Transformation of approaches to accreditation as a factor for building an effective quality management system in a medical organization: a comparative analysis of the experience of initial and repeated cycles

Background: The accreditation of medical organizations in Russia is transformed from a voluntary procedure into an obligatory element of the healthcare system. However, its perception as a formal bureaucratic barrier often outweighs the potential benefits of implementing quality management systems (QMS).

Objective: To conduct a comparative analysis of the organizational models used in the preparation for initial accreditation and re-accreditation, and to evaluate their effectiveness in integrating standards into clinical practice and involving staff.

Materials and methods: A longitudinal observational study was conducted at a multidisciplinary hospital with 597 beds over the period from 2022 to 2025. The following methods were used: participant observation, document analysis, staff questionnaires (n=220) on culture safety scales (based on the AHRQ Hospital Survey on Patient Safety Culture), semi-structured interviews with managers (n=15), analysis of key performance indicators (KPIs) of processes.

Results: The initial accreditation which was implemented through a temporary “headquarters”, resulted in obtaining a certificate, but did not form a functional QMS. There was an increase in negative perception of the changes: 78% of the staff assessed the innovations as “an additional bureaucratic burden”. A repeated cycle based on a process-oriented approach (appointing process owners, creating a quality project office) allowed standards to be integrated into the daily work. The introduction of tools focused on solving the acute problems of staff (unified electronic check-lists, five-minute meetings on quality) led to statistically significant changes: reduction in time for unproductive documentation by 35% (p<0.05), increase in the number of reports of risks and undesirable events by 4.2 times, increase in indicators on the scales of “Learning from mistakes” and “Openness of communications” by an average of 40%.

Conclusion: The effectiveness of accreditation as a tool for development is not determined by formal compliance with standards, but rather by the depth of organizational transformation. The transition from a project-based approach to a more system-oriented one, based on process management and the proactive involvement of staff by solving their operational issues, is a critical success factor. This approach transforms accreditation from a costly process into an investment that ensures the long-term viability and competitiveness of the organization.