Hospital Accreditation: Challenges and Results

Authors

DOI:

https://doi.org/10.5007/2175-8077.2025.e98377

Keywords:

Accreditation, Hospital organization, Performance

Abstract

Objective – This article aims to analyze aspects related to the challenges and results arising from the accreditation process and their relationship with perceived hospital organizational performance.

Methodology – The sample was made up of 88 respondents from hospital organizations in the South region of Brazil, being collected for accessibility and convenience. Canonical correlation analysis was used to process and analyze the data.

Originality/relevance – The importance and contribution of this study lies in exploring how challenges and outcomes interrelate with perceived hospital performance, thus shedding light on related topics.

Results – The results obtained with the accreditation process are correlated with the perceived hospital organizational performance (H1), as the strength of association between the dimensions presented a high and significant coefficient of variation (0.869 – p-value of 0.000), a canonical R2 of 0.755 considerable and Wilks' Lambda (0.242) close to zero. In contrast, aspects related to challenges arising from the accreditation process (H2) did not demonstrate a statistically significant relationship.

Theoretical contributions – Contributed to the proposition of a model to analyze perceived performance and its relationship with the challenges and results originating in the process of implementing and maintaining the hospital accreditation method.

Contributions to management – Pragmatically, the study allows managers to understand which attitudes and actions can create obstacles in the implementation and maintenance of accreditation and interpret which processes and practices must be maintained permanently.

Author Biographies

Luciano Trentin, Universidade Regional de Blumenau - FURB

Qualification: PhD in Accounting Sciences and Administration from the Fundação Universidade Regional de Blumenau - FURB (2021); Master in Production Engineering from Centro Universitário Tupy - UNISOCIESC (2017); Specialist in Controllership and Finance from the Pontifical Catholic University of Paraná - PUC (2011) and Human Resources Management from the University of the West of Santa Catarina - UNOESC (2000); Graduated in Administration from the University of Planalto Catarinense - UNIPLAC (1999). Guest professor at the University of Vale do Itajaí - UNIVALI of the Lato Sensu Postgraduate course in Specialization in Occupational Safety Engineering and Industrial Maintenance Engineering; Professor at the Regional University of Blumenau - FURB of the Undergraduate courses in Administration, Accounting Sciences and Information Systems. Content professor at the Leonardo da Vinci University Center - UNIASSELVI. 20 years of experience in the areas of Executive Management of Human Resources, Quality and General Administration in large companies, in growth, transformation, merger and acquisition processes. Focus on strategic positioning, efficient resource management, factory management and operations, innovation, technology and finance, having worked in companies such as: Klabin, Teleperformance, Univali, Unoesc, Arxo and CMJ Têxtil. He works with research and teaching mainly on the following topics: human resources management; quality management; lean manufacturing; organizational maturity models; occupational hygiene. Works with research mainly on the following topics: Human Resources Management; Quality management; Lean Manufacturing; Organizational Maturity Models; Relationship with Stakeholders; and Occupational Hygiene.

Gérson Tontini, Universidade Regional de Blumenau - FURB

Qualification: Doctor in Mechanical Engineering and Post Doctorate in Administration.

References

ACS – American College of Surgeons. (2024). “The ‘Minimum Standard’ Document”. Available in: https://www.facs.org/about-acs/archives/past-highlights/minimumhighlight/. Acessed on Jan/27th.

Alástico, G. P. (2013). Impactos das práticas da acreditação no desempenho hospitalar: Um survey em hospitais do estado de São Paulo. Tese de Doutorado em Engenharia de Produção. Universidade Federal de São Carlos – UFSCAR. São Carlos/SP. https://doi.org/10.14393/19834071.2012.15182

Algunmeeyn, A., & Mrayyan, M. T. (2022). Understanding the factors influencing the implementation of accreditation in Jordanian Hospitals: the nurses’ view. BMJ Open Quality, 11(3). https://doi.org/10.1136/bmjoq-2022-001912

Algunmeeyn, A., Alrawashdeh, M., & Alhabashneh, H. (2020). Benefits of applying for hospital accreditation: the perspective of staff. Journal of Nursing Management, 28(6), 1233-1240. https://doi.org/10.1111/jonm.13066

Alhawajreh, M. J., Paterson, A. S., & Jackson, W. J. (2023). Impact of hospital accreditation on quality improvement in healthcare: a systematic review. PloS one, 18(12), e0294180. https://doi.org/10.1371/journal.pone.0294180

Alkhenizan, A., & Shaw, C. (2011). Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Annals of Saudi medicine, 31(4), 407-416. https://doi.org/10.4103/0256-4947.83204

Al Kuwaiti, A., & Al Muhanna, F. A. (2019). Challenges facing healthcare leadership in attaining accreditation of teaching hospitals. Leadership in Health Services, 32(2), 170-181. https://doi.org/10.1108/LHS-01-2018-0002

Andres, E. B., Song, W., Schooling, C. M., & Johnston, J. M. (2019). The influence of hospital accreditation: a longitudinal assessment of organisational culture. BMC health services research, 19(1), 1-8. https://doi.org/10.1186/s12913-019-4279-7

Blokdyk, G. (2024). Delphi Method A Complete Guide. 5STARCooks Publisher, 250p.

Blondiau, A., Mettler, T., & Winter, R. (2016). Designing and implementing maturity models in hospitals: An experience report from 5 years of research. Health informatics journal, 22(3), 758-767. https://doi.org/10.1177/1460458215590249

Bogh, S. B., Blom, A., Raben, D. C., Braithwaite, J., Thude, B., Hollnagel, E., & Plessen, C. V. (2018). Hospital accreditation: staff experiences and perceptions. International journal of health care quality assurance, 31(5), 420-427. https://doi.org/10.1108/IJHCQA-06-2017-0115

Braz, R. G. F., Scavarda, L. F., & Martins, R. A. (2011). Reviewing and improving performance measurement systems: An action research. International Journal of Production Economics, 133(2), 751-760. https://doi.org/10.1016/j.ijpe.2011.06.003

Brubakk, K., Vist, G. E., Bukholm, G., Barach, P., & Tjomsland, O. (2015). A systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC health services research, 15, 1-10. https://doi.org/10.1186/s12913-015-0933-x

Campbell, G., & Skillings, J. H. (1985). Nonparametric stepwise multiple comparison procedures. Journal of the American Statistical Association, 80(392), 998-1003. https://doi.org/10.1080/01621459.1985.10478216

Cleff, T. (2025). Applied Statistics and Multivariate Data Analysis for Business and Economics: A Modern Approach Using R, SPSS, Stata, and Excel (Springer Texts in Business and Economics). Second edition. Springer Publishers, 580p. https://doi.org/10.1007/978-3-031-78070-7

Cleverley, W. O., & Harvey, R. K. (1992). Competitive strategy for successful hospital management. Journal of Healthcare Management, 37(1), p. 53.

Cosenz, F., Noto, G., Cavadi, G., Bivona, E., & Scirè, G. (2024). Pursuing sustainable performance in healthcare organizations: a sustainable business model perspective. Journal of Health Organization and Management, 38(5), 741-759. https://doi.org/10.1108/jhom-12-2023-0369

Costa Jr., H. (2015). Qualidade e Segurança em Saúde. Os Caminhos da Melhoria Via Acreditação Internacional. Relatos, Experiências e Práticas. 1ª edição. Editora Doc Editora, 188p.

Couttolenc, B. F., & La Forgia, G. M. (2009). Desempenho hospitalar no Brasil: em busca da excelência. 1ª edição. Editora Singular, 496 p.

Davenport, T. H. (1994). Reengenharia de processos: como inovar na empresa através da tecnologia da informação. 5ª edição. Editora Campus, 408p.

Dedianto, D., Handoko, V. R., & Maruta, I. A. (2025). The Role of Transformational Leadership Style and Organizational Culture in Hospital Accreditation Success: a Case Study at RSUD Prabumulih. Formosa Journal of Applied Sciences, 4(6), 1843-1856. https://doi.org/10.55927/fjas.v4i6.191

Edirimanna, J. P. K. (2022). Impact of service quality on customer satisfaction in queensbury private hospital. Master of Business Administration. Cardiff Metropolitan University.

Emmaniel, R. (2025). Research Methodology in Hospital Management. 1st Edition. Publisher ‏SSM Publication.

Farias, R. M., Piccihiai, D., Caruso, D., & Boeger, M. (2019). Gestão com indicadores em hotelaria hospitalar o estado da arte: Métodos, processos, tendências e propostas. 1ª edição. Editora Sarvier, 367p.

Farrag, A., & Harris, Y. (2021). A discussion of the United States’ and Egypt’s health care quality improvement efforts. International Journal of Healthcare Management, 14(1), 136-143. https://doi.org/10.1080/20479700.2019.1620454

Fávero, L. P., & Belfiore, P. (2024). Manual de Análise de Dados: Estatística e Machine Learning com Excel®, SPSS®, Stata®, R® e Python®. 2ª edição. Rio de Janeiro: GEN LTC, 1288p.

François, P., & Pomey, M. P. (2005). Implantation de la gestion de la qualité dans les hôpitaux français, jeux d’acteurs et transformations induites. Revue d'épidémiologie et de santé publique, 53, 4-11. https://doi.org/10.1016/s0398-7620(05)84753-4

Freire, E. M. R., Silva, V. C. D., Vieira, A., Matos, S. S. D., & Alves, M. (2019). A comunicação como estratégia para manutenção da acreditação hospitalar. Escola Anna Nery, 23(1), 1-9. . https://doi.org/10.1590/2177-9465-EAN-2018-0224

García-Altés, A., Zonco, L., Borrell, C., & Plasència, A. (2006). Measuring the performance of health care services: a review of international experiences and their application to urban contexts. Gaceta sanitaria, 20, 316-324. https://doi.org/10.1157/13091148

Gaspar, T., Sousa, B., Alves, E., & Coelho, A. (2024, November). Are Healthcare Organizations Healthy Work Ecosystems? Health and Well-Being of Health Professionals. In Healthcare, 12(22), 2277. https://doi.org/10.3390/healthcare12222277

Ghazanfari, F., Mosadeghrad, A. M., Jaafari Pooyan, E., & Mobaraki, H. (2021). Iran hospital accreditation standards: challenges and solutions. The International Journal of Health Planning and Management, 36(3), 958-975. https://doi.org/10.1002/hpm.3144

Grove, A. L., Meredith, J. O., Macintyre, M., Angelis, J., & Neailey, K. (2010). Lean implementation in primary care health visiting services in National Health Service UK. BMJ quality & safety, 19(5), 1–5. https://doi.org/10.1136/qshc.2009.039719

Gonçalo, C. R., & Borges, M. D. L. (2010). Organizações de saúde intensivas em conhecimento: um estudo no contexto de serviços de alta complexidade. Saúde e Sociedade, 19, 449-461. https://doi.org/10.1590/S0104-12902010000200020

Gutari, C. L. (2022). An Exploratory, Qualitative, Enterprise-Level Management Model for a World Health Organization Defined Type III Field Hospital: Preliminary System Description, Concept of Operations and Alignment Strategies for Deployment during the Uncertainties of an International Earthquake Response. Doctor of Philosophy. The George Washington University.

Hair Jr., J. F., & Black, W. C. (2018). Multivariate Data Analysis, 8th edition. Cengage India Publisher, 832p.

Hair Jr., J. F., Page, M. J., & Brunsveld, N. (2019). Essentials of business research methods. Routledge, 4ª edition, 508p. ISBN-13: 978-0367196189

IBES – Grupo IBES. (2023). O cenário da Acreditação em saúde no Brasil. Disponível em: https://www.ibes.med.br/o-cenario-da-acreditacao-em-saude-no-brasil/. Acessado em: jan/24. https://doi.org/10.55232/1087001.41

JCI - Joint Commission International. (2024). Joint Commission International Fact Sheet A Available in: https://www.jointcommission.org/resources/news-and-multimedia/fact-sheets/facts-about-joint-commission-international/#:~:text=JCI%20is%20the%20industry%2Dleading,1%2C000%20accredited%20and%20certified%20organizations. Acessed on Jan/24. https://doi.org/10.1016/s1549-3741(04)30103-6

Kaplan, R. S., & Norton, D. P. (2006). Alignment: Using the balanced scorecard to create corporate synergies. 1st edition. Harvard Business Press, 320p.

Karamali, M., Bahadori, M., Ravangard, R., & Yaghoubi, M. (2020). Knowledge mapping of hospital accreditation research: a coword analysis. International Journal of Health Care Quality Assurance, 33(6), 429-445. https://doi.org/10.1108/IJHCQA-03-2020-0050

Kotler, p., & Keller, K. L. (2021). Marketing Management. 16ª edition. Pearson Publishing, 608p.

Kuhlmann, S. (2010). Performance Measurement in European local governments: a comparative analysis of reform experiences in Great Britain, France, Sweden and Germany. International Review of Administrative Sciences, 76(2), 331-345. https://doi.org/10.1177/0020852310372050

Langabeer, J. R., & Napiewocki, J. (2000). Competitive business strategy for teaching hospitals. 1st edition. Greenwood Publishing Group, 312p. https://doi.org/10.5040/9798400629679

Li, R. (2023). Impact of accreditation level in hospital system on quality of care and financial performance. Master of Science. University of Manitoba. Manitoba Province, Canada.

López-Viñas, M. L., Costa, N., Tirvió, C., Davins, J., Manzanera, R., Ribera, J., ... & Vallès, R. (2014). Modelo de acreditación de centros de atención hospitalaria aguda de Cataluña. Medicina Clínica, 143, 68-73. https://doi.org/10.1016/j.medcli.2014.07.014

Macinati, M. S. (2008). The relationship between quality management systems and organizational performance in the Italian National Health Service. Health policy, 85(2), 228-241. https://doi.org/10.1016/j.healthpol.2007.07.013

Mansour, W., Boyd, A., & Walshe, K. (2020). The development of hospital accreditation in low-and middle-income countries: a literature review. Health policy and planning, 35(6), 684-700. https://doi.org/10.1093/heapol/czaa011

Martins, V. F., Carmo, C. R. S., Naganga, C. S., & Pereira, V. S. (2013). Acreditação em Organizações de Saúde: Um estudo exploratório. Cadernos da FUCAMP, 12(16).

McDermott, A. M., Conway, E., Cafferkey, K., Bosak, J., & Flood, P. C. (2019). Performance management in context: formative cross-functional performance monitoring for improvement and the mediating role of relational coordination in hospitals. The International Journal of Human Resource Management, 30(3), 436-456. https://doi.org/10.1080/09585192.2017.1278714

Miles, I., Kastrinos, N., Flanagan, K., Bilderbeek, R., Den Hertog, P., Huntink, W., & Bouman, M. (1995). Knowledge-Intensive Business Services: Users. Carriers and Sources of Innovation, EIMS publication, (15), 25-90. https://doi.org/10.1108/IJHCQA-11-2012-0119

Minvielle, E., Sicotte, C., Champagne, F., Contandriopoulos, A. P., Jeantet, M., Préaubert, N., ... & Richard, C. (2008). Hospital performance: Competing or shared values?. Health Policy, 87(1), 8-19. https://doi.org/10.1016/j.healthpol.2007.09.017

Moffett, M. L., Morgan, R. O., & Ashton, C. M. (2005). Strategic opportunities in the oversight of the US hospital accreditation system. Health policy, 75(1), 109-115. https://doi.org/10.1016/j.healthpol.2005.03.005

Moradi, S., Ansari, R., & Taherkhani, R. (2022). A systematic analysis of construction performance management: Key performance indicators from 2000 to 2020. Iranian Journal of Science and Technology, Transactions of Civil Engineering, 46(1), 15-31. https://doi.org/10.1007/s40996-021-00626-7

Mosadeghrad, A. M. (2021). Hospital accreditation: The good, the bad, and the ugly. International Journal of Healthcare Management, 14(4), 1597-1601. https://doi.org/10.1080/20479700.2020.1762052

Mosadeghrad, A. M. (2018). Iran hospital accreditation: future directions. In: J Braithwaite, et al. editors. Health care systems: future predictions for global care. 1st Edition. Boca Raton, FL: Taylor & Francis, 285–291. https://doi.org/10.1201/b22185-43

Mosadeghrad, A. M. (2014). Patient choice of a hospital: implications for health policy and management. International journal of health care quality assurance, 27(2), 152-164. https://doi.org/10.1108/IJHCQA-11-2012-0119

Mosadeghrad, A. M., Sari, A. A., & Yousefinezhadi, T. (2017). Evaluation of hospital accreditation method. Tehran University of Medical Sciences Journal, 75(4), 288-298.

Mosadeghrad, A. M., Shahebrahimi, S. S., & Ghazanfari, M. (2018). Exploring the relationship between accreditation and hospital performance: using data mining approach. Journal of School of Public Health and Institute of Public Health Research, 16(1), 33-50.

Nafari, E., & Rezaei, B. (2022). Relationship between human resources strategies and organizational performance based on the balanced scorecard in a public hospital in Iran: a cross-sectional study. BMC health services research, 22(1), 363. https://doi.org/10.1186/s12913-022-07767-z

Neely, A., Gregory, M., & Platts, K. (2005). Performance measurement system design: A literature review and research agenda. International journal of operations & production management, 25(12), 1228-1263. https://doi.org/10.1108/01443579510083622

Oliveira, J. L. C. D., Gabriel, C. S., Fertonani, H. P., & Matsuda, L. M. (2017). Management changes resulting from hospital accreditation. Revista Latino-Americana de Enfermagem, 25, e2851. https://doi.org/10.1590/1518-8345.1394.2851

ONA - Organização Nacional de Acreditação. (2024a). O que é Acreditação?. Disponível em: https://www.ona.org.br/acreditacao/o-que-e-acreditacao/#:~:text=A%20Acredita%C3%A7%C3%A3o%20%C3%A9%20um%20m%C3%A9todo,assist%C3%AAncia%20no%20setor%20de%20sa%C3%BAde. Acessado em: jan/24. https://doi.org/10.22564/4simbgf2010.194

ONA - Organização Nacional de Acreditação. (2024b). No Princípio: da Colaboração à Fundação. Available in: https://www.ona.org.br/20anos/no-principio/#:~:text=Nascia%2C%20assim%2C%20a%20Organiza%C3%A7%C3%A3o%20Nacional,1o%20de%20junho%20de%201999. Accessed on Jan/27. https://doi.org/10.22564/4simbgf2010.194

Phua, J., Koh, Y., Du, B., Tang, Y. Q., Divatia, J. V., Tan, C. C., ... & Chan, Y. H. (2011). Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. Bmj, 342. https://doi.org/10.1136/bmj.d3245

Pires, B. S. M., Oliveira, L. Z. F. D., Siqueira, C. L., Feldman, L. B., Oliveira, R. A., & Gasparino, R. C. (2018). Ambiente de trabalho do enfermeiro: comparação entre hospitais privados e público. Einstein (São Paulo), 16(4), 1-6. https://doi.org/10.31744/einstein_journal/2018ao4322

Poister, T. H. (2008). Measuring performance in public and nonprofit organizations. 1st Edition. Jossey-Bass Publishing, 320p.

Porter, M. E., & Teisberg, E. O. (2009). Redefining Health Care: Creating Value-Based Competition on Results. Massachusetts: Harvard Business School Press. https://doi.org/10.1108/17506120810865442

Possolli, G. E. (2017). Acreditação hospitalar: gestão da qualidade, mudança organizacional e educação permanente. 1ª edição. Editora InterSabere, 284p.

Rafael, D. N., & Aquino, S. (2019). Percepção de gestores sobre a auditoria ONA em um Compounding Center em processo de acreditação. Revista Gestão e Planejamento, 20, 367-457. https://doi.org/10.21714/2178-8030gep.v20.4293

Ramos, G. I. S. (2018). Discussão da Acreditação Como Elemento Catalisador do Desempenho e Competitividade no Setor Hospitalar. Revista Paraense de Contabilidade-RPC, 3(2), 19-25. https://doi.org/10.36562/rpa.v3i2.31

Saadati, M., Yarifard, K., Azami-Agdash, S., & Tabrizi, J. S. (2015). Challenges and potential drivers of accreditation in the Iranian hospitals. International Journal of Hospital Research, 4(1), 37-42.

Saadati, M., Bahadori, M., Teymourzadeh, E., Ravangard, R., Alimohammadzadeh, K., & Mojtaba Hosseini, S. (2018). Accreditation in one teaching hospital: a phenomenology study among Iranian nurses. International Journal of Health Care Quality Assurance, 31(7), 855-863. https://doi.org/10.1108/IJHCQA-08-2017-0150

Silva, G. G. (2023). Inovação e Tecnologia na Gestão Hospitalar. 1ª edição. Editora Clube dos Autores, 223p.

Smits, P. A., Champagne, F., Contandriopoulos, D., Sicotte, C., & Préval, J. (2008). Conceptualizing performance in accreditation. International Journal for Quality in Health Care, 20(1), 47-52. https://doi.org/10.1093/intqhc/mzm056

Stoner, J. A. F.; Freeman, R. E. (1999). Administração. 5ª edição. Editora Prentice Hall do Brasil, 536p.

Terra, J. D. R., & Berssaneti, F. T. (2017). Acreditação hospitalar e seus impactos nas boas práticas em serviços da saúde. O Mundo da Saúde, 41(1), 11-17. https://doi.org/10.15343/0104-7809.201741011117

Treib, J. N., Magalhães, A. M. M. D., Carvalho, S. C. G., Seeger, V. G., Barbosa, A. D. S., & Oliveira, J. L. C. D. (2022). Panorama da acreditação (inter) nacional no Brasil. Escola Anna Nery, 26. https://doi.org/10.1590/2177-9465-EAN-2022-0024pt

Triantafillou, P. (2014). Against all odds? Understanding the emergence of accreditation of the Danish hospitals. Social Science & Medicine, 101, 78-85. https://doi.org/10.1016/j.socscimed.2013.11.009

Vieira, R. V., dos Santos Cardoso, E. F., da Silva Franco, G., dos Santos, I. F., Umbelino, F. D. S. C., Silveira, Y. S., ... & Cavalli, L. S. (2023). A influência da gestão hospitalar eficiente na promoção da saúde: como está a relação entre administração e saúde atualmente?. Revista Psipro, 2(4), 16-41. https://doi.org/10.7476/9786557080511.0003

Viriato, A. V., & Moura, A. (2021). Administração hospitalar: curso de especialização. eBook. Editora Manole, 676p.

Walburg, J., Bevan, H., Wilderspin, J., & Lemmens, K. (2006). Performance management in health care: improving patient outcomes: an integrated approach. 1st edition. Publisher‎ Routledge, 248p. https://doi.org/10.4324/9780203356807

Yarmohammadian, M. H., Shokri, A., Bahmanziari, N., & Kordi, A. (2014). Blind spots on accreditation program. Journal of Health System Research, 9(11), 1158-1166.

Yousefinezhadi, T., Mosadeghrad, A. M., Hinchcliff, R., & Akbari-Sari, A. (2020). Evaluation results of national hospital accreditation program in Iran: The view of hospital managers. Journal of Healthcare Quality Research, 35(1), 12-18. https://doi.org/10.1016/j.jhqr.2019.08.008

Published

2025-12-29

How to Cite

Trentin, L., & Tontini, G. (2025). Hospital Accreditation: Challenges and Results. Revista De Ciências Da Administração, 27(67), 1–32. https://doi.org/10.5007/2175-8077.2025.e98377

Similar Articles

<< < 4 5 6 7 8 9 10 11 12 13 > >> 

You may also start an advanced similarity search for this article.