Accreditation through the eyes of nurse managers: an infinite staircase or a phenomenon that evaporates like water

Abstract

Purpose: This study aims to develop a comprehensive understanding of improving quality and safety in healthcare by thoroughly examining the impact of accreditation processes on hospital operations and exploring nurse managers' experiences with these processes.

Design/methodology/approach: This study was designed as a qualitative research project. Semi-structured online interviews were employed to capture participants' subjective experiences and perspectives on the processes. Participants were purposively selected from nurse managers working in various hospitals, enabling the collection of rich and detailed data from individuals actively involved in accreditation processes. Thematic analysis was adopted for data analysis, systematically coding and categorizing the collected data into themes.

Findings: This study explores the impact of employee and patient-centered approaches, communication and managerial strategies on healthcare inequalities. It reveals that while efficient workflows emerged in employee-centered approaches, high workloads and varying adaptability persisted. Patient-centered care showed strong links between patient safety, care quality and empathic communication. Team collaboration enhanced service quality and patient-staff interactions had positive effects. Resource management and institutionalization improved operational efficiency and transparency, while accreditation reduced healthcare inequalities.

Research limitations/implications: Despite the valuable insights offered by this study, several limitations must be acknowledged. First, the study's focus on a specific context - hospital accreditation processes in private hospitals in Turkey - restricts the generalizability of the findings to other healthcare settings or countries with different healthcare systems. The experiences and perspectives of nurse managers in public hospitals or other healthcare environments, such as primary care or long-term care facilities, were not examined and may differ significantly. Second, the study's qualitative nature indicates that its findings are based on the subjective views and experiences of a relatively small sample of nurse managers. While this approach provides in-depth insights, it does not permit the broad statistical generalizability that quantitative studies may offer. Furthermore, although efforts were made to ensure the reliability and validity of the data through thematic analysis, the interpretation of findings may still be influenced by researcher biases, primarily since the study involved a single-country context with a specific cultural and healthcare setting. Lastly, the study did not investigate the long-term effects of accreditation on healthcare systems or assess how the evolution of accreditation standards might impact future healthcare delivery. Further longitudinal studies could offer a more comprehensive understanding of the lasting effects of accreditation processes.

Practical implications: This study offers valuable insights for nurse managers and their teams, enabling more effective resource management implementation, internal team collaboration and patient-centered strategies. Enhancing employee satisfaction and patient experience can improve healthcare quality and foster a more efficient healthcare environment. Additionally, process improvement recommendations for efficient resource utilization can boost operational efficiency in healthcare institutions. By considering these findings in strategic decision-making, managers can elevate employee and patient satisfaction. Furthermore, the insights from this study can be directly translated into practice by incorporating accreditation-focused leadership training into continuous professional development programs for nurse managers and healthcare administrators. These findings offer actionable guidance for designing hospital workflows that prioritize patient safety, communication and organizational resilience. From a policy perspective, the results support the development of flexible accreditation frameworks that align with local healthcare system capacities and workforce realities. In an educational context, integrating accreditation concepts into nursing and healthcare management curricula can better prepare future professionals for leadership roles. Societally, improving transparency, patient trust and equity through accreditation processes can enhance public confidence in healthcare systems and contribute to greater healthcare accessibility and quality of life improvements across communities. These implications are consistent with the findings and conclusions of the study, highlighting the potential for research to bridge theory and practice effectively while promoting tangible advancements in healthcare delivery and public health outcomes.

Social implications: This research underscores the societal impact of workforce management and patient care in the healthcare sector. Balancing healthcare workers' workloads and working conditions improves their quality of life and positively influences patient care. Fostering a strong culture of collaboration among staff enhances healthcare service effectiveness and boosts patient satisfaction, contributing to healthier individuals and increasing trust in health systems. Moreover, institutional transparency and effective communication can elevate public acceptance and trust in healthcare services. Strengthening the right to quality care ensures equitable access to health services, playing a crucial role in meeting the health needs of all societal segments and reinforcing public trust in the health system.

Originality/value: This study provides a novel view on hospital accreditation by exploring the experiences of nurse managers, who are often overlooked yet central to healthcare operations. Unlike studies that use mostly quantitative methods or focus on institutional outcomes, it captures the real-life insights of nurse managers, highlighting both human and organizational aspects of accreditation. This qualitative exploration, grounded in thematic analysis, distinctly highlights an often-overlooked stakeholder group. It addresses a gap in previous research where the subjective experiences and operational challenges faced by nurse managers during accreditation processes have remained underexplored.

Keywords: Accreditation; Healthcare operations; Nurse managers; Quality improvement; Thematic analysis.