Understanding the impact of accreditation on quality in healthcare: A grounded theory approach.

Objective: To explore how organizations respond to and interact with the accreditation process and the actual and potential mechanisms through which accreditation may influence quality.

Design: Qualitative grounded theory study.

Setting: Organizations who had participated in Accreditation Canada's Qmentum program during January 2014-June 2016.

Participants: Individuals who had coordinated the accreditation process or were involved in managing or promoting quality.

Results: The accreditation process is largely viewed as a quality assurance process, which often feeds in to quality improvement activities if the feedback aligns with organizational priorities. Three key stages are required for accreditation to impact quality: coherence, organizational buy-in and organizational action. These stages map to constructs outlined in Normalization Process Theory. Coherence is established when an organization and its staff perceive that accreditation aligns with the organization's beliefs, context and model of service delivery. Organizational buy-in is established when there is both a conceptual champion and an operational champion, and is influenced by both internal and external contextual factors. Quality improvement action occurs when organizations take purposeful action in response to observations, feedback or self-reflection resulting from the accreditation process.

Conclusions: The accreditation process has the potential to influence quality through a series of three mechanisms: coherence, organizational buy-in and collective quality improvement action. Internal and external contextual factors, including individual characteristics, influence an organization's experience of accreditation.