Document Type : Original Article


1 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Department of Health Services Management, School of Health Management and Information, Iran University of Medical Sciences, Tehran, Iran

2 Health Management and Economic Research Center, Isfahan University of Medical Sciences, Isfahan

3 Department of Medical and Surgical, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord,

4 Department of Health Services Management, School of Health Management and Information, Iran University of Medical Sciences, Tehran, Iran


INTRODUCTION: In the Iranian Accreditation System, leadership and management standards have
been almost ignored and not paid enough and necessary attention to the structural components
and the infrastructures standards in management and leadership sections. Governing body, medical
staff, chief executive officer (CEO), and nursing management standards are inadequate and lack
accountability. These standards could lead to reform and finally provide the context for accomplishment
of an appropriate accreditation program.
MATERIALS AND METHODS: This is a descriptive, comparative, and qualitative study. It was done
in two phases. The first phase included literature review of the standards of the selected countries
followed by comparison of the standards of the board of trustees, medical staff, CEOs, and nursing
management standards to develop the primary framework for Iranian hospitals. In phase two, the
primary framework was validated true three rounds of Delphi technique.
RESULTS: Surveying the accreditation system standards in selected countries included the USA,
Egypt, Malaysia, and Iran. It was found that the management and leadership standards were classify
as governing body, medical staff, CEOs, and nursing management standards. The result of this study
provides a framework for improvement of the Iranian national accreditation program.
CONCLUSION: In regarded to the importance of the leadership and management standards in
reform and change and promotion of the health services quality, efficiency, and effectiveness, the
results of this study showed that the present standards of the Iranian accreditation assessment
system and guidelines lack the necessary infrastructures for implementing a successful national
accreditation program.


1. Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A,
Schwartzman A. National Hospital Discharge Survey: 2007
Summary: US Department of Health and Human Services, Centers
for Disease Control and Prevention. National Center for Health
Statistics; 2010.
2. Rosen AK, Singer S, Shibei Zhao, Shokeen P, Meterko M, Gaba D,
et al. Hospital safety climate and safety outcomes: Is there a
relationship in the VA? Med Care Res Rev 2010;67:590‑608.
3. 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;369:1134‑42.
4. Smits H, SupachutikulA, Mate KS. Hospital accreditation: Lessons
from low‑ and middle‑income countries. Global Health 2014;10:65.
5. Jiang HJ, Lockee C, Fraser I. Enhancing board oversight on
quality of hospital care: An agency theory perspective. Health
Care Manage Rev 2012;37:144‑53.
6. Shaw C. External assessment of health care. BMJ 2001;322:851‑4.
7. Tamuz M, Harrison MI. Improving patient safety in hospitals:
Contributions of high‑reliability theory and normal accident
theory. Health Serv Res 2006;41:1654‑76.
8. Wasson JH, Godfrey MM, Nelson EC, Mohr JJ, Batalden PB.
Microsystems in health care: Part 4. Planning patient‑centered
care. Jt Comm J Qual Saf 2003;29:227‑37.
9. Sartang AG, Yazdi H, Jabbari A, Niknam N, Naghdi B, Jafari H,
et al. Evaluation of safety management indexes in amin educational
hospital Isfahan in 2013. Glob J Med Res Stud 2014;1:125‑9.
10. ManojlovichM. The effect of nursing leadership on hospital nurses’
professional practice behaviors. J Nurs Adm 2005;35:366‑74.
11. Reeleder D, Goel V, Singer PA, Martin DK. Leadership and
priority setting: The perspective of hospital CEOs. Health Policy
12. Fletcher D, Wagstaff CR. Organizational psychology in elite
sport: Its emergence, application and future. Psychol Sport Exerc
13. Fisher ES, Staiger DO, Bynum JP, Gottlieb DJ. Creating
accountable care organizations: The extended hospital medical
staff. Health Aff (Millwood) 2007;26:w44‑57.
14. Goeschel CA, Wachter RM, Pronovost PJ. Responsibility for
quality improvement and patient safety: Hospital board and
medical staff leadership challenges. Chest 2010;138:171‑8.
15. Alexander JA, Lee S‑YD. The effects of CEO succession and
tenure on failure of rural community hospitals. J Appl Behav Sci
16. De Savigny D, Adam T. Systems Thinking for Health Systems
Strengthening. Geneva, Switzerland: World Health Organization;
17. Anderson DJ, Webster CS. A systems approach to the
reduction of medication error on the hospital ward. J Adv Nurs
18. Cummings G, Hayduk L, Estabrooks C. Mitigating the impact of
hospital restructuring on nurses: The responsibility of emotionally
intelligent leadership. Nurs Res 2005;54:2‑12.
19. Rad AM, Yarmohammadian MH. A study of relationship between
managers’ leadership style and employees’ job satisfaction. Int J
Health Care Qual Assur Inc Leadersh Health Serv 2006;19:xi‑xviii.
20. Horty JF, Mulholland DM. The legal status of the hospital medical
staff. St. Louis Univ Law J 1978;22:485.
21. Association AP. The Principles of Medical Ethics: With
Annotations Especially Applicable To Psychiatry. American
Psychiatric Pub Incorporated; 2001.
22. Donahue KT, vanOstenberg P. Joint commission international
accreditation: Relationship to four models of evaluation. Int J
Qual Health Care 2000;12:243‑6.
23. Linstone HA, Turoff M. The Delphi Method: Techniques and
Applications. Addison‑Wesley Reading, MA; 1975.
24. Joint Commission on Accreditation of Healthcare Organizations,
Joint Commission Accreditation Hospital. Comprehensive
Accreditation Manual for Hospitals: The Official Handbook:
Camh. Joint Commission Resources; 2007.
25. 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
26. Jones J, Wilson A, Parker H, Wynn A, Jagger C, Spiers N, et al.
Economic evaluation of hospital at home versus hospital care:
Cost minimisation analysis of data from randomised controlled
trial. BMJ 1999;319:1547‑50.
27. Yusof MM, Kuljis J, Papazafeiropoulou A, Stergioulas LK. An
evaluation framework for health information systems: Human,
organization and technology‑fit factors (HOT‑fit). Int J Med
Inform 2008;77:386‑98.
28. Abdul Rahman R, Haneem Mohamed Ali F. Board, audit
committee, culture and earnings management: Malaysian
evidence. Managerial Auditing J 2006;21:783‑804