Hospital accreditation: Driving best outcomes through continuity of midwifery care? A scoping review

Jenny Gamble, Jenny Browne, Debra K. Creedy

Research output: Contribution to journalReview articlepeer-review

7 Citations (Scopus)


Problem: Continuity of midwifery care models are the gold standard of maternity care. Despite being recommended by the Australian Health Ministers’ Advisory Council, few women in Australia have access to such models. Background: Extensive research shows that if all women had access to continuity of midwifery care, maternal and neonatal outcomes would improve. Hospital accreditation, the main national safety and quality system in Australia, aims to encourage and enable the translation of healthcare quality and safety standards into practice. Aim: This paper explored the realities and possibilities of a health care accreditation system driving health service re-organisation towards the provision of continuity of midwifery care for childbearing women. Methods: A scoping review sought literature at the macro (policy) level. From 3036 records identified, the final number of sources included was 100:73 research articles and eight expert opinion pieces/editorials from journals, 15 government/accreditation documents, three government/accreditation websites, and one thesis. Findings: Two narrative themes emerged: (1) Hospital accreditation: ‘Here to stay’ but no clear evidence and calls for change. (2) Measuring and implementing quality and safety in maternity care. Discussion: Regulatory frameworks drive hospitals’ priorities, potentially creating conditions for change. The case for reform in the hospital accreditation system is persuasive and, in maternity services, clear. Mechanisms to actualise the required changes in maternity care are less apparent, but clearly possible. Conclusions: Structural changes to Australia's health accreditation system are needed to prioritise, and mandate, continuity of midwifery care.

Original languageEnglish
Pages (from-to)113-121
Number of pages9
JournalWomen and Birth
Issue number2
Early online date25 Feb 2020
Publication statusPublished - Mar 2021
Externally publishedYes

Bibliographical note

Funding Information:
The case for change in the hospital accreditation system is persuasive, and the need for reform of maternity services clear, yet mechanisms to actualise the required changes in maternity care are less apparent. Despite continuity of midwifery care models being the gold standard of care, and being recommended by the Australian Health Minister’s Advisory Council, it is estimated that still only 10% of women in Australia have access to such models [ 99 :2]. The Australian Commission on Safety and Quality in Health Care (ACSQHC), established in 2006, is funded by the Commonwealth, state and territory governments ‘to lead and coordinate national improvements in safety and quality in health care’ [ 100 ]. A corporate Commonwealth entity, the Commission’s annual program of work is developed in consultation with the Australian, State and Territory health ministers. The Australian Health Service Safety and Quality Accreditation (AHSSQA) Scheme provides for the national coordination of accreditation processes. In describing a recent review of the AHSSQA Scheme, the ACSQHC website states, ‘Feedback from State and Territory regulators and chief executives of health service organisations has identified concerns with some aspects of the Scheme, including its ability to reliably verify an organisation’s safety and quality systems’ [ 100 ]. Further, the site states: ‘The Commission has reviewed the AHSSQA Scheme with a view to updating and improving accreditation processes’. Research is continually underway to improve the accreditation process in Australia, for example, a trial in Queensland on short-notice accreditation recently found less expensive, more engaging and truer validation of QS standards and recommended trials be run in other sites [ 101 ]. A new collaborative report by The Deeble Institute for Health Policy Research, Australian Hospital and Healthcare Association with the Australian Council on Healthcare Standards (ACHS) [ 102 :9] suggests, in line with other literature, that healthcare accreditation effectiveness is largely ‘determined by the effectiveness and appropriateness of the standards, guidelines and protocols it assures against’. Another recent Australian study [ 103 :5] emphasises the importance of evidence based practice at strategic policy level. This is particularly so in Australia’s highly regulated health system where ‘the national policy context with its emphasis on external accreditation of quality and safety standards, provides a strong driver for organisations to engage in EBP’. The authors found a requirement for a balance of top-down and bottom-up leadership to both enforce and enable evidence based care.

Publisher Copyright:
© 2020 Australian College of Midwives


  • Continuity of midwifery care
  • Hospital accreditation
  • Regulation
  • Scoping review

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Maternity and Midwifery


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