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Table 5 Thematic analysis of the semi-structured interviews

From: The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon

Topic

N (%)*

Benefits of accreditation

 

Documentation

12(55%)

   Recording minutes of meetings

 

   Thoroughly completing medical records

 

   Documenting rules and regulations

 

Translation of theories of quality into actions

9(41%)

Introduction and reinforcement of quality standards

7(32%)

   Infection control

 

   Occupational safety

 

   Waste management

 

   Fire management

 

   Incident and accident reporting

 

Enhanced employee awareness and involvement

7(32%)

   Giving guidance to employees

 

   Empowering employees and engaging them in decision making

 

   Developing a job description for employees and clarifying their tasks

 

   Better evaluation of employees

 

Better relationship between the centers and the communities they serves

5(23%)

   Role of social workers

 

   Health awareness lectures and campaigns

 

   Community needs assessment

 

   Home visits

 

Improved work conditions

4(18%)

   Work flow became more organized and systematic

 

Enhanced role of management and leadership

3(14%)

   Forming interdisciplinary quality team

 

   Strategic plans

 

   Action plans

 

Better relationship between the centers and patients

3(14%)

   Follow-up on patients

 

   Taking client suggestions, complaints and compliments into consideration

 

   Enhanced patient confidentiality

 

Better relationship between the centers and local authorities

2(9%)

   Strengthened relationship with the Ministry of Public Health

 

   Strengthened relationship with the Ministry of Social Affairs

 

   Strengthened relationship with municipalities

 

The effect of accreditation on staff

 

Staff training, education and development

10(45%)

   Staff perceived accreditation as an opportunity to develop themselves

 

   Staff perceived accreditation as an opportunity to help the society

 

   Accreditation made staff more aware about their rights

 

Enhanced communication between staff and the management

3(14%)

   Engaging staff from the beginning of the process

 

   Allowing staff to voice their opinions and concerns regarding accreditation

 

Enhanced communication among staff

3(14%)

   The importance of teamwork was emphasized

 

The effect of accreditation on patients

 

Increased patient satisfaction

8(36%)

   Increased satisfaction with the setting

 

   Increased satisfaction with sanitation

 

   Increased satisfaction with the quality of services

 

   Increased patient trust in the center

 

Number of patients increased

7(32%)

   Attracting more patients from neighboring villages and higher social class

 

Enhanced relationship between patients and the medical team

4(18%)

   Physicians compliance to appointments

 

   Nurses involvement in patient care

 

Enabling and success factors

 

Commitment and support from the management

7(32%)

   Forming an accreditation committee

 

   Distributing tasks

 

   Good teamwork

 

Continuous training sessions and workshops

7(32%)

Challenges

 

Financial barriers

11(50%)

Staff resistance

11(50%)

   Accreditation was a new and vague concept

 

   Difficulty in communicating the importance of accreditation

 

   Resistance more prevalent among older employees

 

Staff shortages

8(36%)

   Heavy workload

 

   Not able to ensure enough physicians and specialists

 

   High turnover rate of staff

 

   Physicians have limited time to assess medical history and complete medical record

 

Not all the standards are applicable to the context of PHC centers in Lebanon

7(32%)

Referral system among centers and to hospitals is lacking

3(14%)

Strategies for improving implementation of accreditation

 

Financial support

10(45%)

   From Ministry of Public Health and international agencies

 

Follow-up meetings and communication and collaboration with the MOPH, the accreditation team, and among PHC centers, and hospitals

11(50%)

Local experts are recommended to perform assessment

4(18%)

Practical training sessions and continuing education

2(9%)

Engaging municipalities to gain their support

2(9%)

  1. *Percentages are calculated out of a total of 22 facility directors who responded to the interview.