title: Quality of care in accredited and nonaccredited hospitals:  perceptions of nurses in the Eastern Province, Saudi Arabia.
abstract: BACKGROUND
  Although Saudi Arabia is one of the first countries in the Eastern Mediterranean Region to implement healthcare accreditation standards, little is known about its impact on nurse assessment of the provision of healthcare.
  
  
  OBJECTIVE
  The main objectives of this study were to determine the quality of healthcare services provided by accredited and nonaccredited hospitals on the basis of the views of nurses. In addition, this study aimed to explore the potential contributing factors affecting the quality of care.
  
  
  METHODS
  A cross-sectional study was carried out at one accredited and another nonaccredited hospital at Al-Khobar city, Saudi Arabia. A questionnaire was used to assess nurses' perceptions of the quality of healthcare provided in the target hospitals on a five-point Likert scale tool. A total of 164 nurses were surveyed.
  
  
  METHODS
  Quality of healthcare services and the potential contributing factors affecting the quality of care.
  
  
  RESULTS
  The most highly rated scales by nurses were 'education & training' (mean=4.09), followed by 'quality management' (mean=3.96) at the accredited hospital compared with 'use of data' (mean=3.56) and 'strategic quality planning' (mean=3.56) at the nonaccredited hospital. For both hospitals, the lowest scores were assigned to the 'reward' (mean=2.78 and 3.06 by nurses at accredited and nonaccredited hospitals, respectively). Nurses' rating for all scales was higher in the accredited compared with the nonaccredited hospital, except for the reward scale. The difference was statistically significant for all scales, except human resource utilization (P≤0.02). In accredited hospitals and for different scales, nurses with 4-6 years of experience, Saudi nurses, and those aged 30-35 years had significantly higher agreement scores than their counterparts. For the accredited hospitals, the predictors of good-quality results were leadership, commitment and support (P=0.019), and strategic quality planning (P=0.007). For nonaccredited hospitals, predictors of good quality results were leadership, commitment, and support (P=0.001).
  
  
  CONCLUSIONS
  As perceived by nurses in study hospitals, accredited hospitals perform favorably compared with nonaccredited hospitals in almost all quality scales. Thus, accreditation can be considered a tool for improving hospital quality. The most important determinants of quality in healthcare were leadership, commitment and support, and strategic quality planning.
authors.affiliation: aDepartment of Health Information Management and Technology, College of Applied Medical Sciences, University of Dammam, Dammam, Kingdom of Saudi Arabia.
authors.forename: Mona Faisal
authors.initials: MF
authors.lastname: Al-Qahtani
authors.forename: Maram A
authors.initials: MA
authors.lastname: Al-Medaires
authors.forename: Shahad K
authors.initials: SK
authors.lastname: Al-Dohailan
authors.forename: Hind T
authors.initials: HT
authors.lastname: Al-Sharani
authors.forename: Najla M
authors.initials: NM
authors.lastname: Al-Dossary
authors.forename: Eman N
authors.initials: EN
authors.lastname: Khuridah
mesh_terms: D000068:Accreditation; D003430:Cross-Sectional Studies; D006761:Hospitals; D006801:Humans; D009726:Nurses; D012529:Saudi Arabia