Challenges of implementing the accreditation model in military and university hospitals in Iran: a qualitative study

Abstract

Background The aim of this study was to present challenges of implementing the accreditation model in university and military hospitals in Iran. Methods In this qualitative study, purposive sampling was used to select hospital managers and implementers of the model working in 3 hospitals affiliated to Kerman University of Medical Sciences and in 3 military hospitals in Kerman, Iran. A total of 39 participants were interviewed, and semi-structured questionnaires and thematic analysis were used for data collection and analysis, respectively. Results In this study, 5 major codes and 17 subcodes were identified: (1) perspectives on accreditation model with 5 subcodes: a difficult and time-consuming model, less attention to the patient, accreditation as a way of money acquisition, not being cost-effective, and accreditation means incorrect documentation; (2) absence of appropriate executive policy, with 3 subcodes: lack of financial funds and personnel, disregarding local conditions in implementation and evaluation, and absence of the principle of unity of command; (3) training problems of the accreditation model, with 2 subcodes: absence of proper training and incoordination of training and evaluation; (4) human resources problems, with 3 subcodes: no profit for nonphysician personnel, heavy workload of the personnel, and physicians’ nonparticipation; (5) evaluation problems, with 4 subcodes: no precise and comprehensive evaluation, inconformity of authorities’ perspectives on evaluation, considerable change in evaluation criteria, and excessive reliance on certificates. Conclusions This study provided useful data on the challenges of implementing hospitals’ accreditation, which can be used by health policymakers to revise and modify accreditation procedures in Iran and other countries with similar conditions. The accreditation model is comprehensive and has been implemented to improve the quality of services and patients’ safety. The basic philosophy of hospital accreditation did not fully comply with the underlying conditions of the hospitals. The hospital staff considered accreditation as the ultimate goal rather than a means for achieving quality of service. The Ministry of Health and Medical Education performed accreditation hastily for all Iranian hospitals, while the hospitals were not prepared and equipped to implement the accreditation model.

Stakeholders’ Perception of the Palestinian Health Workforce Accreditation and Regulation System: A Focus on Conceptualization, Influencing Factors and Barriers, and the Way Forward

“…The participants described individual, professional, and political factors such as the political division and absence of the Legislative Council, financial resources and mobilization capacities, multi-stakeholder communication, coordination between the MoH, unions/syndicates and academic institutions, regulatory laws, procedures and administrative orders, governance and health system structure, research, scientific collaboration with academic institutions, knowledge exchange and continuous learning and education. Some of these factors mirror the findings of studies from other countries [25,33,34]. A qualitative study from Pakistan identified many factors affecting the accreditation and regulation process.…”

The association between first-time accreditation and the delivery of recommended care: a before and after study in the Faroe Islands

“…While the accreditation preparation process can be a critical step through which accreditation can have an impact, it can also pose some challenges. Experiences related to the process has been investigated in a number of studies [ 52 – 54 ]. A Danish study, interviewing staff from Danish public hospitals, found that the implementation process, especially in relation to the first accreditation cycle, was chaotic and characterized by uncertainly.…”

“…The heavy workload and new tasks may have been a contributing factor to the lack of consistent improvements across all diagnostic groups. Previous studies have reported that the implementation process is a period with less time and focus on patient care and many preparations may be performed at the expense of other tasks [ 52 – 54 ]. Moreover, the process may include unnecessary documentation and bureaucracy resulting in lower quality of services [ 54 ].…”

“…Previous studies have reported that the implementation process is a period with less time and focus on patient care and many preparations may be performed at the expense of other tasks [ 52 – 54 ]. Moreover, the process may include unnecessary documentation and bureaucracy resulting in lower quality of services [ 54 ]. Although there are no detailed descriptions on how an accreditation model should be implemented to make the task worthwhile, there is some evidence that the process should be meaningful to the people in charge of the implementation [ 52 ].…”

Medical colleges’ challenges and coping strategies in implementing accreditation standards in Pakistan

“…Similar accreditation challenges of increased workload, faculty resistance and too many standards were reported in a study from Iran. 19 Participants of our study mentioned several coping strategies to get through the accreditation process successfully. Most strategies were mere box-ticking exercises to maximize accreditation scores, rather than addressing the gaps in the quality of education in a more transformative and sustainable manner.…”