IJHS 5 | International Journal of Health Studies 2017;3(3) IJHS 2017;3(3):5-8 ijhs.shmu.ac.ir doi:10.22100/ijhs.v3i3.257 Original Article International Journal of Health Studies The Impact of Structure, Process and Output on the Establishment of an Accreditation System in Social Security Hospitals in Tehran Zahra Ebrahim 1 , Amir Ashkan Nasiripour 1* , Pouran Raeissi 2 1 Dept. of Health Services Management, Electronic Branch, Islamic Azad University, Tehran, Iran. 2 Dept. of Health Services Management, Iran University of Medical Sciences, Tehran, Iran. Received: 24 July 2017 Accepted: 24 August 2017 Abstract Background: The lack of an evaluation mechanism and effective accreditation for hospitals in addition to increasing healthcare costs jeopardizes the overall health of communities. This study was conducted to identify and prioritize factors affecting the establishment of an accreditation system in social security hospitals in Tehran in 2015. Methods: This is a cross-sectional study and participants consisted of academic experts, hospital chiefs, managers, head nurses and supervisors, and staff of quality improvement in departments of social security in hospitals in Tehran City, Iran. Study samples were of 170 participants. A 5-points Likert scale questionnaire, according to the Donabedian model (structure, process, and output), with 24 items, was used. For data analysis, SPSS software version 22 and Pearson correlation coefficient, one-sample t-test and linear regression were used. Results: Out of 170 participants, 49 (28.8%) were male and 121 (71.2%) were female. T-test results showed that all dimensions had a significant effect on the accreditation system (P<0.05). Also, pearson correlation coefficient results showed that all aspects had a significant correlation with each other (P<0.05). In the regression model, R 2 showed that 89.6% of changes of the dependent variable could be predicted. Conclusions: The correct implementation of hospital accreditation requires the specific education for personnel so that they can easily understand the accreditation model and standardized processes that need to be established in the hospital. Keywords: Accreditation, Donabedian Model, Social security. * Corresponding to: AA Nasiripour, Email: nasiripour@srbiau.ac.ir Please cite this paper as: Ebrahim Z, Nasiripour AA, Raeissi P. The impact of structure, process and output on the establishment of an accreditation system in social security hospitals in Tehran. Int J Health Stud 2017;3(3):5-8. Introduction Performance and quality assessment systems are an indispensable part of management of all organizations, public or private, to ensure improvement and sustainable growth in the competitive environment, and health sector organizations are no exception to this rule. 1 Hospitals have attracted the attention of health system policymakers due to the high budgets paid to them. Therefore, the promotion of hospitals’ financials and quality is among the first priority of health sector policy makers. 2,3 Hospital accreditation, with its potentially important role in promoting health of societies and reducing costs has become a controversial issue. 4 Accreditation can be defined through approval of performance to meet predefined standards by a peer external and independent evaluator group such as Joint Commission International (JCI). 5 Government responsibility for society’s health forces them to establish an effective system that is accountable to patients for all their health needs. Therefore, strengthening accreditation programs for health organizations is one of the most important issues for any health system. 6 To assess hospitals’ performance, many indicators can be used. One group of such indicators is bed management measures as outputs. Beds’ occupation, beds’ turn-over, and average lengths of stay are the most important and most usable indicators in this group. 7-10 Production and provision of services in hospitals, costs control and management, and finally efficiency and productivity of hospitals, depend on such procedural and performance indicators. 11,12 Despite its rather long run of hospital accreditation programs, Iran’s hospitals are hardly studied for examining the effect of accreditation on their performance indicators, especially after the launch of the new version of accreditation in 36 section and 2157 indicators in March 2013. 13 The few conducted studies were qualitative and investigated the role of hospitals’ assessment on shaping the performance, and on personnel and hospitals’ behavior, 14-16 through which some negative and unwanted results have been reported such as misrepresentation of data by hospitals and increased anxiety and stress among hospital employees. 17 A study which examined the effect of accreditation suffers from either poor methodology or lack of enough follow up to observe the real long term impacts. 18 Some studies have been conducted as cross-sectionals and compared the mean of target variable just in two points of time; while the ideal approach to measure the effect of an intervention is randomized controlled trials, in many cases, due to lack of control group, this method is not applicable. 19-21 Time series analysis is a type of longitudinal research that investigates the casual relationships over time, 19,20,22 and could be a good alternative for investigating the impacts of an intervention when no control group is available. As no longitudinal study has been conducted to assess the impact of accreditation on healthcare outcomes in Iran, we aimed to investigate the importance of structure, process and outcome of accreditation on implementation to led hospitals directly or indirectly to better performance. 23