Benefits of applying for hospital accreditation: The perspective of staff

2.1 Jordanian hospitals

As discussed above, Jordan's health care system has been developed with greater relevance to the needs of the nation, compared with most other Middle Eastern countries. Day et al. (2013) observe that Jordan has a relatively advanced health care. Moreover, its health care system is divided into two sectors: private and public. With regard to public health care institutions, there are 1,245 health care centres operated by the Jordanian Ministry of Health, 27 of these being hospitals that provide 37% of all hospital beds across the country. All kinds of preventive, therapeutic, organisational and management services are provided in Jordan's public and private health sectors. Conversely, in the private sector, 56 hospitals provide 36% of the total number of hospital beds in the country, along with primary, secondary and tertiary services.

2.2 Hospital accreditation

Despite the many advantages and widespread adoption of TQM worldwide, what has been observed in the Middle East is a slow adoption rate for TQM processes. As such, Jordan is currently endeavouring to improve its quality management in different sectors, namely banking, hospitality and education, aside from ordinary business and manufacturing industries. The standard is a level that defines the quality of the work to attain accreditation. It covers all aspects of health care organisations' work such as the care of patients and their families, access to health care and continuity, diagnostic services, dominant leadership style, safety and support services, and quality improvement. Application of accreditation standards will improve information management, human resources education and training, and nursing services. However, several hospitals in Jordan (public sector and private) are seeking to develop their health services to keep abreast of international developments and to obtain accreditation. Hospital staff are educated about achievement of accreditation standards, and self-assessments regarding compliance with established standards are conducted to gain a certificate of accreditation. According to the Jordan's Health Care Accreditation Council, professional health care activities have in fact been improved to define the responsibilities of quality coordinators, as well as to promote the importance of quality in health facilities. In addition, the US Agency for the international development of health care projects in Jordan was initiated in 2008, in order to maintain a strong relationship with Jordan's Ministry of Health. Recently, several Jordanian hospitals have adopted TQM processes, in a bid to enhance the quality of care that they deliver. Moreover, as stated by A'aqoulah et al. (2016), this management procedure has been crucial over recent years, as there is greater focus on the quality of services and products delivered by businesses and other types of organisation.

2.3 Cost-effectiveness

Accreditation is realized as a tool to recognize high-performing hospitals and departments integrating quality improvement into their normal daily work, and aiming to increase efficiency and effectiveness (Bender & Halverson, 2010). Additionally, Alkhenizan and Shaw (2011) found that applying accreditation programmes enhances clinical outcomes of a wide spectrum of clinical conditions. The implementation of accreditation had led to improved patient satisfaction.

2.4 Patient satisfaction

To make the optimal patient comfortable, medical team should spend a lot of time for listening to the patients. In addition, the patient should feel comfortable when care is delivered by medical team and nurses as special in the hospital.

Comfortable environment and sanitation enable the patient to be more satisfied with health care (Senarath et al., 2013). Organisational culture (set of shared beliefs, values and norms about the way things should be done in an organisation) as a quality improvement strategy should be developed to improve the quality of care and patient satisfaction (Kozier ). Since patient's satisfaction is a critical health outcome indicator, organisational culture directly and positively affects the quality of care, and accordingly, patient satisfaction is indirectly affected. Organisational culture also positively and directly affects job satisfaction, which indirectly affects patient satisfaction (Tzeng, 2002). Besides, a study conducted by Paccioni, Sicotte, and Champagne (2008) showed that implementation programmes for accreditation were linked with enhanced customer satisfaction in terms of addressing user complaints.

2.5 Patient safety

To comprehend the activities required for the improvement in patient safety culture, it is the first fundamental to set up the principle factors in medical attendants' view of patient safety culture inside health care associations. The writing distinguishes various elements deciding medical caretakers' view of patient safety culture at the authoritative, administrative and individual levels (Yahyaoui, 2014). One such activity comprises viable authority, which is required at all levels inside an association, so as to make progress in setting up the more secure practice as of now ailing in Jordanian health care culture.

2.6 Improved reputation

3.1 The research methodology

The study design consisted of a qualitative approach, as it was considered to be the best method of achieving the study aims and objectives, offering an in-depth comprehension of the benefit of implementing accreditation standards in Jordanian hospitals. A qualitative study is the preferred strategy when ‘How?’ or ‘What?’ questions are posed).

3.2 The study sample

The sample in this present qualitative investigation consisted of nurses and doctors in two hospitals (one public and one private) located in Jordan. A total of 20 respondents were selected for interview in this project, drawn from the two different hospitals. In the public hospital, the researcher interviewed 5 participants of nursing and 5 doctors, while in private hospital, the numbers were 5 nurses and 5 doctors. Only eleven of the interviewees were female, and these consisted of six nurses and two doctors. All the other participants were male, also working in different positions. Out of all those approached to be interviewed, no one declined to take part. Privacy and confidentiality were assured by the researcher to all the participants. For privacy and confidentiality reasons, the names of the interviewees cannot be mentioned. Participants were referred to using a code, consisting of N and D, and numbered 1–10 in abbreviated format, for example ‘Interviewee N1’ or ‘Interviewee N10’. The selection of hospital nurses and doctors for the interviews was based on convenience and purposive sampling technique, resulting in a total of 20 respondents. The prime consideration with the sampling process in current was to recruit and select informants who could offer a deep understanding of the issues under investigation and to recruit and select them in such a way as to give credibility to the results so that they can be potentially generalized to another context or a larger population.

3.3 The study instrument

The investigator selected semi-structured interviews (face-to-face) to gather data. These were conducted with suitable participants, namely nurses and doctors. The questions concentrated on the background and experience of these nurses and doctors and their opinions on the benefits of accreditation, as observed in their hospitals. Specifically, the interview questions concentrated on what hospitals could achieve in relation to patient safety, patient satisfaction, cost and quality improvement. Ethical approval to execute the present research was obtained from the relevant committees at government and hospital levels, these being the ethics committees at two Jordanian hospitals. Consent forms and information sheets were distributed to potential respondents, based on their interest in participating in the project.

3.4 Setting adding

The current investigation was undertaken in Amman, the capital of Jordan, involving the two of the largest hospitals (one private and one public), most important and most famous medical hospitals in Jordan. For confidentiality purpose, the names of the hospitals are not reported. The private hospital in terms of the variety of medical specialties and services is available. An average of 200 patients attend daily and 30,000 patients did so in 2019. The hospital, which was established in 2001, includes all medical specialities with capacity of 120 beds. It makes 15–20 admissions and 20–25 discharges each day. It was accredited in September 2010, which means that it took around nine years and five months to achieve accreditation. The public hospital is a general tertiary care hospital. The hospital, which was opened for patient care in 1997, has a capacity of 170 beds. It has around 900 employees working in different specialities. It is accredited since 2006.

3.5 Data gathering

As mentioned previously, face-to-face interviews were used as the main method of gathering data from the two hospitals in this study, which commenced after obtaining the essential ethical approval. The ethical approval to execute the present research was obtained from the relevant committees at government and private hospital levels, these being the ethics committees at two Jordanian hospitals. Any participants who were willing to be interviewed were then sent an email form, indicating that they had agreed to take part and giving an opportunity for the investigator to arrange an appointment for the interview. Consent forms and information sheets were then distributed to the prospective participants, based on their interest in participating in this study. The participant information sheet contained details of the research study and the methods that would be used to collect and analyse the relevant data, as well as the purposes for which these data would be used. Likewise, the participants were informed that they had the right to withdraw from the study at any time. In addition, the researcher asked the participants to sign a consent form on the day of the interview, emphasizing that their needs took priority over the study. Their permission was likewise obtained for the interview to be audio-recorded and for future use of the transcripts. Each interview was then digitally recorded, while notes were also taken during the interviews. The face-to-face interview process began with greetings and an introduction, after which the participant read through the information sheet and signed the informed consent form. The interviewee's background data and demographic information were subsequently collected, followed by the scheduled interview questions and prompts.

The interviews varied slightly in duration, with the shortest being 30 min and the longest being 45 min. In each interview, the investigator spent around 5 min outlining the research background, presenting the study topic, explaining the research gap, emphasizing support for the investigation and stating the study aim and objectives.

3.6 Data analysis

The data from the 20 interviews were analysed with the aid of the NVivo qualitative data analysis software package. The audio-recorded interviews were transcribed verbatim, and these transcripts were reviewed, before the data within them were analysed. Later, the data were imported into the NVivo qualitative data analysis software package to assist with linking concepts contained in the data. In this study, thematic analysis was selected as the data analysis method, since it was considered as the most appropriate method for the current study. The data analysis procedures for this study were as follows: (a) The researcher familiarized himself with the content and information in the transcriptions; (b) the researcher continued to read each transcription line by line to find key words, meanings or concepts relating to the aims of the study; (c) the coding was refined by assembling similar codes and attempting to group codes together; (d) in the practical retrieval process, the researcher collected in one place all the text that was coded with same code, copying and pasting the text into separate labelled files for each code, using the Word program; (e) the researcher organised and gathered all coded data into themes; and (f) common themes were identified, and inferences were made from them, with sample quotes being selected to illustrate the themes that emerged.

4.1 Characteristics of the Interviewees

Only four of the interviewees were female. However, the majority were over 45 years of age and most were graduates. They worked at different levels within the hospitals, but all had over 10 years' work experience, while most had 20–25 years' work experience.

4.2 Themes Related to the benefits associated with the implementation of accreditation

The data analysis explored the following key themes relating to the benefits of implementing accreditation in hospitals in Jordan, as described by the respondents during the interviews.