Open Access Research article

Stakeholder perspectives on implementing accreditation programs: a qualitative study of enabling factors

Reece Hinchcliff1*, David Greenfield1, Johanna I Westbrook2, Marjorie Pawsey1, Virginia Mumford1 and Jeffrey Braithwaite1

Author Affiliations

1 Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney 2052, Australia

2 Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney 2052, Australia

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BMC Health Services Research 2013, 13:437  doi:10.1186/1472-6963-13-437

Published: 24 October 2013



Accreditation programs are complex, system-wide quality and safety interventions. Despite their international popularity, evidence of their effectiveness is weak and contradictory. This may be due to variable implementation in different contexts. However, there is limited research that informs implementation strategies. We aimed to advance knowledge in this area by identifying factors that enable effective implementation of accreditation programs across different healthcare settings.


We conducted 39 focus groups and eight interviews between 2011 and 2012, involving 258 diverse healthcare stakeholders from every Australian State and Territory. Interviews were semi-structured and focused on the aims, implementation and consequences of three prominent accreditation programs in the aged, primary and acute care sectors. Data were thematically analysed to distil and categorise facilitators of effective implementation.


Four factors were identified as critical enablers of effective implementation: the accreditation program is collaborative, valid and uses relevant standards; accreditation is favourably received by health professionals; healthcare organisations are capable of embracing accreditation; and accreditation is appropriately aligned with other regulatory initiatives and supported by relevant incentives.


Strategic implementation of accreditation programs should target the four factors emerging from this study, which may increase the likelihood of accreditation being implemented successfully.

Implementation research; Accreditation; Quality improvement; Quality and safety; Health services research; Knowledge translation; Organisational context; Qualitative research; Interviews; Focus groups