Challenges of Accreditation in Hospitals and Their Operational Solutions Publisher

Summary: What hinders hospital accreditation? Interviews in Iran identified 22 challenges and 26 proposed solutions, including shortages linked to sanctions and central oversight. #Hospitals #HealthQuality

Afshari M ; Corani Bahador R ; Alirezaei S
Source: International Journal of Health Care Quality Assurance Published:2025

Abstract

Purpose – Monitoring and evaluation are crucial for healthcare quality assurance. This study systematically aims to explore the unique challenges encountered during the implementation of mandatory hospital accreditation in a centralized healthcare context and develops a set of operationally sound solutions. Design/methodology/approach – A qualitative methodology was utilized, with semi-structured interviews conducted with 17 hospital managers, supervisors and accreditation officials in Iranian hospitals in 2024. Participants were selected through purposive sampling with maximum variation, and interviews continued until theoretical saturation. Lincoln and Guba’s criteria were applied to ensure the data’s trustworthiness. The data were analyzed using the content analysis technique with MAXQDA 10 software. Findings – Twenty-two challenges were identified in the themes of leadership and strategic management; human capital development and engagement and contextual coordination and adaptation. In total, 26 practical solutions were also identified for implementing the accreditation program in hospitals. Research limitations/implications – This study provides a comprehensive examination of the experiences of specialists and experts regarding the challenges of hospital accreditation and practical solutions for addressing these challenges. In fact, this research offers multi-dimensional, actionable recommendations for policymakers, accreditation management bodies and service providers, moving beyond mere compliance to leverage accreditation for genuine competitive advantage and public accountability. Practical implications – While this research provides essential data for administrative decision-makers overseeing the accreditation process, we recognize that a purely administrative focus is inherently one-sided. Therefore, to fully realize the social and political value of our findings, this section translates the results into multi-dimensional, actionable recommendations for various key groups: For policymakers/governmental bodies (establish a cross-sectoral review board composed of representatives from patient advocacy groups, insurance providers and regulatory agencies to periodically review and validate accreditation criteria against current societal expectations, ensuring relevance and public accountability), accreditation management bodies and industry/service providers (service providers must move beyond mere compliance by utilizing the findings of this study to proactively map internal processes against the high-implementability factors identified). This involves viewing accreditation not as a hurdle, but as a roadmap for competitive advantage through demonstrable quality assurance that directly influences patient trust and market share. Social implications – This study yields significant implications across several domains, capitalizing on the crucial role of accreditation in enhancing quality, ensuring patient safety and promoting stakeholder satisfaction. Originality/value – Despite the implementation of accreditation requirements in hospitals and continuous monitoring, we still observe shortcomings and deficiencies in some cases, which are addressed in hospital accreditation standards. By identifying the challenges faced by hospitals in this area locally and providing practical solutions, as well as implementing corrective interventions, positive steps can be taken towards the effective implementation of accreditation in hospitals. Previous studies largely focus on challenges within voluntary accreditation models (e.g. JCI and ACS), where commitment is market-driven. This study, conversely, investigates these challenges within the nationally mandated, highly centralized and culturally hierarchical Iranian healthcare context. This shift in mandatory governance creates unique friction points, such as the intense impact of frequent management changes and political influence on resource allocation, which are absent or minimized in voluntary systems. The identification of challenges directly linked to international sanctions (e.g. resource shortages and outdated technology) is a novel contribution that connects quality improvement literature with geopolitical realities. This link is vital for understanding accreditation barriers in sanctioned or developing economies and has not been adequately addressed in the existing global literature. While generalizability across all countries is limited, the findings serve as a crucial benchmark for the wider set of Middle Eastern, highly centralized, and developing economies facing similar governance and resource constraints. The 22 challenges and 26 solutions identified offer a localized framework that is highly applicable to systems operating under similar resource pressures. © 2025 Emerald Publishing Limited