Research Article

Saudi J Health Syst Res 2023;3:154–161 Received: November 26, 2022

Accepted: February 6, 2023
DOI: 10.1159/000529643 Published online: March 30, 2023

Accreditation Impact on Quality of Healthcare

Organization Services and Culture in a Tertiary
Hospital in Saudi Arabia
Mohammed A. Babakkor a Waleed M. Kattan b

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aNeurology Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia; bDepartment of
Health Services and Hospitals Administration, Faculty of Economics and Administration, King Abdulaziz University,
Jeddah, Saudi Arabia

Keywords be a personal environment. It revealed a strong relationship

Accreditation · Quality · Culture · Impact · Saudi between employees’ views of the accreditation effect and a
group culture type. Conclusion: This study’s findings
matched those of a literature review that revealed a relation
Abstract between accreditation and quality. Accreditation can help
Introduction: While accreditation is thought to promote foster an organizational culture changing toward a culture
healthcare quality, a literature review revealed a scarcity of that values skill development, cooperation, outcomes qual-
studies conducted in Saudi Arabia addressing the relation- ity, and customer satisfaction. Accreditation processes have
ship between accreditation and better care quality and been found to promote a long-lasting and sustained im-
healthcare organization culture. Objectives: This research provement in quality of care and culture change. It demon-
examined the accreditation effect on care quality and cul- strated the crucial leadership influences in reaching this
ture presented in King Abdullah Medical City (KAMC), as a goal. © 2023 The Author(s).
healthcare organization, from the perspective of healthcare Published by S. Karger AG, Basel

workers. Methods: The study design is a cross-sectional

quantitative using anonymous and self-administered ques-
tionnaire for data collection from healthcare employees. The Introduction
total number of participants was 218. Descriptive analysis
was used, including means, range, and standard deviation. Accreditation is considered a way designed to en-
Also, the χ2 test was used for the association between the hance the quality, effectiveness, and efficiency of health-
variables. Results: The result of the study showed that most care organizations by improving its three primary levels
of the dimensions associated with quality of care received structure, process, and outcome [1]. In general, accred-
high ratings. It revealed a significant beneficial association itation is often seen as a systematic program that as-
between employees’ perceptions of accreditation and qual- sesses organization performance against a set of stan-
ity of care across all these dimensions. The most dominant dards via evaluation and reviewing functions and prac-
culture at KAMC was a group type demonstrated KAMC to tices [1, 2].

[email protected] © 2023 The Author(s). Correspondence to:

www.karger.com/sjh Published by S. Karger AG, Basel Mohammed A. Babakkor, babakkor.m @ kamc.med.sa
This is an Open Access article licensed under the Creative Commons
Attribution-NonCommercial-4.0 International License (CC BY-NC)
(http://www.karger.com/Services/OpenAccessLicense), applicable to
the online version of the article only. Usage and distribution for com-
mercial purposes requires written permission.
 In 1998, The Joint Commission International (JCI) ed [8]. The result was consistent with Alkhenizan report-
was founded and extended its activities outside the USA. ed that accredited hospitals improved clinical outcomes
Because the standards of accreditation at international in areas such as pain management, infection control, and
are different from those within the USA, the JCI is com- trauma care [7]. According to Braithwaite, this associa-
mitted to enhancing the quality and safety of patient care tion is not strong and should be interpreted carefully [5].
around the world. In Saudi Arabia, the importance of us- However, others discovered no different statistical signif-
ing accreditation processes to raise the efficiency of icance in performance between accredited and unaccred-
healthcare facilities has increased over the past years [3]. ited hospitals [9].
In 2005, the Central Board for Accreditation of Health- Accreditation provoked organizational changes
care Institutions (CBAHI) was established in order to de- through process implementation, system integration,
velop and enforce standards of quality in all healthcare and, in some cases, organizational structure improve-
provider organizations in Saudi Arabia. The main tasks ments [10]. Organizations are forced to meet the quality
of CBAHI are to develop the standards of quality of criteria required by accrediting bodies, thereby creating a
healthcare services and provide certificates of accredita- need to focus on changes that impact the organization’s
tion for healthcare organizations that meet the criteria various functional and strategic dimensions, leading to a

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and comply with the standards. It also provides profes- state of learning and improvement in the organization.
sional counselling, training, and education to healthcare Environmental change induces organizational learning;
facilities as well as sharing the finding and recommenda- hence, an organization defensively lines up with the set-
tions of analysis of medical errors and patient safety con- ting to achieve stability and competitiveness [11].
ditions with the stakeholders. In addition, CBAHI devel- Lanteigne [10] assessed the incorporation of the ac-
ops criteria for classification of healthcare organizations creditation Canada program as a cause of change and
determining the range of pricing in private hospitals [4]. learning of organization in two healthcare institutes in
Despite the widespread use of accreditation in several Canada and Italy. The researcher reported that persons,
parts of the world and the prevailing belief that accredita- teams, and institutes had valuable learning [10]. Another
tion was linked to variables influencing the successful research accomplished by Pomey et al. [12] aimed to ex-
quality of healthcare and organizational outcomes, only amine how accreditation led to changes in a corporation
limited scientific research contributed to its recognition that could increase the quality and safety of care. It was a
as an indicator of the success of healthcare [5]. The litera- retrospective study that analyzed characteristics and ex-
ture showed an inconsistent result on the impact of plored changes related to accreditation in five Canadian
healthcare organization accreditation. Some studies im- Healthcare Organisations (HCOs) with various accredi-
plied that accreditation had contributed immensely to tation profiles. Findings demonstrated that the accredita-
improving the quality of healthcare organizations, while tion program was a significantly successful mechanism
others have indicated no effect. for fostering collaboration and steady quality improve-
A systematic review study was conducted by Green- ment [12].
field and Braithwaite [6], in which 3,000 articles were In Saudi Arabia, very few studies addressed the accred-
identified. The review discovered that motivation of itation effect on healthcare quality services. Al Awa et al.
change and skill improvement was reasonably consistent [13] conducted a study collecting 119 performance met-
across accredited hospitals, with significant improve- rics. The author found that accreditation benefited pa-
ments. The data conflicted across professional attitudes tient safety and quality-of-care indicators [13].
toward accreditation, organizational impact, economic Almasabi and Thomas [3] assessed the effect of
impact, and quality and program evaluations. Ultimately, CBAHI accreditation on quality of care using a mixed-
insufficient research exists to make a conclusion regard- method research design. Although the study showed
ing the effect of accreditation on patient and public per- some improvement in the procedure, no influence of
ceptions [6]. Based on a review study carried out by accreditation on quality outcomes could be demon-
Alkhenizan [7], twenty-six studies that examined the im- strated [3].
pact of accreditation were recognized and met the inclu- Although numerous studies have recognized that ac-
sion criteria. The research finding indicated a positive ef- creditation in healthcare organizations is an essential ele-
fect of the accreditation process on clinical outcomes [7]. ment for improving the quality of patient care and safety,
Schmaltz demonstrated more improvement in JCI-ac- a great deal of research is needed to evaluate the real ac-
credited hospitals’ performance than those not-accredit- creditation effect on patient healthcare quality and orga-

Accreditation Impact on Healthcare Saudi J Health Syst Res 2023;3:154–161 155

Quality and Culture DOI: 10.1159/000529643
nization culture. Also, very few studies from the KSA as- not know = 9. For the professional engagement section, the par-
sessed the accreditation effect on the quality of care. None ticipant was required to rate each question from “1 – never” to
“5 – always.”
of these studies explored an association of accreditation
with organizational culture changes. The current study Culture Questionnaire
aims to fill this gap in literature. The culture questionnaire offers four aspects of understanding
organizational culture: character, the managers, cohesion, and em-
phasis. It was used to evaluate organization changing by looking at
Method different cultures (group culture, developmental culture, hierar-
chical culture, and rational culture) in terms of contextual vari-
This quantitative, cross-sectional study aims to explore and ables in the learning process [11, 12, 15].
quantify the potential association between participation in accred- The purpose of grading these four dimensions was to deter-
itation and quality of care and organizational culture change. The mine what kind of culture the hospital has. Within each of the four
study was carried out at King Abdullah Medical City (KAMC), dimensions, the respondents weighed the four scenarios by mark-
Makkah, Saudi Arabia, a 500-bed non-profit healthcare organiza- ing which situation matched the corresponding amount of time.
tion considered a tertiary services provider Center. KAMC has The researcher was devoted to adhering to all ethical concerns nec-
been accredited by JCIA since 2013 and had been reaccredited in essary to handle research; ethics approval was acquired from IRB

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2019. KAMC also has been accredited by CBAHI since 2017 and Committees at King Abdullah Medical City to carry out the study
had been reaccredited in 2020. The target population included all with IRB reference number 20-712.
KAMC employees: managers, administrative personnel, physi-
cians, nurses, dentists, pharmacists, technicians, dietitians, and Data Management and Statistical Analysis
support staff. To maximize the study sample size, it was decided to send the
In the current study, we used an anonymous, self-0adminis- questionnaire to all KAMC employees. The collected data were
tered questionnaire that had previously been developed and uti- transferred into an Excel spreadsheet, where data coding was per-
lized by Pomey et al. [14] and in other studies [11, 15]. A link to formed. Then the Excel file was imported into SPSS for analyzing
the electronic questionnaire was sent along with a participation the data. For descriptive purposes, categorical data were presented
invitation message to all KAMC staff through email, and an invita- as percentages, and numeric data were presented as the mean,
tion message explained the aim of the study with an emphasis on standard deviation, or median and range according to data distri-
voluntary participation. bution. The χ2 test was used to compare categorical variables.
Spearman’s correlation was used to explore the association be-
tween ordinal variables. For testing the associations, multivariate
analysis was used, participation in accreditation was taken as an
The Questionnaire independent variable, and quality improvement and organization-
al culture change as dependent variables.
The questionnaire was categorized into two parts: (a) manage-
ment for researching the program for quality enhancement and (b)
culture for understanding the mechanisms of change and learning
in the organization. Results
Management Questionnaire
This part of the questionnaire contained four sections: demo- Approximately 2,000 employees were in KAMC dur-
graphic information, quality of care, professional participation in ing the time of the study that took place. The total number
organizational management, and accreditation impact. Demo- of questionnaires collected was 218 (CI 95%, with a 6.27%
graphic information had eight items. The quality-of-care section margin of error), of which no one was discarded. The
compiles data on the hospital’s involvement in quality improve-
ment in seven areas: leadership (11 items), information and analy- main reason for the high completion percentage was a
sis (7 items), strategic quality planning (7 items), human resources provision in the electronic survey instrument that mini-
utilization (8 items), quality management (9 items), quality results mized the number of parts left blank by not being permit-
(5 items), and customer satisfaction (9 items). Professional par- ted to move on to the next section until the prior one was
ticipation in the organizational management portion assesses par- completed. The sample size represented approximately
ticipants’ degree of engagement in the organization’s management
(4 items). The accreditation impact part contained thirteen ques- 10.9 percent of the total employees in KAMC, which was
tions investigating the effect of the accreditation process on change a convenient obtained sample.
dynamics. It also evaluates organizational learning by examining As seen in Table 1, the results came from demograph-
the degree to which the organization was aligned with its sur- ic characteristics that were more male than female (59.2
roundings. The participant was instructed to tick the box corre- vs. 40.8%). The majorities (56.9%) of respondents were
sponding to each question for demographic information. In the
quality of care and accreditation impact parts, each question was within the age-group Between 30 and 45 years, and all the
assessed by the respondents as strongly disagree = 1, disagree = 2, respondents were full-time. Most participants (61%) have
neither disagree nor agree = 3, agree = 4, agree strongly = 5, or do been involved in the accreditation.

156 Saudi J Health Syst Res 2023;3:154–161 Babakkor/Kattan

DOI: 10.1159/000529643
Table 1. Participants’ demographic characteristics (N = 218) Table 2. Quality improvement perception

N % Quality scales Mean Standard Range

deviation
Demographic details
Gender Leadership 4.02 1.05 3.59
Female 89 40.8 Information and analysis 4.24 1.11 3.79
Male 129 59.2 Strategic quality planning 4.03 1.00 3.57
Age Human resources utilization 3.83 1.08 4.00
<30 years 56 25.7 Quality management 4.25 1.15 3.72
30–45 years 124 56.9 Quality results 4.26 1.35 4.00
46–55 years 24 11.0 Customer satisfaction 4.12 1.01 4.39
>55 years 14 6.4
Working status
Full-time employee 218 100
Part-time – – Table 3. Accreditation participants’ perception
Member of the quality management department

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Yes 35 16.1 Accreditation scales Mean Standard Range
No 183 83.9 deviation
Involved in the accreditation
Yes 133 61.0 Overall Accreditation Impact 4.21 1.10 4.15
No 85 39.0
Years in organization
<5 years 76 34.9
5–10 years 134 61.5
>10 year 8 3.7
nally the utilization of the human resources (mean 3.83,
Occupation variables Std. 1.08).
Clinical The mean scores indicated that the quality-of-care
Physician 64 29.4
Nurse 41 18.8 components’ areas of strength were quality results (4.26),
Technician 42 19.3 quality management (4.25), and information and analysis
Dentist 1 0.5 (4.24). In conclusion, most elements under the quality of
Pharmacist 3 1.4 care obtained high scores, indicating that staff evaluated
Radiology 8 3.7
the corporation as having considerable advancements in
Laboratory 8 3.7
Dietitian 5 2.3 quality and performance.
Managerial
Managerial 9 4.1 Quality-of-Care Perception in Relation to
Other administrative 22 10.1 Demographics
Clinical and managerial
Physician and managerial 8 3.7
The χ2 test was used to assess whether there were sig-
Nurse and managerial 3 1.4 nificant differences in responses based on individual par-
Pharmacist and managerial 1 0.5 ticipants’ characteristics concerning quality improve-
Radiology and managerial 1 0.5 ment. The result demonstrated no considerable differ-
Laboratory and managerial 2 0.9 ences in the quality-of-care values based on respondents’
Total 218 100.0 demographic factors. However, there was a fairly signifi-
cant difference between participants who had been en-
gaged and those who had not been engaged in the ac-
creditation regarding the quality result (p value <0.025).
Quality-of-Care Staff Perception These results indicate that the KAMC successfully im-
As shown in Table 2, the study found that quality re- proved quality and customer care as well as administra-
sults ranked first from the employee’s perspective (mean tive fields.
4.26, Std. 1.35), followed by quality management (mean
4.25, Std. 1.15), then information and analysis (mean Staff Perception of Accreditation Impact
4.24, Std. 1.11) followed by customer satisfaction (mean The means, range, and standard deviations were ob-
4.12, Std. 1.01) and strategic quality planning (mean 4.03, tained for the total scores of items in this section. Table 3
Std. 1.00) then leadership (mean 4.02, Std. 1.05) and fi- demonstrated that the overall impact of accreditation mean

Accreditation Impact on Healthcare Saudi J Health Syst Res 2023;3:154–161 157

Quality and Culture DOI: 10.1159/000529643
Table 4. Accreditation and the quality-of-care correlation Table 5. Culture participants’ perception

Accreditation impact Correlation p value Culture type Mean Range Standard

coefficient deviation

Quality-of-care scales Group (A) 27.50 87.5 14.64

Leadership 0.550 0.001 Developmental (B) 23.35 65 8.96
Information and analysis 0.504 0.001 Hierarchical (C) 26.68 81.75 11.24
Strategic quality planning 0.541 0.001 Rational (D) 23.68 80 13.52
H. resources utilization 0.475 0.001
Quality management 0.508 0.001
Quality results 0.615 0.001
Customer satisfaction 0.578 0.001
Overall quality of care 0.671 0.001 types. The result revealed no significant cultural differ-
ences based on participants’ demographic factors.

Accreditation Impact and Culture Correlation

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score was 4.21, with a standard deviation of 1.10. According The results in Table 6 showed a positive relationship
to the Likert Scale, the mean score falls into the category (of between employees’ views of accreditation and the orga-
3.40 and less than 4.20). These findings indicate that staff nizational culture of group type at KAMC (R = 0.221,
were in agreement on the positive effect of accreditation on p value = 0.001). For the other culture types (hierarchical
the improvement of quality of care in KAMC. – developmental – rational), the result demonstrated that
there was no significant correlation between any of these
Accreditation Impact Perception in Relation to and the employees’ perception of accreditation (all p val-
Demographics ues ≥0.05).
The χ2 test was used to explore whether there were sig-
nificant differences in responses based on the character-
istics of individual participants. The results showed no Discussion
relation between demographic variables and employees’
perception of accreditation impact, with all p values Accreditation and Quality of Care
≥0.05. The findings of all seven elements (quality manage-
ment, human resources utilization, leadership, informa-
Accreditation and the Quality-of-Care Correlation tion and analysis, customer satisfaction, strategic quality
As shown in Table 4, overall accreditation was strong- planning, and quality results) revealed a high rating. Ac-
ly connected with quality (R = 0.671, p value 0.001), with cording to the overall mean scores, the aspects of strength
an R2 value of 0.450, as considered by employees at KMC. in the quality-of-care variables were quality results (4.26),
quality management (4.25), and information and analysis
Staff Perception of Organization Culture (4.24). Quality results ranked the highest score that points
Table 5 represents the results of organizational culture out, according to the staff, the KAMC successfully ob-
at KAMC as the employees perceive it. It shows that there tained considerable progress in quality and customer care
were two dominant cultures at KAMC. The first type was as well as administrative fields. Quality management
a group with a mean score of 27.50, and the second type ranked employees’ second-high score (4.25), revealing
was hierarchical with a mean score of 26.68. These results the degree to which all departments contribute to overall
demonstrate that the culture at KAMC is dominantly quality and performance standards. These study results
based on affiliation, teamwork, and participation values are compatible with the research outcomes [11].
and norms. However, it has some features of the ideals The leadership dimension has been scored high (4.02),
and norms associated with bureaucracy. implying that KAMC’s executives paid great attention to
quality principles embedded in the organization’s man-
Cultural Perception in Relation to Demographics agement structure. These findings match previous re-
The χ2 test was used to determine whether there was a search that stressed the importance of leadership in effec-
significant difference in responses based on the charac- tively executing quality programs [6, 16]. According to
teristics of individual participants in relation to culture the study finding, KAMC evaluated the needs and expec-

158 Saudi J Health Syst Res 2023;3:154–161 Babakkor/Kattan

DOI: 10.1159/000529643
 Table 6. Accreditation impact and culture correlation

Organizational culture
group (A) developmental (B) hierarchical (C) rational (D)

Correlation coefficient 0.221 0.030 −0.086 0.114

p value 0.001 0.662 0.207 0.093

tations of its customers very well, as shown by high scores this research, reporting an effect of accreditation on qual-
in customer satisfaction (4.12). ity and customer satisfaction. However, in contrast to
According to the survey, human resource utilization these findings, Sack et al. [20] and Ghareeb et al. [11] re-
was a weakness compared to other dimensions in the or- ported no considerable relation between accreditation
ganization (3.83), which indicates that employees in and customer satisfaction [11, 19, 20].
KAMC did not believe they were receiving appropriate Greenfield and Braithwaite [6] reported that accredi-

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quality development training and education. The study tation was effective when there was a high level of staff
finding demonstrated that age, gender, occupation, and involvement and dedication. The result of the current
working years in the organization did not affect the rat- study was congruent with that was reported in the previ-
ing, according to the demographic statistics in the quali- ous studies, as it showed that staff involvement in accred-
ty-of-care section. The result, however, revealed a posi- itation had a positive influence on quality improvement.
tive relationship between the involvement of workers in Ghareeb et al. [11] found a correlation between em-
accreditation and the quality result subsection. This find- ployees who worked more than 10 years in a firm and the
ing is consistent with the results of Ghareeb et al. [11] and effect of accreditation on quality as perceived employees.
Weber [15] that indicated staff who engaged in accredita- This study contradicted these findings and found no sig-
tion had a more positive attitude toward quality. nificant relationship between the duration of working in
The accreditation impact section revealed that the over- an organization and the effect of accreditation on quality
all employees agreed that accreditation benefits the organi- advancement. This study’s result indicated that accredi-
zation. However, demographic analyses in this section re- tation’s impact on quality improvement was a long-last-
vealed that there had been no discrepancies in the organiza- ing effect that conflicted with the findings of Greenfield
tion depending on gender, age, occupation, involvement in et al. [21], who concluded that improvement was only
accreditation, or years of working. A strong relation was noticed during the corporation’s preparation for the as-
found between the accreditation and quality-of-care sec- sessment.
tions in the evaluation of the correlation analysis, indicating
that KAMC staff considered accreditation a great resource Accreditation and Organization Culture
that induced significant quality improvements. The two dominating cultures at KAMC, based on the
This study’s findings matched those of a literature re- current findings of the culture questionnaire, were group,
view that revealed a relation between accreditation and with a mean score of 27.50, and hierarchical, with a mean
quality. According to Beaumont [17], there is a correla- score of 26.68. The organization’s primary culture type
tion between implementing quality initiatives and engag- (i.e., the group type) demonstrated KAMC to be a per-
ing in accreditation [11, 17, 18]. The findings also re- sonal environment in which employees were deeply mo-
vealed that accreditation and strategic quality planning tivated and devoted, and supervisors were compassionate
have a beneficial correlation that was consistent with Lan- and focused on their workers’ progress and advancement.
teigne’s research [10] on the impact of accreditation on The group culture fostered an environment that pro-
relational and strategic changes in corporations. Accord- motes quality improvement. The second most common
ing to Salmon [2], hospitals in the accreditation process choice was a hierarchical culture, which defined the cor-
had a greater rate of adherence to quality requirements poration as a highly codified and organized environment
than those not included in the accreditation process. characterized by regularity and efficient operating proce-
Based on El Jardali’s research [19], accreditation has a fa- dures and dominated by regulatory requirements and rig-
vorable effect on both quality and customer satisfaction. id policies. According to previous studies, healthcare in-
Such results were in agreement with the conclusions of stitutions are prone to synthesizing various cultural types.

Accreditation Impact on Healthcare Saudi J Health Syst Res 2023;3:154–161 159

Quality and Culture DOI: 10.1159/000529643
Indeed, this may be a requirement as they must have at agement approach that induces a change in the same way
least some features of each type [15]. a new strategic plan would [12, 23, 24]. The outcomes of
The correlation analysis found that accreditation pos- the current study were also supported in alignment with
itively correlates with group culture as viewed by staff. the previous literature findings.
The study’s results showed that KAMC was a group cul-
ture revealed that the firm created a culture that favored Limitations
quality progress. This finding was consistent with the This study has a few limitations discovered and high-
high-quality score results as well. In other words, the lighted in the following lines:
KAMC staff perceived a positive accreditation effect on 1. The sample size in this study did not reach the minimum
culture changing toward team members with the power number to achieve a CI of 95% with a 5% margin error.
to influence the quality, caring for patients, policies, and The main reason for that was the too-long questionnaire,
management. However, the study showed that accredita- making many participants not complete the survey.
tion had no association with other culture types. The 2. In this study, the method for the data collection, a self-
healthcare leaders really do need to recognize the signifi- report questionnaire, was used, which raised the likeli-
cance of having a group culture that encourages quality hood of over- or below estimation of the participant’s

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enhancement makes it possible for staff to feel that they impressions.
are a part of important developments that are taking 3. Using a single quantitative approach, instead of mul-
place, puts a strong emphasis on staff training to increase tiple, for data collection would be considered a limita-
employee awareness of quality improvement interven- tion in this study.
tion. Consequently, the organizations created a culture 4. This research was done in only one medical institute;
that favored acquiring knowledge, sharing ideas, trans- thus, the results of this analysis would not easily be
ferring information, enhancing change, and quality im- generalized to other healthcare organizations.
provement.
These findings reinforce the previous studies that stat-
ed that when healthcare organizations embrace essential Conclusions
characteristics such as cooperation, communication, and
allegiance, they can achieve a higher level of adoption and This quantitative cross-sectional study assessed the ac-
implementation of quality improvement. Accreditation creditation effect on the quality of care. It also examined
can help foster an organizational culture changing toward whether accreditation improved organizational culture.
a culture that values skill development, cooperation, out- Overall, the JCIA and CBAHI accreditation processes
comes quality, and customer satisfaction [11, 22]. have been found to promote improvement in quality of
The findings of this research showed a significantly care and change. This positive impact of accreditation on
positive correlation between accreditation and quality quality-of-care improvement, as recognized by organiza-
care in seven elements, demonstrating that accreditation tion staff, has extended beyond the period of accredita-
has a beneficial effect on these aspects such as quality tion preparation to long-lasting and sustained impact.
management, human resource utilization, leadership, The results demonstrated the crucial leadership influ-
quality results, and customer satisfaction. Therefore, ac- ences in reaching this goal. Additionally, a more substan-
creditation also impacted organization culture and learn- tial commitment to quality improvement education and
ing in these dimensions. As a result of accreditation, it is training is required due to the critical nature of involving
believed that the organization increased its capabilities to employees in accreditation and quality improvement ini-
be internalized by its staff members, resulting in changes, tiatives. The study reinforced what has been explored in
learning, and an acceptance of change becoming customs previous literature studies that the main driving force be-
and habits [11, 15]. hind change is the organizational culture that is influ-
The previous research indicated that when firms focus enced positively by accreditation.
on accreditation, they implement huge strategic plans to
alter the current condition and move it up to higher stan-
dards of quality, as mandated by the accrediting author- Acknowledgments
ity [10, 14]. Also, it was illustrated that accreditation is a We are very grateful to Soha Elmory, MD, PhD, KAMC re-
source for acquiring knowledge and improving service search center for her insightful comments on an initial version of
quality. Consequently, accreditation is viewed as a man- the manuscript.

160 Saudi J Health Syst Res 2023;3:154–161 Babakkor/Kattan

DOI: 10.1159/000529643
 Statement of Ethics Funding Sources

This study was reviewed and approved by the Institutional Re- The authors did not receive any funding related to this study.
view Board (IRB) Committee at King Abdullah Medical City,
Makkah with IRB reference number 20-712. The researcher was
devoted to adhering to all ethical concerns necessary to handle re- Author Contributions
search. A written informed consent was obtained for participation
in this study. Mohammed A. Babakkor and Waleed M. Kattan: designed the
framework, analyzed the data, drafted the manuscript, and ap-
proved the final version.
Conflict of Interest Statement

The authors have no conflicts of interest to declare. Data Availability Statement

All data generated or analyzed during this study are included

in this article. Further inquiries can be directed to the correspond-
ing author.

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Accreditation Impact on Healthcare Saudi J Health Syst Res 2023;3:154–161 161

Quality and Culture DOI: 10.1159/000529643