Background and objective: Accreditation, a priority of Ministry of Health in Iran, is an evaluative tool of healthcare systems especially hospitals. The development of each system included healthcare one with no efficient evaluative system lacks basic concepts and tools to accomplish the organization objectives.

Methodology: This is a descriptive and analytical study. When considered hypotheses and objectives were determined, and some initial studies were carried out on research topic, librarian and documentary researches were initiated. Index cards and collecting data were accomplished by referring to librarian sources and information banks. Statistical information carried out through applying hospital information and gathering statistics on the first, second, third, and fourth months of year.

Findings: In this study, we have concluded that accreditation is of high importance in hospitals and all three hypotheses of successful reviving in infants, decreasing caesarean section by personal satisfaction, increasing natural childbirth and releasing from hospital are in a direct and positive relation with personal satisfaction to improve hospital quality by considering presented approaches. Mobini hospital of Sabzevar can have a vital role in improving the quality.

Keywords: accreditation, quality, Shahidan-e-Mobini hospital

As a result of competitive needs, the healthcare organizations face with too many challenges. An environment in which economical, lawful, and political motivations of healthcare presenters should control expenses and preserve quality, quality improvement is considered as the only way to achieve success. So, most healthcare system managers and authorities know making standard, accreditation, and the evaluation of healthcare systems as necessary items to improve quality.¹ Therefore, accreditation is of high importance in the organization, and signifies as systematic evaluation of healthcare centers with determined standards focusing on continuous development of quality, customer orientation, and safety in patients and personnel. Accreditation is applied to give some explanation on the quality of healthcare services, also it is considered as the basic thought of quality. The basis of accreditation is composed of the policy of health caring and the comprehension of what is concerned with caring quality, and focusing on basic principles to make the development of healthcare system united and active.² When hospital is ready to be evaluated by foreign assessors providing that all predicted standards be controlled, the accreditation standards based on ability in providing care are determined by management and personnel with safety to evaluate and reform the healthcare structure, processes, and results. Accreditation should be improved continuously, and should be accomplished in a determined period of time.³ Hospitals with accreditation present more qualified services and intensify quality and safety of cares, cures, and services in the society. As a whole, accreditation improves management risk, helps the organization, and creates patients` safety culture in the organization.⁴ Therefore, the role of accreditation on improving quality in hospitals is considered in this study, and three hypotheses will be studied.

This is a descriptive and analytical study. When considered hypotheses and objectives were determined, and some initial studies were carried out on research topic, librarian and documentary researches were initiated. Index cards and collecting data were accomplished by referring to librarian sources and information banks. Statistical information carried out through applying hospital information and gathering statistics on the first, second, third, and fourth months of year.

Research hypotheses

1) Infants successful reviving have influenced hospital quality.

2) The decreasing number of caesarean section with personal satisfaction has influenced hospital quality.

3) Releasing with personal satisfaction have influenced hospital quality.

Accreditation

Accreditation signifies a systematic evaluation of healthcare centers with determined standards influenced improving quality, paying attention toward patients, and improving safety for personnel and patients.⁵ Improving team working, creating motivation to make clinical methods standard, controlling and uniting of quality instructions, the development of inner evaluation, learning from inspectors` experiences, improving hospital`s situation, and improving satisfaction in patients, consumers, and staffs are among interesting features of accreditation.⁶ Accreditation is applied to describe hospital quality and as a basis of quality is applied. In following, some objectives will be defined to accredit hospital: 1) The improving of services quality, 2) The improving of safety for patients and personnel, 3) Education and empowering, 4) Symmetrical growth and systematic thought, 5) Accreditation in customers and government on the quality of presented services, 6) Encouraging service units to have a continuous development through continuous evaluations.⁷

Quality

In a viewpoint, quality indicates to the coincidence of a product or service with predicted necessities (customer's needs and expectations). Presented healthcare services signify as presented healthcare services to individuals and societies increasing desired healthcare services, and coinciding with update professional knowledge. Quality refers to a continuous development of procedures and much improvement as a process of determining standards, evaluation and creating some changes. The disability of creating changes in organizations and people's behavior were considered as the most active factors in the inefficiency of qualitative actions. Caring activities, and performance quality in presenting services can result in attracting satisfaction in customers.⁸

Accreditation necessity in hospital

As accreditation is a part on comprehensive necessities and expectations and quality and customer orientation of accreditation schedule included the most important factors to justify the necessity of accreditation, hospitals try to apply accreditation. Accreditation is a means of achieving improving quality, and focuses in a large extent on patients and obtaining their satisfaction. Accreditation is determined by competition and differentiation with other hospitals. The competitive space of healthcare systems and taking some actions by healthcare systems to obtain reputation and popularity among customers will be accomplished through accreditation.

The effect of accreditation on patient’s satisfaction

Attracting attention in customer’s results in high referral by customers and admittance affecting service presenting. Accreditation through customer orientation, improvement in answering, and serving responsibilities in correct ways can improve satisfaction and affect service presenting. When hospital quality was appeared through accreditation, the organization knows this method as an effective tool in increasing quality and can achieve customers` satisfaction. As a result of increasing number of answering by physicians and more rapid procedure of curing, more satisfaction has been obtained. Also, as experiences individuals are working, services are accomplished in a correct way. Scholars believe that more satisfaction can be achieved by respecting to patients rights and culture.¹⁰

Shahidan-e-Mobini hospital

Shahidan-e-Mobini hospital with approved 100 beds and 96 active beds, enjoying from professional personnel in specialty and faculty members of Medical University, an experienced personnel with great activities in women and childbirth fields, family planning, childbirth, curing women's diseases, and specialized services on immature babies is a most well-known hospitals of Razavi Khorasan Province educating medical and paramedical students to study in these fields. This healthcare center makes try to improve services concerned with services by enjoying suitable and modern management strategies to consider patients' rights through establishing clinical establishment, improving the services, and to make wards equipped.

Some international standards concerned with healthcare indices

1. The prevalence of infectious diseases among 1-2% of released patients.
2. Hospital consulting in 15-20% cases.
3. 18-20% caesarean section to whole childbirths in a hospital.
4. At least, the autopsy of 25% of deaths.
5. Death among mothers in 2.5% of whole childbirths.
6. Death among babies in 2% of whole childbirths.
7. The side effects of curing among 2-4% of released patients.
8. Death rate after surgery in less than 1% of patients.

Three indices were considered in Shahidan-e-Mobini hospital of Sabzevar included 1) The successful reviving of babies (CPR) which was considered in initial second, third, and fourth of 2015 and three first months of 2016. The results indicated that hospital quality was accomplished through physicians` and personnel’s solutions (Table 1). At it can be observed from the above table, hospital quality was accomplished by physicians and personnel`s solutions of the accreditation ward on in three first months of 2016. These solutions include:

1. The presence of neonatologist and neonatal nurse at the time of childbirth.
2. The coordination among neonatologists, childbirth ward, surgery room, and reviving team.
3. Establishing the reviving workshop for personnel.
4. NICU personnel`s justification on the positive effect of reviving ill babies.
5. The devoting of extra working time per six reviving cases in NICU personnel on reviving ill babies in childbirth ward.

The average of second index concerned with decreasing caesarean section with personal satisfaction and increasing natural childbirth, the average of this index has been presented in the following (Table 2). This decreasing in caesarean section results in following items included:

1. Establishing an specialized committee of women with first caesarean.
2. The previous caesarean should not be less than 41-42 weeks; otherwise some acceptable midwifery reasons were mattered.
3. The previous caesarean should not be less than 40 weeks; otherwise some acceptable midwifery reasons were mattered.
4. Devoting a special space to indolent clinic.
5. Contacting with Health administer to report referral numbers of near cities to Sabzevar.
6. The consideration of all caesarean files to study the reason.
7. The advertisement of natural childbirth in main streets of city by advertising billboards and city televisions.
8. The consideration of satisfaction results of childbirth block in increasing natural childbirth.
9. The paper of childbirth report should be typed.
10. Some classes should be established to teach nursing mothers.

The average of the third index relating to releasing with personal satisfaction has been presented in following: (Table 3). This decreasing in caesarean section results in some increasing in following items included:

1. Patients` referring process.
2. The hospital hotelling and increasing satisfaction.
3. Respecting to customers.
4. The presence of on-call neonatologist.
5. The estimation of wards in each day by hospital management and improving quality manager.

Therefore, accreditation results in continuous improving of processes, comparison reforming and correct accomplishing of standards. Accreditation is applied to give explanation on quality, also it is considered as the though base of quality defined for hospital accreditation.

Accreditation can be accomplished through bedding and a suitable selection with accreditation model and beneficiaries' attention toward accreditation necessity, continuous monitoring, creating suitable information systems, making information clear, and some changes in attitude of each organization; also it can have positive effects on achieving hospital objectives and enhancing hospital quality. As accreditation was considered as an effective and positive factor on the quality and performance of healthcare system services, and too much attention should be paid toward this matter, it is suggested to hospital authorities to take priority accreditation. The positive effects of accreditation can be increased by emphasizing on performance indices and bedding through educating and increasing awareness among hospital staffs, indicating budget, and scheduling to have accreditation in productivity, commitment, and team working. Some actions have been taken by staff` approaches of Shahidan-e-Mobini hospital, and all these three hypotheses and indices were effective in improving hospital quality.

The authors all made equal contributions to this paper.

The Authors have no conflicts of interest.

Hereby, we extend our gratitude to the Students Research Committee of Sabzevar University of Medical Sciences, healthcare centers of Sabzevar city, and all the mothers for assisting us in this research project.

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