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Attitudes Towards Accreditation and Quality Improvement Activities Among Hospital Employees in Iran: A Quantitative Study

Authors Kakemam E, Rajabi MR, Raeissi P, Ehlers LH

Received 17 June 2020

Accepted for publication 22 July 2020

Published 13 August 2020 Volume 2020:13 Pages 799—807


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Edris Kakemam,1 Mohammad Reza Rajabi,2 Pouran Raeissi,3 Lars Holger Ehlers4

1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Cardiology, Faculty of Medicine, Shahed University, Tehran, Iran; 3Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran; 4Danish Center for Healthcare Improvements, Institute of Business and Management, Faculty of Social Sciences, Aalborg University, Aalborg, Denmark

Correspondence: Edris Kakemam Department of Health Management and Economics, School of Public Health
Tehran University of Medical Sciences, Tehran, Iran

Purpose: The hospital accreditation system in Iran is relatively young, having been introduced in 2012. Therefore, there is a real need for research on the status and impact of hospital accreditation in Iran. The purpose of this study was to evaluate and compare attitudes towards accreditation and quality improvement activities among hospital employees, specifically the attitudes towards the impact of accreditation on the quality of healthcare and its benefits in Iran.
Materials and Methods: A cross-sectional survey was carried out at 23 teaching hospitals in three metropolises in Iran, all of which successfully passed national accreditation surveys. Some 1213 hospital managers, administrative staff, nurses, and para-clinical staff participated in the survey. The main outcome measures were quality results, and the activities related to quality improvement include senior managers’ commitment and support, strategic quality planning, education and training, rewards and recognition, quality management, use of data, the involvement of professionals in accreditation, and accreditation benefits. The questionnaire was applied using a 5-point Likert scale ranging from 1 “strongly disagree” to 5 “strongly agree”. One-way analysis of variance (ANOVA) was used to compare mean values between respondent groups.
Results: Among nurses and managers, there was low support for accreditation and even less among para-clinical staff who fail to see accreditation having a positive impact on healthcare quality. Also, nurses’ attitudes toward the accreditation benefits were more positive compared with the two other groups. Staff stated that the main reasons for low support were a lack of education and training to act upon the accreditation survey results and a lack of management visibility and support for quality improvement.
Conclusion: Improving quality through means of hospital accreditation is a complex process with high demands for management and employees. Questionnaires on employees’ attitudes and perceptions of the impact of accreditation and quality improvement-related activities in the hospitals can provide valuable information on the current problems of a hospital accreditation program.

Keywords: accreditation, quality improvement, employees, surveys, Iran

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