Conceptualizing performance in accreditation.

ABSTRACT

OBJECTIVE: To compare the conceptualization of performance underlying different accreditation manuals. DATA SOURCES Accreditation manuals were selected from the 2003 WHO report titled 'Quality and Accreditation in Healthcare Services'. We used manuals from WHO-listed countries that most influenced the standards Canada, France, the USA and Australia. The fifth manual is published by the Pan American Health Organization (PAHO). EXTRACTION METHODS: Standards from each manual were classified by two independent reviewers. The coding grid, which was based on a Parsonian-based integrative framework on performance, was composed of performance dimensions and their interlinks/alignments. PRINCIPAL FINDINGS: The four dimensions of quality, goal-attainment, adaptation to the external environment and values, along with their alignments, were given differing levels of importance in the five manuals. The Australian manual emphasizes all four dimensions and their alignments. The PAHO accreditation focuses mainly on quality. The manuals from Canada, France and the USA fall somewhere between the two accreditation extremes of complete versus one-dimensional. Finally, we present a taxonomy of the conceptualization of performance in accreditation manuals that distinguishes between quality-oriented and alignment-oriented accreditation manuals. CONCLUSIONS: Specific conceptualizations of performance underlying accreditation manuals may not be neutral. Perhaps, more normative accreditation manuals are associated with authoritative management styles, or more balanced accreditation manuals with comprehensive management styles. Our comparative analysis is a first step toward better understanding the relationship between the conceptualization of performance and the management style adopted in a particular healthcare organization. This relationship could help explain the variation observed in healthcare organization performance.