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    Accreditation as a Tool for Quality Improvement and Motivation

    By Kurt Jensen, Accreditation for Cardiovascular Excellence

    A recent study conducted in Denmark suggests that accreditation can promote practitioners' intrinsic motivation to provide quality care. 

    The study, published in the August volume of Social Science & Medicine, asks an important question of accreditation processes: does the external motivation of accreditation interfere with health professionals' intrinsic motivation to provide quality care?

    The question comes from the fields of psychology and behavioral economics, where it has been shown that poorly-designed external incentives might have the opposite of their intended effect by "crowding out" indviduals' intrinsic motivation to perform particular tasks or to perform them to the best of their ability. Incentives might also transactionalize good behavior—making providing quality care an economic consideration rather than an ethical one, for example.

    Are these pitfalls true for accreditation? While accreditation does not act as a direct monetary incentive system, it does provide external recognition which may act as an incentive. When the end goal is promoting the highest quality care, it is worth examining whether or not accreditation may have an opposite-of-intended effect.

    The Danish investigators did just that, finding reaffirming results for supportive accreditation systems. "Intrinsic motivation seems to be stimulated in response to being accredited when [General Practitioners] perceive accreditation as a tool for quality development," write the study authors. "This is an important finding, because studies have linked intrinsic motivation to performance."

    This study also reaffirms our own experience with Accreditation for Cardiovascular Excellence. ACE accreditation standards have all be carefully designed to be a high quality, supportive tool for quality improvement across various practices in cardiovascular healthcare delivery. Those facilities that have been accredited confirm that ACE accreditation also promotes the intrinsic motivation of cardiovascular professionals to provide truly excellent care to patients around the world.