep patients safe.

The study revealed that accreditation does indeed leave a positive mark on how hospitals function, though the experience varies depending on who is asked and which system is used. When the researchers analyzed the responses, they found that accreditation helped clarify the roles of staff members, ensuring everyone knew exactly what they were supposed to do. It also strengthened the rights of patients, making sure their voices were heard and their safety was prioritized. In terms of the physical and organizational structure of the hospitals, the process led to better management of engineering systems, such as power and water supplies, and improved the overall knowledge and skills of the employees. The process of seeking accreditation also fostered a culture of safety, where staff became more vigilant about preventing infections and managing risks before they turned into problems.

However, the researchers also found that the benefits were not felt equally by everyone in the hospital hierarchy. The mid-level managers, such as department heads and quality officers who are often on the front lines of implementing these standards, reported seeing a stronger positive impact than the senior executives. These mid-level leaders felt that accreditation did a better job of defining patient rights, creating a safety culture, and standardizing how care was delivered. Despite this difference in perception, both groups of leaders agreed on one significant point: the process costs money. Achieving and maintaining accreditation requires increased spending on infection control measures, training staff, and verifying their credentials. The study noted that hospitals with the international Joint Commission accreditation faced higher costs than those with the domestic standards, likely due to more expensive fees and the need for extensive staff training. Interestingly, the government-run public facilities, which followed the National Quality Assurance Standards, managed to achieve certification with lower overall costs, suggesting that a tailored approach can work well for public health systems with limited budgets.

Beyond the general operations, the study looked at specific indicators of patient safety and care quality to see if the numbers actually improved. The data showed a clear upward trend in several critical areas, indicating that hospitals perceived positive changes in these metrics following accreditation. Hospitals reported better adherence to surgical safety checklists, which are simple lists of steps to follow before an operation to prevent errors. There was also a noticeable improvement in hand hygiene compliance, a simple but vital practice that prevents the spread of disease. The study found that respondents perceived an improvement in the management of needle stick injuries, and the management of medical records improved, with fewer instances of missing or incorrect consent forms. The study also found that hospitals reported positive trends in the rates of infections related to catheters and surgical sites, and they were better at reporting and managing medication errors. These improvements suggest that the rigorous standards of accreditation translate into tangible, life-saving changes in how care is delivered.

Ultimately, the research paints a picture of accreditation as a powerful tool for improving healthcare in a developing nation, provided the costs are managed wisely. The study concludes that while the journey to accreditation is expensive and demanding, it leads to better-organized hospitals, safer environments for patients, and more skilled staff. The process helps hospitals move away from chaotic, informal practices toward a system where safety and quality are built into the daily routine. For India, and potentially other low- and middle-income countries, the findings suggest that homegrown standards like the National Quality Assurance Standards can offer a cost-effective path to these benefits, especially for public facilities. The evidence indicates that when hospitals commit to these standards, they do not just get a certificate on the wall; they build a foundation for safer, more reliable care that patients can trust.