Table 2 Challenges of physicians’ participation in accreditation programs in hospitals in eastern Iran based on qualitative method
The main concepts | Sub-concept | Items |
|---|---|---|
Cultural | Motivation | ➢ Lack of connection between accreditation and physician performance |
➢ Lack of incentives | ||
➢ Non-compliance of the evaluation results with the actual performance of the hospital | ||
]➢ Lack of distinction between positive practices in the field of accreditation | ||
➢ Lack of perceived rewards for participating in accreditation for physicians | ||
➢ Lack of perceived hospital ratings based on accreditation score | ||
Patient Demand | ➢ A false impression of the patient’s judgment about services | |
➢ Lack of sense of demand in patients | ||
Mutual trust and evaluation system | ➢ Low focus of management team on physicians | |
➢ Inadequate monitoring systems to monitor physician involvement | ||
➢ Lack of confidence in management | ||
➢ No requirement for physicians to participate in the process of accreditation by managers | ||
➢ Lack of capable managers in the hospital | ||
Organizational | High workload | ➢ The contrast between quality and quantity in public hospitals |
➢ High volume of work in public hospitals | ||
➢ Public or private hospital | ||
➢ Improper referral system | ||
➢ Existence of many patients due to the reputation of the hospital | ||
Understand the role of the quality management unit | ➢ Not understanding the accreditation requirement | |
➢ Lack of knowledge about the nature of accreditation | ||
➢ Lack of understanding of the importance of accreditation by physicians | ||
➢ Inefficiency of the quality improvement office in attracting the participation of physicians | ||
➢ Lack of common language between people involved in the accreditation process | ||
Unreality of accreditation | ➢ Negative effect of the evaluator | |
➢ Non-compliance of accreditation criteria with the actual performance of the hospital | ||
➢ Lack of transparency of accreditation metrics | ||
➢ Lack of accreditation criteria based on different medical specialties | ||
➢ The unity of the evaluator and the evaluated entity | ||
Nature of accreditation | ➢ Separation of hospital accreditation from educational accreditation | |
➢ High volume of documentation in accreditation | ||
➢ Time-consuming accreditation process | ||
➢ Lack of attention to the nature of the species team in accreditation | ||
➢ Early reversal of general accreditation policies | ||
➢ Non-continuous accreditation | ||
➢ Paper Game Knowing accreditation | ||
➢ Mandatory nature of the accreditation process | ||
➢ Stressful nature of accreditation | ||
➢ The nature of the validation test | ||
➢ The non-competitive nature of accreditation | ||
Empowering physicians in the field of quality | ➢ Lack of familiarity of specialized assistants with accreditation | |
➢ Lack of training in the process of quality improvement and accreditation in retraining courses | ||
➢ Lack of training in the process of quality improvement and accreditation during education | ||
➢ Inadequate skills of physicians to participate in accreditation | ||
➢ Ineffectiveness of trainings related to the process of quality improvement and accreditation | ||
Effective communication | ➢ Non-compliance of the hospital information system with the needs of physicians | |
➢ The lack of a communication channel between physicians and the Office of Quality Improvement | ||
➢ The lack of a communication channel between physicians and managers of hospitals | ||
Resource constraints | ➢ Equipment limitations | |
➢ Limited human resources | ||
➢ Limitation of physical resources | ||
➢ Limited financial resources | ||
Behavioral | Ambiguity in the role | ➢ Ambiguity in the role of the physician in the accreditation process |
➢ Doctor of several hospitals | ||
➢ Multi-occupational physician | ||
➢ Doctor’s lack of commitment to the hospital | ||
➢ Lack of proper understanding of job duties | ||
➢ Lack of sense of responsibility for tasks | ||
Uncertainty about how to participate | ➢ Feel violation of the autonomy of doctors | |
➢ Ignoring accreditation | ||
➢ Sense of cost imposition | ||
➢ Get used to past trends | ||
➢ Lack of prioritization of accreditation for the physician | ||
➢ A view based on the separation of accreditation from clinical practice | ||
➢ Lack of feeling the need for accreditation | ||
➢ Uncertainty about the continuation of the accreditation program in its current form | ||
➢ Accreditation is not institutionalized in organizational culture | ||
➢ Existence of a sense of Nepotism in the accreditation process |