In 2005, the Central Board for Accreditation of Healthcare Institutions (CBAHI) was launched in Saudi Arabia in order to improve the quality of care. By 2010, the first hospital was accredited by CBAHI, followed by many hospitals in following years. The aim of this study is to examine the impact of CBAHI on quality of care. In this study we used a mixed methods approach involving surveys, documentary analyses and semi‐structure interviews. Surveys data were collected from 669 staff. Documentary analyses included mortality, infection and length of stay. The semi‐structure interview data were gathered from 12 senior managers. Data were collected from three accredited public hospitals. Although some improvements in procedure were recognised, CBAHI does not monitor the continuity of health care delivery and had no effect on quality outcomes in our analysis. This study illustrates a need to sustain improvements over time in the accreditation cycle. Copyright © 2016 John Wiley & Sons, Ltd.