Challenges and Strengths of Fourth-Generation Accreditation Standards from the Perspective of Nurses at Afzalipour Hospital in Kerman: A Qualitative Study

Abstract

Background: Accreditation is a team effort to improve service quality. Nurses, as key members of the care team, play an important role in implementing accreditation standards. This study aimed to explain the challenges and strengths of the implementation of fourth-generation accreditation from the perspective of nurses. Methods: The present study was a qualitative one conducted using content analysis. The research population included nurses of Afzalipour hospital in Kerman, Iran. Using purposive and snowball sampling, 5 nurses, 5 head nurses, and 3 supervisors were selected for accreditation. The data were collected through semi-structured interviews. The interviews were transcribed, coded, categorized, and analyzed separately. Then, using content analysis, the data obtained from the interviews were reduced and given a structure and system. Data analysis was performed using MAXQDA software (version 10). Results: The most important challenges in this study were increasing nurses’ workload and working pressure and weakening nurses’ relationship with the patient. Moreover, there was no adequate infrastructure to implement accreditation. The strengths of implementing accreditation standards included increasing nurses’ awareness, improving reporting and documentation, increasing patient safety, and improving organizational processes. Conclusion: The results of this study emphasized the need to implement accreditation standards to integrate working methods and improve the quality of services and patient safety. Solving the existing challenges is a way to ensure the quality and continuous improvement of nursing services. In general, the results of this study provide useful information to policy makers and senior managers of the health system to reform the structure of hospital accreditation.

Job (dis-)satisfaction in pay-for-performance health care contexts: a meta-synthesis of qualitative literature

“…Indeed, pay is perceived to be a “hygiene” factor but not necessarily a motivating one; that is, inadequate pay produces demotivation, but motivation does not necessarily increase as pay increases (Karimi et al. , 2022).…”

“…When the context, broadly understood, is supportive, the first finding is an increase in job satisfaction (e.g. Karimi et al. , 2022; Maharani et al.…”

“…Indeed, pay is perceived to be a "hygiene" factor but not necessarily a motivating one; that is, inadequate pay produces demotivation, but motivation does not necessarily increase as pay increases (Karimi et al, 2022). Since P4P alone is not sufficient to increase motivation, it is important to plan different types of incentives based on workers' attitudes and personalities in order to promote positive competition that limits pressure from peers and the organization.…”

“…When the context, broadly understood, is supportive, the first finding is an increase in job satisfaction (e.g. Karimi et al, 2022;Maharani et al, 2022;Maisey et al, 2008;Sabitova et al, 2022). Job satisfaction is a significant indicator of the quality of health care (Maharani et al, 2022), and the excerpts from the reviewed literature suggest that workers in the health care sector experience greater job satisfaction when they work in a supportive environment.…”

“…One example is that of health care workers who perceive their jobs as more satisfying than hospital-based medical workdespite finding them more mundane and characterized by heavy workload, confusing job descriptions, unsatisfactory income and a lack of professional development (Zhang et al, 2017) because they are satisfied with their salary and promotion opportunities (Maharani et al, 2022). Monetary compensation therefore affects the level of well-being and satisfaction at work and consequently the values and ethics of public service also benefit from P4P-based systems (Karimi et al, 2022;Millar et al, 2017).…”