Progress of Development in Generations of the National Hospital Accreditation Program in Iran

Background: Studies have often examined the challenges presented to implementation of accreditation. Nonetheless, after developing and implementing four generations accreditation over 25 years, multiple questions been left unanswered regarding number resolved challenges, emergence new problems, as well mitigation these problems by policymakers managers for next generations. Objectives: Therefore, present study aims explain development progress last two National Hospital Accreditation Program (NHAP) with previous versions in Iran. Methods: As a qualitative research, Semi‐structured interviews were conducted 2020. Through purposive sampling, 20 hospital at different levels experience all participated. Thematic analysis was used analyze. Results: The themes included designing measurement criteria, supervisor's performance (university ministry), hospital's performance, process, announcing results outcomes. Moreover, status national explained categories, including improvable points, improved cases deterioration.‎ Conclusion: revision process NHAP Iran is indicative an upward trend, almost proper modifications made. Significant changes made since third generation. Changes performance-oriented highlighted patient safety very helpful. Changing assessment universities affiliated Ministerial, which trying become partly external evaluation. In addition, some positive achieved fourth generation, significant reduction more professional evaluators, elimination document uploads, definition outpatient criteria. points follows: defining limitations physicians' evaluating input instead output, lack medical guidelines, failure pay attention hospital-type continuous monitoring universities, motivation mechanisms