The Prerequisites of Executing the Accreditation Program for Primary Healthcare: A Systematic Review and Meta-Synthesis
Abstract
Background: In Iran, the primary healthcare system is the front-line for society's encounter with healthcare. Health planners aim to enhance quality and administer an accreditation program. This study examined program administration prerequisites through systematic review and meta-synthesis.
Methods: We conducted a systematic review and meta-synthesis of qualitative literature using Thomas and Hudson's framework. Peer-reviewed papers were searched in Scopus, PubMed, Web of Science, Google, and Google Scholar up to 2023.
Results: The search found 1308 articles, with 37 relevant ones selected for review. Data extraction included setting, participants, study design, data collection, analysis, and themes. Thirteen qualitative subthemes were identified and were categorized under three elements of the Donabedian model.
Conclusion: Before implementing a plan, it is crucial to consider its executive prerequisites. Revision and trial-and-error approaches can be costly and time-consuming, potentially hindering the plan's effectiveness and diverting organizations from their primary goal, leading to failure.
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2. Glazier, R & North American Primary Care Research Group (2008). Mapping the future of primary healthcare research in Canada. Ann Fam Med, 6(1): 89–90.
3. Desta BF, Azeb A, Ismael BA, et al (2020). Leadership, governance and management for improving district capacity and performance: the case of USAID Transform: Primary Health Care. BMC Fam Pract, 21 (1):252.
4. World Health Organization (2003). Quality and accreditation in health care services: a global review.
5. Shaw C (2004). The external assessment of health services. World Hosp Health Serv, 40 (1):24-7, 50, 51.
6. Bahadori M, Ravangard R, Alimohammadzadeh K (2015). The accreditation of hospitals in Iran. Iran J Public Health, 44 (2) :295-96.
7. World Health Organization (2008). The world health report 2008: primary health care now more than ever. Available from: https://www.who.int/director-general/speeches/detail/primary-health-care---now-more-than-ever
8. World Health Organization (2010). The world health report: health systems financing: the path to universal coverage: executive summary. Available from: https://www.paho.org/en/documents/world-health-report-2010-health-systems-financing-path-universal-coverage
9. EMRO, W (2015). Expert consultation on improving the quality of care at primary health care level through the implementation of quality indicators and standards. Summary report. Available from: https://applications.emro.who.int/docs/IC_Meet_Rep_2015_EN_16418.pdf?ua=1
10. Bondas T, Hall EO (2007). Challenges in approaching metasynthesis research. Qual Health Res, 17 (1):113-21.
11. Thomas J, Harden A (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol, 8:45.
12. Sibthorpe B, Gardner K (2007). A conceptual framework for performance assessment in primary health care. Aust J Prim Health, 13 (2):96-103.
13. Alotaibi, S. Y. (2023). Accreditation of primary health care centres in the KSA: Lessons from developed and developing countries. J Taibah Univ Med Sci, 18(4): 711-25.
14. Tabrizi JS, Gharibi F (2021). Developing national functional accreditation model for primary healthcares with emphasis on family practice in Iran. Korean J Fam Med, 42 (3):232-39.
15. Al Saffer Q, Al-Ghaith T, Alshehri A, et al (2021). The capacity of primary health care facilities in Saudi Arabia: infrastructure, services, drug availability, and human resources. BMC Health Serv Res, 21 (1):365.
16. Tabrizi JS, Gharibi F (2019). Primary healthcare accreditation standards: a systematic review. Int J Health Care Qual Assur, 32(2): 310-20.
17. Van Weel C, Alnasir F, Farahat T, et al (2018). Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries. Eur J Gen Pract, 24 (1):39-44.
18. Ghareeb A, Said H, El Zoghbi M (2018). Examining the impact of accreditation on a primary healthcare organization in Qatar. BMC Med Educ, 18 (1):216.
19. Rider N, Frazier CM, McKasson S, et al (2018). Achieving public health standards and increasing accreditation readiness: findings from the National Public Health Improvement Initiative. J Public Health Manag Pract, 24 (4):392-99.
20. Gharibi F, Tabrizi JS (2018). Development of an accreditation model for health education and promotion programs in the Iranian primary healthcare system: a Delphi study. Health Promot Perspect, 8 (2):155-62.
21. ALRubaey MG, Farhan AR, Kadhem HJ (2018). The impact of accreditation of primary healthcare centers on quality of care as perceived by healthcare providers and directors in Baghdad. Iraqi J Community Med, 31(1): 1-5.
22. Saut AM, Berssaneti FT, Moreno MC (2017). Evaluating the impact of accreditation on Brazilian healthcare organizations: a quantitative study. Int J Qual Health Care, 29 (5):713-21.
23. Alsakkak MA, Alwahabi SA, Alsalhi HM, et al (2017). Outcome of the first Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) primary health care accreditation cycle in Saudi Arabia. Saudi Med J, 38 (11):1132-36.
24. Silva SD, Fonseca A. (2017). Portuguese primary healthcare–sustainability through quality management. Int J Qual Reliab Manag, 34(2), 251-64.
25. Debono D, Greenfield D, Testa L, et al (2017). Understanding stakeholders’ perspectives and experiences of general practice accreditation. Health Policy, 121 (7):816-22.
26. Alyahya M, Hijazi H, Harvey H (2018). Explaining the accreditation process from the institutional isomorphism perspective: a case study of Jordanian primary healthcare centers. Int J Health Plann Manage, 33 (1):102-20.
27. O’Malley AS, Rich EC (2015). Measuring comprehensiveness of primary care: challenges and opportunities. J Gen Intern Med, 30 Suppl 3(Suppl 3):S568-75.
28. Nouwens E, Van Lieshout J, Wensing M (2015). Determinants of impact of a practice accreditation program in primary care: a qualitative study. BMC Fam Pract, 16:78.
29. Saprii L, Richards E, Kokho P, et al (2015). Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles. Hum Resour Health, 13:95.
30. Tabrizi J-S, Farahbakhsh M, Shahgoli J, et al (2015). Designing excellence and quality model for training centers of primary health care: a Delphi Method study. Iran J Public Health, 44 (10):1367-75.
31. Diab SM (2015). The Effect of Primary Health Accreditation Standards on the Primary Health Care Quality and Employees Satisfaction in the Jordanian Health Care Centers. Int J Acad Res Bus Soc Sci, 5 (4):157-63.
32. Pineault R, Da Silva RB, Prud’homme A, et al (2014). Impact of Québec’s healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up. BMC Health Serv Res, 14: 229.
33. Saleh SS, Alameddine MS, Natafgi NM (2014). Beyond accreditation: a multi-track quality-enhancing strategy for primary health care in low-and middle-income countries. Int J Health Serv, 44 (2):355-72.
34. Greenfield D, Civil M, Donnison A, et al (2014). A mechanism for revising accreditation standards: a study of the process, resources required and evaluation outcomes. BMC Health Serv Res, 14 :571.
35. El-Jardali F, Hemadeh R, Jaafar M, et al (2014). The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon. BMC Health Serv Res, 14:86.
36. Almasabi12 MH (2013). An overview of quality and accreditation in the health sector within Saudi Arabia. Int J Health Res Innov, 1 (3): 1-5.
37. Bailie R, Matthews V, Brands J, et al (2013). A systems-based partnership learning model for strengthening primary healthcare. Implement Sci, 8:143.
38. O'Beirne M, Zwicker K, Sterling PD, et al (2013). The status of accreditation in primary care. Qual Prim Care, 21 (1):23-31.
39. Shaw CD, Braithwaite J, Moldovan M, et al (2013). Profiling health-care accreditation organizations: an international survey. Int J Qual Health Care, 25 (3):222-31.
40. Tabrizi JS, Gharibi F, Pirahary S (2013). Developing of national accreditation model for rural health centers in Iran health system. Iran J Public Health, 42 (12):1438-45.
41. Braithwaite J, Shaw CD, Moldovan M, et al (2012). Comparison of health service accreditation programs in low-and middle-income countries with those in higher income countries: a cross-sectional study. Int J Qual Health Care, 24 (6):568-77.
42. Szecsenyi J, Campbell S, Broge B, et al (2011). Effectiveness of a quality-improvement program in improving management of primary care practices. CMAJ, 183 (18):E1326-33.
43. Buetow S, Wellingham J (2003). Accreditation of general practices: challenges and lessons. Qual Saf Health Care, 12 (2):129-35.
44. Scrivens E (1998). Widening the scope of accreditation–issues and challenges in community and primary care. Int J Qual Health Care, 10 (3):191-97.
45. Kousgaard MB, Thorsen T, Due TD (2019). Experiences of accreditation impact in general practice–a qualitative study among general practitioners and their staff. BMC Fam Pract, 20 (1):146.
46. Al-Mhasnah A, Salleh F, Afthanorhan A, et al (2018). The relationship between services quality and customer satisfaction among Jordanian healthcare sector. Manag Sci Lett, 8 (12):1413-20.
47. Due TD, Thorsen T, Kousgaard MB (2019). Understanding accreditation standards in general practice–a qualitative study. BMC Fam Pract, 20 (1):23.
48. McCullough K, Andrew L, Genoni A, et al (2023). An examination of primary health care nursing service evaluation using the Donabedian model: A systematic review. Res Nurs Health, 46(1):159-76.
49. Yassoub R, Hashimi S, Awada S, et al (2014). Responsiveness of Lebanon's primary healthcare centers to non‐communicable diseases and related healthcare needs. Int J Health Plann Manage, 29 (4):407-21.
50. Ettorchi-Tardy A, Levif M, Michel P (2012). Benchmarking: a method for continuous quality improvement in health. Healthc Policy, 7 (4):e101-19.
51. Shortell SM, O'Brien JL, Carman JM, et al (1995). Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. Health Serv Res, 30 (2):377-401.
52. Van Weel C, Kassai R, Qidwai W, et al (2016). Primary healthcare policy implementation in South Asia. BMJ Glob Health, 1 (2):e000057.
53. Jaafaripouyan E, Mosadeghrad A, Salarvand A (2018). Performance of accreditation surveyors in Tehran hospitals: Strengths and weaknesses. Journal of Hospital, 17 (3):31-43 [In Persian]
54. Mosadeghrad A, Shakibaei E (2017). Hospital accreditation implementation prerequisites. Journal of Hospital, 16 (3):43-45 [In Persian]
55. Mosadeghrad AM, Yousefinezhadi T (2019). Evaluation of hospital accreditation implementation in Iran. Payesh (Health Monitor), 18 (1):23-35. [In Persian]
56. Santoso KA, Dewi A (2020). Differences in the Level of Understanding Patient Safety in the Accredited and Not Accredited Primary Healthcare Facilities. Int J Sci Healthc Res, 5 (4):338-42.
57. Straus SE, Tetroe J, Graham I (2009). Defining knowledge translation. CMAJ, 181 (3-4):165-68.
58. Straus S, Tetroe J, Graham ID (2013). Knowledge translation in health care: moving from evidence to practice. 2nd ed. John Wiley & Sons.
59. Hemadeh R, Kdouh O, Hammoud R, et al (2020). The primary healthcare network in Lebanon: a national facility assessment. East Mediterr Health J, 26 (6): 700-707.
60. de Brún T, O’Reilly-de Brún M, van Weel-Baumgarten E, et al (2017). Using Participatory Learning & Action (PLA) research techniques for inter-stakeholder dialogue in primary healthcare: an analysis of stakeholders’ experiences. Res Involv Engagem, 3:28.
61. Norman WV, Dunn S, Guilbert E, et al (2011). Developing a National Family Planning Primary Healthcare Research Program: Opportunities and Priorities Identified through Stakeholder and Expert Consultations. Vancouver : University of British Columbia Library. Available from: https://open.library.ubc.ca/soa/cIRcle/collections/facultyresearchandpublications/52383/items/1.0315346?o=11
62. Al Tehewy M, Salem B, Habil I, et al (2009). Evaluation of accreditation program in non-governmental organizations' health units in Egypt: short-term outcomes. Int J Qual Health Care, 21 (3):183-9.
2. Glazier, R & North American Primary Care Research Group (2008). Mapping the future of primary healthcare research in Canada. Ann Fam Med, 6(1): 89–90.
3. Desta BF, Azeb A, Ismael BA, et al (2020). Leadership, governance and management for improving district capacity and performance: the case of USAID Transform: Primary Health Care. BMC Fam Pract, 21 (1):252.
4. World Health Organization (2003). Quality and accreditation in health care services: a global review.
5. Shaw C (2004). The external assessment of health services. World Hosp Health Serv, 40 (1):24-7, 50, 51.
6. Bahadori M, Ravangard R, Alimohammadzadeh K (2015). The accreditation of hospitals in Iran. Iran J Public Health, 44 (2) :295-96.
7. World Health Organization (2008). The world health report 2008: primary health care now more than ever. Available from: https://www.who.int/director-general/speeches/detail/primary-health-care---now-more-than-ever
8. World Health Organization (2010). The world health report: health systems financing: the path to universal coverage: executive summary. Available from: https://www.paho.org/en/documents/world-health-report-2010-health-systems-financing-path-universal-coverage
9. EMRO, W (2015). Expert consultation on improving the quality of care at primary health care level through the implementation of quality indicators and standards. Summary report. Available from: https://applications.emro.who.int/docs/IC_Meet_Rep_2015_EN_16418.pdf?ua=1
10. Bondas T, Hall EO (2007). Challenges in approaching metasynthesis research. Qual Health Res, 17 (1):113-21.
11. Thomas J, Harden A (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol, 8:45.
12. Sibthorpe B, Gardner K (2007). A conceptual framework for performance assessment in primary health care. Aust J Prim Health, 13 (2):96-103.
13. Alotaibi, S. Y. (2023). Accreditation of primary health care centres in the KSA: Lessons from developed and developing countries. J Taibah Univ Med Sci, 18(4): 711-25.
14. Tabrizi JS, Gharibi F (2021). Developing national functional accreditation model for primary healthcares with emphasis on family practice in Iran. Korean J Fam Med, 42 (3):232-39.
15. Al Saffer Q, Al-Ghaith T, Alshehri A, et al (2021). The capacity of primary health care facilities in Saudi Arabia: infrastructure, services, drug availability, and human resources. BMC Health Serv Res, 21 (1):365.
16. Tabrizi JS, Gharibi F (2019). Primary healthcare accreditation standards: a systematic review. Int J Health Care Qual Assur, 32(2): 310-20.
17. Van Weel C, Alnasir F, Farahat T, et al (2018). Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries. Eur J Gen Pract, 24 (1):39-44.
18. Ghareeb A, Said H, El Zoghbi M (2018). Examining the impact of accreditation on a primary healthcare organization in Qatar. BMC Med Educ, 18 (1):216.
19. Rider N, Frazier CM, McKasson S, et al (2018). Achieving public health standards and increasing accreditation readiness: findings from the National Public Health Improvement Initiative. J Public Health Manag Pract, 24 (4):392-99.
20. Gharibi F, Tabrizi JS (2018). Development of an accreditation model for health education and promotion programs in the Iranian primary healthcare system: a Delphi study. Health Promot Perspect, 8 (2):155-62.
21. ALRubaey MG, Farhan AR, Kadhem HJ (2018). The impact of accreditation of primary healthcare centers on quality of care as perceived by healthcare providers and directors in Baghdad. Iraqi J Community Med, 31(1): 1-5.
22. Saut AM, Berssaneti FT, Moreno MC (2017). Evaluating the impact of accreditation on Brazilian healthcare organizations: a quantitative study. Int J Qual Health Care, 29 (5):713-21.
23. Alsakkak MA, Alwahabi SA, Alsalhi HM, et al (2017). Outcome of the first Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) primary health care accreditation cycle in Saudi Arabia. Saudi Med J, 38 (11):1132-36.
24. Silva SD, Fonseca A. (2017). Portuguese primary healthcare–sustainability through quality management. Int J Qual Reliab Manag, 34(2), 251-64.
25. Debono D, Greenfield D, Testa L, et al (2017). Understanding stakeholders’ perspectives and experiences of general practice accreditation. Health Policy, 121 (7):816-22.
26. Alyahya M, Hijazi H, Harvey H (2018). Explaining the accreditation process from the institutional isomorphism perspective: a case study of Jordanian primary healthcare centers. Int J Health Plann Manage, 33 (1):102-20.
27. O’Malley AS, Rich EC (2015). Measuring comprehensiveness of primary care: challenges and opportunities. J Gen Intern Med, 30 Suppl 3(Suppl 3):S568-75.
28. Nouwens E, Van Lieshout J, Wensing M (2015). Determinants of impact of a practice accreditation program in primary care: a qualitative study. BMC Fam Pract, 16:78.
29. Saprii L, Richards E, Kokho P, et al (2015). Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles. Hum Resour Health, 13:95.
30. Tabrizi J-S, Farahbakhsh M, Shahgoli J, et al (2015). Designing excellence and quality model for training centers of primary health care: a Delphi Method study. Iran J Public Health, 44 (10):1367-75.
31. Diab SM (2015). The Effect of Primary Health Accreditation Standards on the Primary Health Care Quality and Employees Satisfaction in the Jordanian Health Care Centers. Int J Acad Res Bus Soc Sci, 5 (4):157-63.
32. Pineault R, Da Silva RB, Prud’homme A, et al (2014). Impact of Québec’s healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up. BMC Health Serv Res, 14: 229.
33. Saleh SS, Alameddine MS, Natafgi NM (2014). Beyond accreditation: a multi-track quality-enhancing strategy for primary health care in low-and middle-income countries. Int J Health Serv, 44 (2):355-72.
34. Greenfield D, Civil M, Donnison A, et al (2014). A mechanism for revising accreditation standards: a study of the process, resources required and evaluation outcomes. BMC Health Serv Res, 14 :571.
35. El-Jardali F, Hemadeh R, Jaafar M, et al (2014). The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon. BMC Health Serv Res, 14:86.
36. Almasabi12 MH (2013). An overview of quality and accreditation in the health sector within Saudi Arabia. Int J Health Res Innov, 1 (3): 1-5.
37. Bailie R, Matthews V, Brands J, et al (2013). A systems-based partnership learning model for strengthening primary healthcare. Implement Sci, 8:143.
38. O'Beirne M, Zwicker K, Sterling PD, et al (2013). The status of accreditation in primary care. Qual Prim Care, 21 (1):23-31.
39. Shaw CD, Braithwaite J, Moldovan M, et al (2013). Profiling health-care accreditation organizations: an international survey. Int J Qual Health Care, 25 (3):222-31.
40. Tabrizi JS, Gharibi F, Pirahary S (2013). Developing of national accreditation model for rural health centers in Iran health system. Iran J Public Health, 42 (12):1438-45.
41. Braithwaite J, Shaw CD, Moldovan M, et al (2012). Comparison of health service accreditation programs in low-and middle-income countries with those in higher income countries: a cross-sectional study. Int J Qual Health Care, 24 (6):568-77.
42. Szecsenyi J, Campbell S, Broge B, et al (2011). Effectiveness of a quality-improvement program in improving management of primary care practices. CMAJ, 183 (18):E1326-33.
43. Buetow S, Wellingham J (2003). Accreditation of general practices: challenges and lessons. Qual Saf Health Care, 12 (2):129-35.
44. Scrivens E (1998). Widening the scope of accreditation–issues and challenges in community and primary care. Int J Qual Health Care, 10 (3):191-97.
45. Kousgaard MB, Thorsen T, Due TD (2019). Experiences of accreditation impact in general practice–a qualitative study among general practitioners and their staff. BMC Fam Pract, 20 (1):146.
46. Al-Mhasnah A, Salleh F, Afthanorhan A, et al (2018). The relationship between services quality and customer satisfaction among Jordanian healthcare sector. Manag Sci Lett, 8 (12):1413-20.
47. Due TD, Thorsen T, Kousgaard MB (2019). Understanding accreditation standards in general practice–a qualitative study. BMC Fam Pract, 20 (1):23.
48. McCullough K, Andrew L, Genoni A, et al (2023). An examination of primary health care nursing service evaluation using the Donabedian model: A systematic review. Res Nurs Health, 46(1):159-76.
49. Yassoub R, Hashimi S, Awada S, et al (2014). Responsiveness of Lebanon's primary healthcare centers to non‐communicable diseases and related healthcare needs. Int J Health Plann Manage, 29 (4):407-21.
50. Ettorchi-Tardy A, Levif M, Michel P (2012). Benchmarking: a method for continuous quality improvement in health. Healthc Policy, 7 (4):e101-19.
51. Shortell SM, O'Brien JL, Carman JM, et al (1995). Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. Health Serv Res, 30 (2):377-401.
52. Van Weel C, Kassai R, Qidwai W, et al (2016). Primary healthcare policy implementation in South Asia. BMJ Glob Health, 1 (2):e000057.
53. Jaafaripouyan E, Mosadeghrad A, Salarvand A (2018). Performance of accreditation surveyors in Tehran hospitals: Strengths and weaknesses. Journal of Hospital, 17 (3):31-43 [In Persian]
54. Mosadeghrad A, Shakibaei E (2017). Hospital accreditation implementation prerequisites. Journal of Hospital, 16 (3):43-45 [In Persian]
55. Mosadeghrad AM, Yousefinezhadi T (2019). Evaluation of hospital accreditation implementation in Iran. Payesh (Health Monitor), 18 (1):23-35. [In Persian]
56. Santoso KA, Dewi A (2020). Differences in the Level of Understanding Patient Safety in the Accredited and Not Accredited Primary Healthcare Facilities. Int J Sci Healthc Res, 5 (4):338-42.
57. Straus SE, Tetroe J, Graham I (2009). Defining knowledge translation. CMAJ, 181 (3-4):165-68.
58. Straus S, Tetroe J, Graham ID (2013). Knowledge translation in health care: moving from evidence to practice. 2nd ed. John Wiley & Sons.
59. Hemadeh R, Kdouh O, Hammoud R, et al (2020). The primary healthcare network in Lebanon: a national facility assessment. East Mediterr Health J, 26 (6): 700-707.
60. de Brún T, O’Reilly-de Brún M, van Weel-Baumgarten E, et al (2017). Using Participatory Learning & Action (PLA) research techniques for inter-stakeholder dialogue in primary healthcare: an analysis of stakeholders’ experiences. Res Involv Engagem, 3:28.
61. Norman WV, Dunn S, Guilbert E, et al (2011). Developing a National Family Planning Primary Healthcare Research Program: Opportunities and Priorities Identified through Stakeholder and Expert Consultations. Vancouver : University of British Columbia Library. Available from: https://open.library.ubc.ca/soa/cIRcle/collections/facultyresearchandpublications/52383/items/1.0315346?o=11
62. Al Tehewy M, Salem B, Habil I, et al (2009). Evaluation of accreditation program in non-governmental organizations' health units in Egypt: short-term outcomes. Int J Qual Health Care, 21 (3):183-9.
| Files | ||
| Issue | Vol 53 No 1 (2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v53i1.14683 | |
| Keywords | ||
| Prerequisites Accreditation Primary healthcare | ||
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How to Cite
1.
Etemadi S, Dehnavieh R, Hedayati Pour M, Mehri M, Behzadi A. The Prerequisites of Executing the Accreditation Program for Primary Healthcare: A Systematic Review and Meta-Synthesis. Iran J Public Health. 2023;53(1):59-69.
