Stakeholder Perspectives and Experiences of Implementation of Accreditation and the ISO 9001 Programs in Hospitals of Iran: A Qualitative Study
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Abstract
Background: Accreditation and ISO 9001 programs in hospitals are widely adopted for quality control and quality improvement in healthcare.
Objectives: The objective of this study is to identify stakeholders’ perspectives and experiences regarding the implementation of accreditation and ISO 9001 programs in hospitals affiliated with the Social Security Organization in Alborz Province, Iran.
Methods: In this qualitative study, participants were selected based on purposive sampling. For data collection, semi-structured one-to-one interviews were conducted with hospital staff in different positions (n = 30). All interviews were digitally recorded, transcribed verbatim, and analyzed using thematic analysis.
Results:Based on the analysis, 10 primary themes and 88 subthemes were identified. The 10 primary themes were categorized as experiences, strengths, weaknesses, effective factors, and recommendations for the implementation of accreditation and ISO 9001 programs in hospitals. Proper planning, benchmarking, physician involvement, increased resources, and more training are suggested for the successful implementation of accreditation in hospitals. Additionally, fostering a positive culture, focusing on the executive dimension, changing managerial attitudes, training, and supporting and motivating staff are the most important recommendations for the implementation of the ISO 9001 program.
Conclusions: The results provide important insights into the dimensions of implementing accreditation and ISO programs in hospitals, which can be used by health policymakers and managers to improve the implementation of these programs in Iranian hospitals.
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20. 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 Salamat. 2013;7(4):337-53. Persian.
21. Moradi R, Nemati A, Bahman Ziari N, Shokri A, Mohammadi M,Soltantajiyan A. [Effect of Accreditation on the Health Services Delivering in University Hospitals of Isfahan]. J Health Manag. 2016;6(3):67-76. Persian.
22. Alkhenizan A, Shaw C. The attitude of health care professionals towards accreditation: A systematic review of the literature. J Family Community Med. 2012;19(2):74-80. [PubMed ID:22870409]. [PubMed Central ID:PMC3410183]. https://doi.org/10.4103/2230-8229.98281.
23. Ahmadi M, Khoshgam M, Mohammadpoor A. [Comparative study of the Ministry of Health standards for hospitals with Joint Commission International hospital accreditation standards]. Hakim Res J. 2008;10(4):45-52. Persian.
24. Brubakk K, Vist GE, Bukholm G, Barach P, Tjomsland O. A systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health Serv Res. 2015;15:280. [PubMed ID:26202068]. [PubMed Central ID:PMC4511980]. https://doi.org/10.1186/s12913-015-0933-x.
25. Bogh SB, Blom A, Raben DC, Braithwaite J, Thude B, Hollnagel E, etal. Hospital accreditation: staff experiences and perceptions. Int J Health Care Qual Assur. 2018;31(5):420-7. [PubMed ID:29865965]. https://doi.org/10.1108/IJHCQA-06 2017-0115.
26. Ehlers LH, Jensen MB, Simonsen KB, Rasmussen GS, Braithwaite J. Attitudes towards accreditation among hospital employees in Denmark: a cross-sectional survey. Int J Qual Health Care. 2017;29(5):693-8. [PubMed ID:28992155]. https://doi.org/10.1093/intqhc/mzx090.
27. Ng GK, 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. [PubMed ID:24088588]. https://doi.org/10.12809/hkmj134063.
28. Raeissi P, Nasiripour A, Hesam S. [Performance Evaluation of the Total Quality Management Model (ISO 9001: 2000) in Social Security Organizations’ Hospitals in Tehran Province, Iran]. Health Information Management. 2009;6(2):105-12. Persian.
29. Yousefinezhadi T, Mohamadi E, Safari Palangi H, Akbari Sari A. The Effect of ISO 9001 and the EFQM Model on Improving Hospital Performance: A Systematic Review. Iran Red Crescent Med J. 2015;17(12):e23010. [PubMed ID:26756012]. [PubMed Central ID:PMC4706847]. https://doi.org/10.5812/ircmj.23010.
30. Greenfield D, Pawsey M, Braithwaite J. What motivates professionals to engage in the accreditation of healthcare organizations? Int J Qual Health Care. 2011;23(1):8-14. [PubMed ID:21084322]. https://doi.org/10.1093/intqhc/mzq069.
2. Moradi F, Toghroli R, Abbas J, Ziapour A, Lebni JY, Aghili A, et al. Hospital managers’ skills required and onward challenges: A qualitative study. J Educ Health Promot. 2020;9:228. [PubMed ID:33209920]. [PubMed Central ID:PMC7652088]. https://doi.org/10.4103/jehp.jehp_171_20.
3. Mosadeghrad AM. Comments on “Iran Hospital Accreditation System”. Iran J Public Health. 2016;45(6):837-9. [PubMed ID:27648436]. [PubMed Central ID:PMC5026848].
4. Nekoei-Moghadam M, Amiresmaili M, Iranemansh M, Iranmanesh M. Hospital accreditation in Iran: A qualitative case study of Kerman hospitals. Int J Health Plann Manage. 2018;33(2):426-33.[PubMed ID:29315808]. https://doi.org/10.1002/hpm.2480.
5. Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. N Engl J Med. 2013;369(12):1134-42. [PubMed ID:24047062]. [PubMed Central ID:PMC4107655]. https://doi.org/10.1056/NEJMsa1303118.
6. Zolfaghari M. [Total quality management model in social security organizations]. Tehran: Social Security Research Association Publication; 1997.
7. Agrizzi D, Jaafaripooyan E, Akbarihaghighi F. Key Performance Indicators (KPIs) for healthcare accreditation system. 2010. Available from: https://eprints.soton.ac.uk/79297/1/CRAAG-10-01.pdf.
8. Al Tehewy M, Salem B, Habil I, El Okda S. Evaluation of accreditation program in non-governmental organizations’ health units in Egypt: short-term outcomes. Int J Qual Health Care. 2009;21(3):183-9.[PubMed ID:19439444]. https://doi.org/10.1093/intqhc/mzp014.
9. International Organization for Standardization. ISO 9001:2015 Quality management systems - Requirements. 2015. Available from: https://www.iso.org/standard/62085.html.
10. Abuhav I. ISO 9001: 2015 - A Complete Guide to Quality Management Systems. Boca Raton: CRC Press; 2017.
11. Bahadori M, Ravangard R, Alimohammadzadeh K. The accreditation of hospitals in iran. Iran J Public Health. 2015;44(2):295-6. [PubMed ID:25905070]. [PubMed Central ID:PMC4401894].
12. 12.Yousefinezhadi T, Mosadeghrad AM, Arab M, Ramezani M, Sari AA. An Analysis of Hospital Accreditation Policy in Iran. Iran J Public Health. 2017;46(10):1347-58. [PubMed ID:29308378]. [PubMed Central ID:PMC5750346].
13. Mosadeghrad AM, Nabizade Z. [Evaluation of Iranian hospital accreditation system]. Payesh. 2018;17(6):617-29. Persian.
14. Keshtkaran A, Ahmadzadeh F, Panahiyan H. [The Effect of the Implementation of Quality Management System (ISO 9001: 2002) on the Improvement of the Performance of Medical Records Department in Shiraz Namazi Hospital (2003-2005)]. J Kerman Univ Med Sci. 2009;16(2):375-84. Persian.
15. Yousefinezhadi T, Mosadeghrad AM, Hinchcliff R, Akbari-Sari A. Evaluation results of national hospital accreditation program in Iran: The view of hospital managers. J Healthc Qual Res. 2020;35(1):12-8. [PubMed ID:31964614]. https://doi.org/10.1016/j. jhqr.2019.08.008.
16. Babakian P, Agoush L, Sayad Foshtamy S, Rajabi M. Benefits of ISO 9001-2008 Quality Management System on the Change of Quality Indexes Effectiveness in the Case of Three Iranian Regional Hospitals. Biomed Pharmacol J. 2015;8(1):213-8. https://doi. org/10.13005/bpj/601.
17. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-51. [PubMed ID:24979285]. https://doi.org/10.1097/ACM.0000000000000388.
18. Marshall MN. Sampling for qualitative research. Fam Pract. 1996;13(6):522-5. [PubMed ID:9023528]. https://doi.org/10.1093/fampra/13.6.522.
19. Braun V, Clarke V, Weate P. Using thematic analysis in sport and exercise research. In: Smith B, Sparkes AC, editors. Routledge handbook of qualitative research in sport and exercise. London: Routledge; 2016.
20. 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 Salamat. 2013;7(4):337-53. Persian.
21. Moradi R, Nemati A, Bahman Ziari N, Shokri A, Mohammadi M,Soltantajiyan A. [Effect of Accreditation on the Health Services Delivering in University Hospitals of Isfahan]. J Health Manag. 2016;6(3):67-76. Persian.
22. Alkhenizan A, Shaw C. The attitude of health care professionals towards accreditation: A systematic review of the literature. J Family Community Med. 2012;19(2):74-80. [PubMed ID:22870409]. [PubMed Central ID:PMC3410183]. https://doi.org/10.4103/2230-8229.98281.
23. Ahmadi M, Khoshgam M, Mohammadpoor A. [Comparative study of the Ministry of Health standards for hospitals with Joint Commission International hospital accreditation standards]. Hakim Res J. 2008;10(4):45-52. Persian.
24. Brubakk K, Vist GE, Bukholm G, Barach P, Tjomsland O. A systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health Serv Res. 2015;15:280. [PubMed ID:26202068]. [PubMed Central ID:PMC4511980]. https://doi.org/10.1186/s12913-015-0933-x.
25. Bogh SB, Blom A, Raben DC, Braithwaite J, Thude B, Hollnagel E, etal. Hospital accreditation: staff experiences and perceptions. Int J Health Care Qual Assur. 2018;31(5):420-7. [PubMed ID:29865965]. https://doi.org/10.1108/IJHCQA-06 2017-0115.
26. Ehlers LH, Jensen MB, Simonsen KB, Rasmussen GS, Braithwaite J. Attitudes towards accreditation among hospital employees in Denmark: a cross-sectional survey. Int J Qual Health Care. 2017;29(5):693-8. [PubMed ID:28992155]. https://doi.org/10.1093/intqhc/mzx090.
27. Ng GK, 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. [PubMed ID:24088588]. https://doi.org/10.12809/hkmj134063.
28. Raeissi P, Nasiripour A, Hesam S. [Performance Evaluation of the Total Quality Management Model (ISO 9001: 2000) in Social Security Organizations’ Hospitals in Tehran Province, Iran]. Health Information Management. 2009;6(2):105-12. Persian.
29. Yousefinezhadi T, Mohamadi E, Safari Palangi H, Akbari Sari A. The Effect of ISO 9001 and the EFQM Model on Improving Hospital Performance: A Systematic Review. Iran Red Crescent Med J. 2015;17(12):e23010. [PubMed ID:26756012]. [PubMed Central ID:PMC4706847]. https://doi.org/10.5812/ircmj.23010.
30. Greenfield D, Pawsey M, Braithwaite J. What motivates professionals to engage in the accreditation of healthcare organizations? Int J Qual Health Care. 2011;23(1):8-14. [PubMed ID:21084322]. https://doi.org/10.1093/intqhc/mzq069.
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| Issue | Vol 8 No 3 (2024) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/htaa.v8i3.16403 | |
| Keywords | ||
| Accreditation ISO 9001 Hospital Iran | ||
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How to Cite
1.
Abbaspur behbahani S, Arab M, Mirzaei AM, Tajvar M. Stakeholder Perspectives and Experiences of Implementation of Accreditation and the ISO 9001 Programs in Hospitals of Iran: A Qualitative Study. Health Tech Ass Act. 2024;8(3).
