Risk-Based Accreditation Governance in European Hospitals: A Maturity Framework for Transitioning from Compliance to Organizational Learning

Abstract

Purpose: This paper reframes hospital accreditation in European healthcare from compliance documentation into continuous risk-based governance. Design / Methodology / Approach: A structured narrative synthesis (2010–2026) drawn from PubMed/PMC, Scopus, and OpenAlex informed conceptual framework development following Jaakkola (2020) and Whittemore and Knafl (2005). The paper is explicitly a conceptual contribution and does not constitute a systematic review. Findings: Accreditation effects are stronger on processes, safety culture, and managerial routines than on isolated clinical outcomes. The implementation gap is the disconnection between risk identification, board accountability, incident learning, performance monitoring, and the information infrastructure operationalizing them. Originality / Value: The paper proposes the Risk-Based Accreditation Governance (RBAG) Framework, a four-dimension, three-maturity-level model. Unlike MaPSaF and AHRQ SOPS 2.0, which treat safety culture in isolation, RBAG specifies the architectural integration between accreditation evidence, risk governance routines, and the information layer enabling Level 3 maturity. The framework draws on ISQua 6th Edition (2025), ISO 7101:2023, COSO ERM, IIA Three Lines, and WHO guidance on AI governance (2021b, 2024). Practical Implications: The framework offers a diagnostic for managers, accreditation bodies, and policymakers, clarifying digital infrastructure and AI-enabled surveillance as enablers of governance maturity.