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Open Access Research article

Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology

Cornelia Sack1, Peter Lütkes2, Wolfram Günther3, Raimund Erbel4, Karl-Heinz Jöckel5 and Gerald J Holtmann67*

Author Affiliations

1 Department of Strategy and Medical Planning, University Hospital Essen, Germany

2 Department of Medical Controlling, University Hospital Essen, Germany

3 Picker Institute Germany, Germany

4 Clinic for Cardiology, University Hospital Essen, Germany

5 Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany

6 University Hospital Essen, Executive Board, Germany

7 University of Adelaide, Faculty of Health Sciences, Australia

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BMC Health Services Research 2010, 10:120  doi:10.1186/1472-6963-10-120

Published: 12 May 2010



Subjective parameters such as quality of life or patient satisfaction gain importance as outcome parameters and benchmarks in health care. In many countries hospitals are now undergoing accreditation as mandatory or voluntary measures. It is believed but unproven that accreditations positively influence quality of care and patient satisfaction. The present study aims to assess in a defined specialty (cardiology) the relationship between patient satisfaction (as measured by the recommendation rate) and accreditation status.


Consecutive patients discharged from 25 cardiology units received a validated patient satisfaction questionnaire. Data from 3,037 patients (response rate > 55%) became available for analysis. Recommendation rate was used as primary endpoint. Different control variables such as staffing level were considered.


The 15 accredited units did not differ significantly from the 10 non-accredited units regarding main hospital (i.e. staffing levels, no. of beds) and patient (age, gender) characteristics. The primary endpoint "recommendation rate of a given hospital" for accredited hospitals (65.6%, 95% Confidence Interval (CI) 63.4 - 67.8%) and hospitals without accreditation (65.8%, 95% CI 63.1 - 68.5%) was not significantly different.


Our results support the notion that - at least in the field of cardiology - successful accreditation is not linked with measurable better quality of care as perceived by the patient and reflected by the recommendation rate of a given institution. Hospital accreditation may represent a step towards quality management, but does not seem to improve overall patient satisfaction.