Background: Studies have often examined the challenges presented to the implementation of accreditation. Nonetheless, after developing and implementing four generations of accreditation over 25 years, multiple questions have been left unanswered regarding the number of resolved challenges, the emergence of new challenges and problems, as well as the mitigation of these problems by policymakers and managers for the next generations.
Objectives: Therefore, the present study aims to explain the development progress of the last two generations of the National Hospital Accreditation Program (NHAP) with the previous versions in Iran.
Methods: As a qualitative research, Semi?structured interviews were conducted in 2020. Through purposive sampling, 20 hospital managers at different levels with experience in all four generations participated. Thematic analysis was used to analyze.
Results: The themes included designing the measurement criteria, the supervisor's performance (university and ministry), the hospital's performance, the measurement process, as well as announcing the results and outcomes. Moreover, the status of the development of the national accreditation with previous versions was explained in categories, including improvable points, improved problems, and cases of deterioration.?
Conclusion: The revision process of the NHAP in Iran is indicative of an upward trend, and almost proper modifications have been made. Significant changes have been made since the third generation. Changes in performance-oriented and highlighted patient safety have been very helpful. Changing the assessment of universities affiliated to Ministerial, which is trying to become partly external evaluation. In addition, some positive changes have been achieved in the fourth generation, including a significant reduction in criteria, more professional evaluators, elimination of document uploads, and the definition of outpatient criteria. The improvable points were as follows: defining some measurement criteria, limitations of physicians' criteria, evaluating input instead of output, lack of medical guidelines, failure to pay attention to hospital-type criteria, lack of continuous monitoring of universities, and lack of motivation mechanisms for new criteria.