Challenges of accreditation in hospitals and their operational solutions

Despite the implementation of accreditation requirements in hospitals and continuous monitoring, we still observe shortcomings and deficiencies in some cases, which are addressed in hospital accreditation standards. By identifying the challenges faced by hospitals in this area locally and providing practical solutions, as well as implementing corrective interventions, positive steps can be taken towards the effective implementation of accreditation in hospitals. Previous studies largely focus on challenges within voluntary accreditation models (e.g. JCI and ACS), where commitment is market-driven. This study, conversely, investigates these challenges within the nationally mandated, highly centralized and culturally hierarchical Iranian healthcare context. This shift in mandatory governance creates unique friction points, such as the intense impact of frequent management changes and political influence on resource allocation, which are absent or minimized in voluntary systems. The identification of challenges directly linked to international sanctions (e.g. resource shortages and outdated technology) is a novel contribution that connects quality improvement literature with geopolitical realities. This link is vital for understanding accreditation barriers in sanctioned or developing economies and has not been adequately addressed in the existing global literature. While generalizability across all countries is limited, the findings serve as a crucial benchmark for the wider set of Middle Eastern, highly centralized, and developing economies facing similar governance and resource constraints. The 22 challenges and 26 solutions identified offer a localized framework that is highly applicable to systems operating under similar resource pressures.