title: Explaining the accreditation process from the institutional isomorphism perspective: a case study of Jordanian primary healthcare centers.
abstract: BACKGROUND
  While the main focus of accreditation initiatives has been on hospitals, the implementation of these programs is a relatively new notion among other types of healthcare facilities. Correspondingly, this study aims to understand how accreditation is perceived among primary public healthcare centers using an isomorphic institutional theory.
  
  
  METHODS
  Semi-structured, in-depth interviews were conducted with 56 healthcare professionals and administrative staff from seven non-profit healthcare centers in Jordan using an explanatory case-study approach.
  
  
  RESULTS
  The informants' narratives revealed that all three components of institutional theory: coercive, mimetic, and normative pressure, were drivers for institutional change in seeking accreditation. There was an overlapping and blending between the three various types of pressure. While participants perceived that healthcare centers faced formal and informal pressures to achieve accreditation, health centers were reluctant about the time, amount of effort, and their ability to achieve the accreditation. Ambiguity and fear of failure forced them to model successful ones. Moreover, the findings revealed that normative values of health professionals enhanced institutional isomorphism and influenced the accreditation process.
  
  
  CONCLUSIONS
  Identifying these isomorphic changes may help key stakeholders to develop plans, policies, and procedures that could improve the quality of healthcare and enhance accreditation as an organizational strategic plan. Moreover, the study provided explanations of why and how organizations move to adopt new interventions and grow over time. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Jordan.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alyahya
authors.affiliation: Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Jordan.
authors.forename: Heba
authors.initials: H
authors.lastname: Hijazi
authors.affiliation: Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Jordan.
authors.forename: Heather
authors.initials: H
authors.lastname: Harvey
mesh_terms: D000068:Accreditation / Q000379:methods*; D006270:Health Facility Administrators; D006801:Humans; D007407:Interviews as Topic; D007597:Jordan; D009936:Organizational Innovation; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration
keywords: accreditation; healthcare center; institutional theory; isomorphic pressures; isomorphism