Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units

Purpose This study aims to explore the perceptions of clinical management unit leaders regarding their role in healthcare accreditation processes within a European public hospital. It aims to identify the predisposing, enabling and reinforcing factors that shape leadership practices and influence the development of a quality-oriented organisational culture. Design/methodology/approach A qualitative hermeneutic approach was employed, combining individual and group semi-structured interviews and participant observation. Six healthcare professionals responsible for accreditation projects under the Andalusian Agency for Health Quality participated. Data were analysed using Ricoeur’s interpretative framework, guided by the PRECEDE model. Findings Three themes emerged in this study: (1) conceptual tensions between accreditation and quality culture, (2) leadership as a collective and emotionally demanding endeavour and (3) accreditation as a process that generates both tangible improvements and emotional reinforcement. The study highlights the need to clarify the internal lead’s role and align accreditation language with clinical and managerial realities. Research limitations/implications Future research could examine how gender dynamics influence leadership in accreditation processes. Practical implications Findings support the need for leadership development, institutional investment and the redesign of accreditation standards to better reflect clinical practice and managerial responsibilities. Social implications The study underscores the emotional and cultural impact of organisational change, highlighting the importance of supportive environments that foster shared responsibility, team engagement and sustainable quality improvement. Originality/value This is the first study to apply the PRECEDE model to explore leadership in accreditation. It offers a novel framework for understanding how internal leads navigate quality improvement within complex healthcare organisations and provides actionable insights for institutional development.