The Effectiveness of ISO 9001-Based Healthcare Accreditation Surveyors and Standards on Hospital Performance Outcomes: A Balanced Scorecard Perspective

The purpose of this study was to explore the effectiveness of a new ISO 9001-based healthcare standard by examining the impact of the surveyor (auditor) on adoption outcomes through the lens of the balanced scorecard framework. Using survey data from 88 hospitals that adopted the new standard, the authors illustrate how the surveyor’s relationship with staff impacts process outcomes and hospital goal attainment. Supporting the sequential nature of the balanced scorecard perspective, their findings suggest that quality management programs must be grounded with knowledgeable surveyors who serve as a resource to the hospital. These conditions are positively associated with improved operations, enhanced relationships with hospital customers, and overall hospital performance. The surveyor-staff relationship emphasized in this study corroborates recent investigations suggesting there must be goal alignment between accrediting bodies and adopting organizations, and quality improvement impacts organizational goals through a sequential process. The authors also found that the surveyor plays a critical role in educating hospital staff regarding linkages between accreditation standards and hospital goals. Overall, hospital managers reported that adopting the ISO 9001-based standard improved relationships with government, insurance companies, and patients and increased overall performance objectives.