title: Implementing hospital quality assurance policies in Iran: balancing licensing, annual evaluation, inspections and quality management systems.
abstract: OBJECTIVE
  The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.
  
  
  METHODS
  A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010.
  
  
  RESULTS
  The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government's strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity.
  
  
  CONCLUSIONS
  The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries.
  
  
  CONCLUSIONS
  This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.
authors.affiliation: Department of Social Medicine, Academic Medical Center (AMC)/University of Amsterdam, Netherlands and School of Health Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Asgar
authors.initials: A
authors.lastname: Aghaei Hashjin
authors.forename: Bahram
authors.initials: B
authors.lastname: Delgoshaei
authors.forename: Dionne S
authors.initials: DS
authors.lastname: Kringos
authors.forename: Seyed Jamaladin
authors.initials: SJ
authors.lastname: Tabibi
authors.forename: Jila
authors.initials: J
authors.lastname: Manouchehri
authors.forename: Niek S
authors.initials: NS
authors.lastname: Klazinga
mesh_terms: D003906:Developing Countries; D017598:Efficiency, Organizational; D006284:Health Plan Implementation; D006302:Health Services Research; D006739:Hospital Administration / Q000379:methods*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007492:Iran; D008004:Licensure; D016134:Organizational Policy; D016730:Program Development; D015397:Program Evaluation / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care
keywords: Evaluation; Hospital quality assurance; Inspection; Iran; Licensure; Quality management systems