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.
Sack C, Lütkes P, Günther W, Erbel R, Jöckel KH, Holtmann GJ. Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology. BMC Health Serv Res. 2010;10(1):120. doi: 10.1186/1472-6963-10-120. [PubMed: 20459873].
Greenfield D, Braithwaite J. Health sector accreditation research: a systematic review. Int J Qual Health Care. 2008;20(3):172–83. doi: 10.1093/intqhc/mzn005. [PubMed: 18339666].
Bahadori M, Teymourzadeh E, Ravangard R, Alimohammadzadeh K. Responses to the Criticisms about "The Accreditation of Hospitals in Iran. Iran J Public Health. 2016;45(6):840-2.
Aryankhesal A, Sheldon TA, Mannion R, Mahdipour S. The dysfunctional consequences of a performance measurement system: the case of the Iranian national hospital grading programme. J Health Serv Res Policy. 2015;20(3):138-45. doi: 10.1177/1355819615576252. [PubMed: 25784632].
Khoshamooz H, Goudarzvand Chegini M, Rezaee Kelidbari H. Identifying the executive challenges of the new generation of hospital Accreditation in Iran. Manage Strat Health Syst. 2020;5(2):111-25.
Aryankhesal A, Sheldon TA, Mannion R. Impact of the Iranian hospital grading system on hospitals' adherence to
audited standards: An examination of possible
mechanisms. Health policy. 2014;115(2-3):206-14. doi: 10.1016/j.healthpol.2013.11.004. [PubMed: 24300103].
Sadeghi T, Gholamhoseinni N, Khoshab H, Seyed BS, Karami M, Nouhi E, et al. Assessment managers'and hospital staff knowledge and attitude to accreditation. J Nurs Manag. 2016;5(2):9-17. doi: 10.29252/ijnv.5.2.9.
Mosadeghrad A, Shakibaei E. Hospital Accreditation Implementation Prerequisites. JHOSP. 2017;16(3):43-56.
Mosadeghrad AM, Akbari-sari A, Yousefinezhadi T. Evaluation of hospital accreditation standards. RJMS. 2017;23(153):43-54.
Mosadeghrad Am, Akbari Sa, Yousefinezhadi T. Evaluation of hospital accreditation method. Tehran Univ Med J. 2017;75(4):288-98.
Salehi Z, Payravi H. Challenges in the implementation accreditation process in the hospitals: a narrative review. Iran J Nurs. 2017;30(106):23-34. doi: 10.29252/ijn.30.106.23.
Al-Assaf AF, Akgün HS. Healthcare Accreditation in Kazakhstan: Methods and Impact. Health Care Acad J. 2016;3(2):57-63.
WHO. Report on the expert group meeting on hospital accreditation, Cairo, Egypt: World Health Organization; 2002.
Mahmoodian SS, Safaei F, Meraji M, Kimiafar K, Farsinegar N, Ghasemi R. Challenges and strengths of implementing accreditation process from health information management staff perspective. J Paramed Sci. 2016;5(2):25-33. doi: 10.22038/JPSR.2016.6908.
Yousefinezhadi T, Mosadeghrad Am, Arab M, Ramezani M, Akbari Sari A. An Analysis of hospital accreditation policy in Iran. Iran J Public Health. 2017;46(10):1347-58. [PubMed: 29308378].
Karimi S, Gholipour K, Kordi A, Bahmanziari N, Shokri A. Impact of hospitals accreditation on service delivery from the perspective views of experts: a qualitative study. Payavard. 2013;7(4):337-53.
Greenfield D, Hinchcliff R, Banks M, Mumford V, Hogden A, Debono D, et al. Analysing’ big picture’policy reform mechanisms: the Australian health service safety and quality accreditation scheme. Health Expect. 2015;18(6):3110-22. doi: 10.1111/hex.12300. [PubMed: 25367049].
WHO. Expert group meeting on hospital accreditation, Cairo: world health organization, regional office for the eastern Mediterranean; 2004.
Shaban Khamseh AH, Maleki MR, Tabib SJ, Tofoghi SH. Application of schemer stakeholder analysis to desing an accreditation model in iranian hospitas. J Mil Med. 2017;18(4):335-43.
Bukonda N, Tavrow P, Abdallah H, Hoffner K, Tembo J. Implementing a national hospital accreditation program: the Zambian experience. Int J Qual Health Care. 2003;14(1):7-16. doi: 10.1093/intqhc/14.suppl_1.7. [PubMed: 12572783].
Ng KB, Leung GK, Johnston JM, Cowling BJ. Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis. Hong Kong Med J. 2013;19(5):434-46. doi: 10.12809/hkmj134063. [PubMed: 24088588].
Mosadeghrad AM. Essentials of total quality management: a meta-analysis. Int J Health Care Qual Assur. 2014;27(6):544-58. doi: 10.1108/IJHCQA-07-2013-0082. [PubMed: 25115056].
Mosadeghrad AM. Why TQM does not work in Iranian healthcare organisations. Int J Health Care Qual Assur. 2014;27(4):320-35. doi: 10.1108/IJHCQA-11-2012-0110. [PubMed: 25076606].
Bahadori M, Ravangard R, Alimohammadzadeh K. The Accreditation of Hospital in Iran. Iran J Public Health. 2015;44(2):295-6. [PubMed: 25905070].
Kim MJ, Choi JS. Effects of perception of the healthcare accreditation, and job stress on turnover intention in nurses. J Muscle J Health. 2015;22(2):87-95.
Yousefinezhadi T. An analysis of hospital accre-ditation policy in Iran. [PhD Thesis]. School of Public Health, Tehran University of Medical Sciences, Iran; 2016.
Weiner B. A theory of organizational readiness for change. Implement Sci. 2009;4:67. doi: 10.1186/1748-5908-4-67. [PubMed: 19840381].
Scott SD, Albrecht L, O’Leary K, Ball GD, Hartling L, Hofmeyer A, et al. Systematic review of knowledge translation strategies in the allied health professions. Implement Sci. 2012;7:70. doi: 10.1186/1748-5908-7-70. [PubMed: 22831550].
Hinchcliff R, Ivers RQ, Poulos R, Senserrick T. Utilization of research in policymaking for graduated driver
licensing. Am J Public Health. 2010;100(1):2052-8. doi: 10.2105/AJPH.2009.184713. [PubMed: 20864713].
Best A, Greenhalgh T, Lewis S, Saul JE, Carroll S, Bitz J. Large-system transformation in health care: a realist review. Milbank Q. 2012;90(3):421-56. doi: 10.1111/j.1468-0009.2012.00670.x. [PubMed: 22985277].
Popowski T, Huchon C, Fathallah K, Falissard B, Dumont A, Fauconnier A. Impact of accreditation training for residents on sonographic quality in gynecologic emergencies. J Ultrasound Med. 2015;34(5):829-35. doi: 10.7863/ultra.34.5.829. [PubMed: 25911716].
Teymourzadeh E, Ramezani M, Arab M, Foroushani AR, Sari AA. Surveyor management of hospital accreditation program: a thematic analysis conducted in Iran. Iran Red Crescent Med J. 2016;18(5):e30309. doi: 10.5812/ircmj.30309. [PubMed: 27437132].
Aryankhesal A. Strategic faults in implementation of hospital accreditation programs in developing countries: reflections on the Iranian experience. Int J Health Policy Manag. 2016;5(9):515-7. doi: 10.15171/ijhpm.2016.70. [PubMed: 27694677].
Nandraj S, Khot A, Menon S, Brugha R. A stakeholder approach towards hospital accreditation in India. Health Policy Plan. 2001;16(2):70-9. doi: 10.1093/heapol/16.suppl_2.70. [PubMed: 11772992].