title: The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon.
abstract: BACKGROUND
  In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC.
  
  
  METHODS
  The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors.
  
  
  RESULTS
  The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages.
  
  
  CONCLUSIONS
  To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well.
authors.affiliation: Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon. fe08@aub.edu.lb.
authors.forename: Fadi
authors.initials: F
authors.lastname: El-Jardali
authors.forename: Randa
authors.initials: R
authors.lastname: Hemadeh
authors.forename: Maha
authors.initials: M
authors.lastname: Jaafar
authors.forename: Lucie
authors.initials: L
authors.lastname: Sagherian
authors.forename: Ranime
authors.initials: R
authors.lastname: El-Skaff
authors.forename: Reem
authors.initials: R
authors.lastname: Mdeihly
authors.forename: Diana
authors.initials: D
authors.lastname: Jamal
authors.forename: Nour
authors.initials: N
authors.lastname: Ataya
mesh_terms: D000068:Accreditation; D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006270:Health Facility Administrators; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011795:Surveys and Questionnaires