{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:07:52Z","timestamp":1789477672438,"version":"build-2803163510"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medicine"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healthcare accreditation is widely adopted to improve quality and strengthen institutional credibility. Although research has examined its associations with organisational processes and clinical outcomes, the internal structure of accreditation decisions remains poorly understood. Specifically, the scoring, weighting, and aggregation processes that transform standards compliance into certification results have received limited analytical attention. This scoping review maps the extent to which the published literature addresses accreditation scoring architecture, transparency, and signalling functions in hospital and health service accreditation systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Scoping review was performed in line with PRISMA-ScR. The searches were conducted in PubMed\/MEDLINE, Scopus, Web of Science, and CINAHL using the English-language publications published between January 2000 and March 2026. Sources that were considered eligible were empirical studies, reviews, governance analysis, theoretical papers, and accreditation program documents. The data were obtained through a systematic framework and synthesized in three domains i.e., scoring and weighting mechanisms, transparency and methodological validity as well as market signalling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 2,968 records identified, 27 sources met the eligibility criteria. The majority (85%) defined accreditation as a standards-based compliance intervention focused on organisational outcomes. Ninety-three percent acknowledged methodological limitations in causal inference. Among the included sources, no published evidence was identified that directly examined weighting schemes, score aggregation, threshold logic, or composite score construction. Only six studies addressed transparency beyond binary certification status, and three considered equity implications. Despite 70% of sources describing accreditation as a reputational or legitimacy signal, empirical analysis of the underlying measurement architecture was absent across the entire corpus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Accreditation research has emphasised outcome measurement while neglecting the internal scoring and measurement systems that generate certification decisions. Within the published literature reviewed, the weighting and aggregation mechanisms that shape institutional incentives have received limited analytical attention and remain largely undisclosed in publicly accessible sources. Greater transparency in scoring design and weighting logic is essential, particularly as accreditation becomes more deeply embedded in regulatory, reimbursement, and public reporting frameworks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20503121261484447","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T07:40:22Z","timestamp":1788507622000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Scoring architecture and transparency in healthcare accreditation: A scoping review of measurement design and signalling effects"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1965-9501","authenticated-orcid":false,"given":"Arjavi","family":"Patel","sequence":"first","affiliation":[{"name":"Independent Researcher"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8111-9982","authenticated-orcid":false,"given":"Bhavinkumar","family":"Parmar","sequence":"additional","affiliation":[{"name":"Independent Researcher, Artificial Intelligence and Healthcare Informatics, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sankalp","family":"Sagar","sequence":"additional","affiliation":[{"name":"Research Scholar"},{"name":"Adani University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2012-000852"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzn005"},{"issue":"3","key":"e_1_3_8_4_2","article-title":"Understanding the evolution of health service accreditation research: a literature review from 2012 to 2015","volume":"13","author":"Saut AM","year":"2017","unstructured":"Saut AM, Berssaneti FT. Understanding the evolution of health service accreditation research: a literature review from 2012 to 2015. Rev Adm Hosp Innov Saude [Internet] 2017; 13(3). https:\/\/doi.org\/10.21450\/rahis.v13i3.3210, [cited 2026 Feb 13] Available from. https:\/\/revistas.face.ufmg.br\/index.php\/rahis\/article\/view\/101-121","journal-title":"Rev Adm Hosp Innov Saude [Internet]"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czaa011"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/16.suppl_2.70"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12992-014-0065-9"},{"key":"e_1_3_8_8_2","volume-title":"The Value and Impact of Accreditation in Health Care: A Review of the Literature","author":"Nicklin W","year":"2009","unstructured":"Nicklin W, Dickson S. The Value and Impact of Accreditation in Health Care: A Review of the Literature. Accreditation Canada, 2009. [Internet][cited 2026 Feb 13]. 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Cochrane Database Syst Rev [Internet] 2016; 2016(12): CD008992, [cited 2026 Feb 13]Available from. https:\/\/doi.org\/10.1002\/14651858.CD008992.pub3","journal-title":"Cochrane Database Syst Rev [Internet]"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.36401\/JQSH-21-8"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/20565623.2025.2598252"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzae081"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0325894"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.31344\/ijhhs.v8i1.619"},{"key":"e_1_3_8_22_2","doi-asserted-by":"publisher","DOI":"10.4103\/mgmj.mgmj_66_20"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.4103\/ccd.ccd_489_22"},{"issue":"1","key":"e_1_3_8_24_2","first-page":"1454","article-title":"Factors influencing accreditation seeking behaviour of hospitals in Saudi Arabia: a qualitative study","volume":"22","author":"Al Mansour MA","year":"2022","unstructured":"Al Mansour MA, Al AJR, Al Zahrani MS, et al. Factors influencing accreditation seeking behaviour of hospitals in Saudi Arabia: a qualitative study. BMC Health Serv Res 2022; 22(1): 1454.","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"e_1_3_8_25_2","first-page":"e20240219","article-title":"Factors associated with hospital accreditation in the Brazilian public health system","volume":"78","author":"Lima ACMA","year":"2025","unstructured":"Lima ACMA, Lima RL, Sobral MFF, et al. Factors associated with hospital accreditation in the Brazilian public health system. Rev Bras Enferm 2025; 78(1): e20240219.","journal-title":"Rev Bras Enferm"},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-12-329"},{"key":"e_1_3_8_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-015-0784-5"},{"key":"e_1_3_8_28_2","volume-title":"Organisational Framework for Accreditation of Health Facilities in Gujarat","author":"Government of Gujarat, Health and Family Welfare Department","unstructured":"Government of Gujarat, Health and Family Welfare Department. Organisational Framework for Accreditation of Health Facilities in Gujarat. Gandhinagar; [cited 2026 Feb 17]. Available from. https:\/\/gujhealth.gujarat.gov.in\/images\/pdf\/org_framework_for_accre.pdf"},{"issue":"3","key":"e_1_3_8_29_2","first-page":"131","article-title":"The role of accreditation in ensuring patient safety in hospitals","volume":"8","author":"Naseli B","year":"2019","unstructured":"Naseli B. The role of accreditation in ensuring patient safety in hospitals. Int J Health Policy Manag 2019; 8(3): 131\u2013133.","journal-title":"Int J Health Policy Manag"},{"key":"e_1_3_8_30_2","volume-title":"Hospital Accreditation Program: General Information Brochure","author":"National Accreditation Board for Hospitals and Healthcare Providers (NABH)","year":"2020","unstructured":"National Accreditation Board for Hospitals and Healthcare Providers (NABH). Hospital Accreditation Program: General Information Brochure. : Quality Council of India, 2020. 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