Contextual approach to the performance analysis of Iran’s national accreditation programme for healthcare organisations

Abstract

The importance of focusing on performance measurement systems (PMSs) in the public sector has increased following the introduction of new public management (NPM) initiatives, which placed a greater emphasis on organisational accountability and performance measurement. PMSs have always been a key player in ensuring accountability and improvement in the practices of public sector (e.g. healthcare) organisations. Critical features of the health sector have particularly warranted the application of various internal or external PMSs in this area as well as the regular assessment of their own performance. This is crucial in terms of both maintaining their alignment with the initially determined objectives and improving their merits and capabilities to continuously detect the deficiencies and malpractices in healthcare organisations (HCOs). Iran’s national accreditation programme for healthcare organizations (NAPH) has served as the sole element of macro control and regulation in the country’s health sector at national level. It has been set up to reflect, operationalise and guarantee the intentions of the government for promoting quality and safety in the local HCOs, mainly hospitals, across the country. Despite the NAPH’s importance and vital position in the country’s health system and its long-time implementation, the contextual effects of this evaluator mechanism on the individual hospitals have not been empirically researched in current organizational context; i.e. there is a lack of empirical evidence in the literature on how this macro PMS impacts in practice on the hospitals at local level. Accordingly, this study aims to render a contextual evaluation of the performance of this evaluatory system. A middle-range thinking (MRT) research approach has informed the study. Drawing on this approach, Broadbent and Laughlin’s theoretical framework was adopted to both guide the empirical work and help with the analysis and interpretation of the empirical data. The findings of the study showed that it was mainly the financial benefits rather than the quality improvement merits of the current hospital accreditation and evaluation programme that were apparently the main rationale behind the conformity of the hospitals. Both dysfunctional and beneficial consequences were associated with the NAPH by the hospitals’ members. In addition, the hospitals showed different reactions including rejection and gaming as well as absorption to achieve the beneficial gains of the programme. However, they also adopted some requirements of the NAPH exclusively in view of its perceived merits and some other contextual factors. Changes in the hospitals as a result of the programme occurred mostly in the early years following its introduction or modification. This study further provides both theoretical and practical research implications for policy and practice for the improvement of this evaluation mechanism

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ORCID for S.C. Brailsford: orcid.org/0000-0002-6665-8230

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