gms | German Medical Science

Background: Quality assurance in hospitals is essential for ensuring patient safety, quality of care and efficiency. Nursing is a key contributor to healthcare quality, yet, a comprehensive overview and comparison on the role and scope of nursing as part of accreditation and certification schemes has been lacking.

Objective: The aim was to identify if and to which extent international accreditation or certification schemes focus on nursing, and to compare their conceptual models and outcome indicators.

Methods: A scoping review was conducted. A search strategy was developed together with a librarian and carried out in January 2024 in PubMed, CINAHL, Web of Science Core Collection, Cochrane Reviews and Google Scholar. Additionally, authoritative websites of accreditation/certification holders were searched. Inclusion criteria were studies on international accreditation or certification schemes for hospital settings with relevance to nursing published in English or German. Screening and data analysis adhered to the Joanna Briggs Institute’s methodology, with reporting following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline (PRISMA-ScR).

Results: The search identified 17.315 records. After removing duplicates and screening of titles/abstracts, 336 full-texts remained. 124 studies were included, identifying seven international accreditation/certification schemes: European Foundation for Quality Management, Evaluation and Quality Improvement Programme, International Organization for Standardization 9001, Joint Commission International, Magnet Recognition Program, Pathway to Excellence Program, Qmentum. The different schemes ranged from highly nursing-specific to no specific focus on nursing and varied in their topics, focus on structure, process and outcome quality and structure and content of requirements. Additionally, the inclusion of outcome indicators varied, with differences in the selection of indicators, compulsoriness of data collection, and use of external benchmarking.

Implication for research and/or (healthcare) practice: First, this review offers an overview of the different schemes, showing large conceptual variations and differences in outcome indicators. Second, hospital managers, policy-makers, patients and the public need to understand the contents and outcomes dimensions of the schemes when making decisions or assessing hospital quality data. Further research is needed regarding the effects of the identified schemes on the quality of care.