Performance in accreditation

Nowadays, the management of health care organization aims at improving the organization's overall performance. Their performance is appreciated during an accreditation process. Accreditation is a world-wide growing process by which health care organizations undergo an evaluation upon their resources, processes and outcomes. Various countries adopt various kinds of accreditation thereby strengthening various dimensions of performance. A comparison of the dimensions of performance taken into consideration in various countries will provide a starting point in our understanding over the performance-oriented policies adopted and the consequences in terms of health care organizations' management. A qualitative analysis of accreditation manuals contents was performed by two reviewers. The following accreditation manuals, falling in the criteria of high frequency of citation in the WHO report on accreditation and availability to the public, were selected: Canada, France, the USA, Australia and the PAHO manual. For each manual, the standards related to performance were classified according to the integrative framework which describes health care organizations' performance with four dimensions and their alignments. Quality, goal-attainment, adaptation to the external environment and values, the four dimensions, are given a different importance in each manual. The Australian accreditation emphasizes all the dimensions and their alignments. PAHO accreditation is mainly centered on quality. Canada, France and the USA range between complete and one-dimensional accreditation. The performance of health care organizations being conceptualized differently, consequences on performance levels and management styles could emerge. Such comparative analysis is a first step to better understand the consequences of policy decisions on health care performance.