Hospital accreditation processes in Saudi Arabia: a thematic analysis of hospital staff experiences.

Background: Hospital accreditation by an international organisation can play an important role in health quality and safety. However, little is known about how managers and front-line employees experience and perceive the effects of accreditation. Their views could inform quality improvement processes and procedures.

Objective: To explore perceptions of employees at the managerial level on the Joint Commission International (JCI) accreditation process and its impact on quality of patient care in Saudi Arabian JCI-accredited hospitals.

Methods: We undertook a qualitative study using semi-structured interviews to explore the perspectives of senior staff from three accredited public hospitals in Saudi Arabia. Interviews were transcribed prior to thematic analysis.

Results: Twenty managers participated in the interviews. The following inter-related themes emerged concerning the JCI accreditation process and its impact on quality of patient care: drivers for the change; the plan for the change; the process of the change; maintaining changes post-accreditation and patients' issues. Participants were positive in their accounts of: drivers for the change; planning for the change needed to achieve accreditation and managing patients' issues. However, participants reported less favourably on: the process of the change; and maintaining changes post-accreditation.

Conclusion: The planning stage was perceived as the easiest component of JCI accreditation. Implementing and maintaining changes post-accreditation that demonstrably promote patient safety and quality of care was perceived as more difficult. When planning for accreditation, institutions need to incorporate strategies to ensure that improvements to care continue beyond the accreditation period.