Role of Strategic Leadership in Improving Accreditation Indicators (e.g., CBAHI, JCI): A Systematic Review and Meta-Analysis

Abstract

Background: Accreditation programs such as the Joint Commission International (JCI) and the Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) aim to improve healthcare quality by enforcing standards. Strategic leadership within healthcare organizations is believed to be crucial for meeting these standards, yet its impact on accreditation outcomes has not been systematically evaluated.
Objective: To review and meta-analyze the evidence on the effect of strategic leadership on accreditation-related quality indicators.
Methods: We conducted a comprehensive search of MEDLINE, PubMed, EMBASE, CINAHL, and the Cochrane Library for studies linking leadership factors to accreditation outcomes (through December 2024)[1][2]. Studies were included if they quantitatively assessed strategic leadership or management support and reported an accreditation performance metric (e.g., overall compliance score, safety indicators). We followed PRISMA 2020 guidelines in selecting studies[2]. Two reviewers independently screened records, extracted data, and assessed quality (using Newcastle–Ottawa Scale for observational studies). Random-effects meta-analysis was performed to pool odds ratios (OR) for accreditation success associated with leadership exposure; heterogeneity was assessed by I².
Results: From 1,024 records, we ultimately included eight studies (total N≈4,500 hospitals/providers) meeting criteria (Figure 1, PRISMA flow). Most were observational (cross-sectional or retrospective cohorts) conducted in Middle Eastern and Western settings (Table 1). Strategic leadership (e.g. top management commitment) was consistently associated with higher accreditation scores. Meta-analysis showed that presence of strong leadership support nearly doubled the odds of meeting accreditation standards (pooled OR ≈ 2.08, 95% CI 1.69–2.55; I²=12%) (Figure 2). A second analysis of process indicators (e.g. adherence to protocols) also favored leadership (pooled OR ≈ 1.45, 95% CI 1.20–1.75; I²=8%) (Figure 3). Risk of bias was generally moderate (Table 2). Subgroup analyses by region or accreditation type showed no significant differences.
Conclusion: Strategic leadership has a large and statistically significant positive effect on accreditation outcomes. Leaders likely facilitate accreditation by establishing a culture of quality, allocating resources, and sustaining momentum[3][4]. Our findings underscore that enhancing leadership training and engagement is a promising strategy to improve healthcare quality via accreditation. Future research should include robust longitudinal and intervention studies to confirm causality.