Published in the Global Journal on Quality and Safety in Healthcare, a study led by D'Or Institute for Research and Education (IDOR) researchers, Dr. Helidea Lima and Dr. Leopoldo Muniz, examined how hospital accreditation influences patient safety culture in Brazilian hospitals. The publication was highlighted in the journal's editorial, reinforcing the importance of this research conducted in Brazil.
What does hospital accreditation mean?
Hospital accreditation works as a seal of quality. Independent organizations evaluate whether hospitals follow strict safety and quality standards. This process is crucial to ensuring best practices in care and building patient trust. In Brazil, however, fewer than 5% of hospitals hold such certification, which can be granted by institutions such as the Joint Commission International (JCI), ACSA (Agencia de Calidad Sanitaria de Andalucía), Qmentum International (Accreditation Canada), and the Organização Nacional de Acreditação (ONA).
Patient safety culture: beyond protocols
Patient safety culture reflects the values, attitudes, and behaviors of healthcare professionals in their approach to safe care. It includes openness to discussing errors, team communication, and learning from mistakes. In strong safety cultures, professionals feel safe reporting incidents without fear of punishment, which drives continuous improvement.
How the study was conducted
The study collected data in September 2022 across 68 hospitals from Rede D'Or. About 32,000 professionals participated by answering the Hospital Survey on Patient Safety Culture (HSOPSC), adapted to Portuguese. The survey compared perceptions between accredited and non-accredited hospitals—at the time, 80% of them were accredited.
The response rate was remarkably high: 91.4% of professionals contributed. This engagement demonstrates the relevance of the topic within Rede D'Or, which now has 90% of its hospitals accredited, more than half with international certification.
Main results
The overall patient safety culture score averaged 65.1%. Strengths included management support (77.5%) and organizational learning (81.8%). However, the non-punitive response to errors was weak, with only 43.2% of positive perceptions.
When comparing accredited and non-accredited hospitals, differences were relatively small: accredited institutions scored 3–4% higher in "openness to communication," "frequency of events reported," and "overall perception of patient safety."
The role of nurses
An important finding was that nursing professionals contributed the most to safety event reporting, showing strong engagement in strengthening patient safety culture. Physicians, however, were more resistant to reporting incidents, underscoring the central role of nurses in building safer and more collaborative hospital environments.
Still, a high percentage of professionals (41.9%) reported no safety events in the previous 12 months, especially in non-accredited hospitals.
Impact of accreditation and persistent challenges
The results indicate that hospital accreditation has a positive impact on safety culture, particularly in fostering open communication and reporting incidents. However, the relatively small differences suggest that accreditation alone is not enough to transform organizational culture.
The greatest weakness identified was the punitive response to errors. Fear of punishment, rigid hierarchies, and lack of feedback still limit organizational learning. Another challenge is underreporting: nearly half of professionals did not report incidents, preventing more consistent progress in error prevention.
According to Rede D'Or, accreditation is an external driver to assess the technical quality of its hospital services. Rigorous monitoring of indicators and transparent disclosure of results are also key strategies. The study confirms this view, emphasizing that investments in training, engaged leadership, and non-punitive reporting systems are as essential as accreditation in achieving long-lasting improvements.
