Assessing the Impact of Hospital Accreditation on Healthcare Quality Management and Provision of Medical Services
Background. The healthcare system plays a pivotal role in implementing socio-economic, medical, and public health measures to safeguard fundamental human rights, specifically health protection, disease prevention, timely treatment, and the extension of life expectancy. This study examines the requir...
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Economics Ecology Socium| _version_ | 1869472211875659776 |
|---|---|
| author | Gognadze, Ketevan Paresashvili, Nino |
| author_facet | Gognadze, Ketevan Paresashvili, Nino |
| author_institution_txt_mv | [
{
"author": "Ketevan Gognadze",
"institution": "Tbilisi State University, Tbilisi, Georgia"
},
{
"author": "Nino Paresashvili",
"institution": "Tbilisi State University, Tbilisi, Georgia"
}
] |
| author_sort | Gognadze, Ketevan |
| baseUrl_str | https://ees-journal.com/index.php/journal/oai |
| collection | OJS |
| datestamp_date | 2026-06-30T15:36:43Z |
| description | Background. The healthcare system plays a pivotal role in implementing socio-economic, medical, and public health measures to safeguard fundamental human rights, specifically health protection, disease prevention, timely treatment, and the extension of life expectancy. This study examines the requirements for medical institutions to obtain certification from international organisations, analyses hospital accreditation in Georgia, examines the current state of healthcare quality, and outlines future perspectives.
Purpose. The study aims to assess the effectiveness of accreditation as a mechanism for improving hospital medical services through accreditation and was conducted using a structured questionnaire administered to medical personnel.
Findings. The objective of the data analysis was to determine the quality of healthcare services provided by clinics to the population and to assess staff awareness of the responsibility of hospital quality management units to ensure service quality, using SPSS software. Additionally, healthcare employees consider implementing international accreditations in medical institutions. General and advanced statistical analyses were used to explore these issues. A total of 336 valid responses from healthcare personnel employed in private clinics in Georgia were included in the analysis. Spearman’s correlation analysis identified a statistically significant positive relationship between perceived improvements in healthcare quality and staff engagement in accreditation-related activities. Furthermore, the chi-square test demonstrated a significant association between clinic location and awareness of international accreditation organisations. The findings also revealed that most respondents perceived accreditation as an important mechanism for improving patient safety, organisational management, and the overall quality of healthcare services.
Implications. Hospital executives must establish dedicated institutional support units to structurally reduce the administrative burden on medical personnel during accreditation transitions. Furthermore, healthcare policymakers can use these empirical insights to design targeted financial and mental health incentive frameworks for the staff. Ultimately, integrating these findings into national strategies will optimise the execution of mandatory compliance policies, turning regulatory pressure into a sustainable mechanism for hospital service quality and competitiveness. |
| doi_str_mv | 10.61954/2616-7107/2026.10.2-8 |
| first_indexed | 2026-07-01T01:00:33Z |
| format | Article |
| fulltext |
Economics Ecology Socium e-ISSN 2786-8958
Volume 10 Issue 2 (2026) ISSN-L 2616-7107
106
Research Article
UDC 614.2:658.562
JEL: I11, I18, M19, M38
ASSESSING THE IMPACT OF HOSPITAL
ACCREDITATION ON HEALTHCARE QUALITY
MANAGEMENT AND PROVISION OF MEDICAL
SERVICES
Ketevan Gognadze
Tbilisi State University,
Tbilisi, Georgia
ORCID iD: 0009-0007-0321-1486
Nino Paresashvili *
Tbilisi State University,
Tbilisi, Georgia
ORCID iD: 0000-0001-6738-5409
*Corresponding author
E-mail: nino.paresashvili@tsu.ge
Background. The healthcare system plays a pivotal
role in implementing socio-economic, medical, and public
health measures to safeguard fundamental human rights,
specifically health protection, disease prevention, timely
treatment, and the extension of life expectancy. This study
examines the requirements for medical institutions to obtain
certification from international organisations, analyses
hospital accreditation in Georgia, examines the current state
of healthcare quality, and outlines future perspectives.
Purpose. The study aims to assess the effectiveness of
accreditation as a mechanism for improving hospital medical
services through accreditation and was conducted using a
structured questionnaire administered to medical personnel.
Findings. The objective of the data analysis was to
determine the quality of healthcare services provided by clinics
to the population and assess staff awareness of the
responsibility of hospital quality management units in
ensuring service quality utilising the SPSS software.
Additionally, healthcare employees consider implementing
international accreditation in medical institutions. General and
advanced statistical analyses were employed to explore these
issues. A total of 336 valid responses from healthcare
personnel employed in private clinics across Georgia were
included in the analysis. Spearman’s correlation analysis
identified a statistically significant positive relationship
between perceived improvements in healthcare quality and
staff engagement in accreditation-related activities.
Furthermore, the chi-square test demonstrated a significant
association between clinic location and awareness of
international accreditation organisations. The findings also
revealed that most respondents perceived accreditation as an
important mechanism for improving patient safety,
organisational management, and the overall quality of
healthcare services.
Implications. Hospital executives must establish
dedicated institutional support units to structurally reduce the
administrative burden on medical personnel during
accreditation transitions. Furthermore, healthcare policymakers
can use these empirical insights to design targeted financial and
mental health incentive frameworks for staff. Ultimately,
integrating these findings into national strategies will optimise
the execution of mandatory compliance policies, turning
regulatory pressure into a sustainable mechanism for hospital
service quality and competitiveness.
Keywords: Certification, Healthcare, International
Accreditation, Medical Personnel, Quality Management.
Received: 24/02/2026
Revised: 15/05/2026
Accepted: 10/06/2026
Published: 30/06/2026
DOI: 10.61954/2616-7107/2026.10.2-8
© Economics Ecology Socium, 2026
CC BY-NC 4.0 license
Economics Ecology Socium e-ISSN 2786-8958
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1. Introduction
1.1. Health System Context and
Structural Development.
The health of the population and the
healthcare systemэs compliance with
international standards are important for
Georgia’s economic stability. The Health Care
and Social Issues Committee of the Parliament
of Georgia, with support from the European
Union and UNDP, developed a long-term
healthcare development strategy and action
plan (Parliament of Georgia, 2017). The
process was inclusive and collaborative, with
broad stakeholder engagement, which was
essential for ensuring high legitimacy. Within
the project, a key priority is to sustain these
improved medical services, which can be
achieved by implementing international
accreditation standards.
The United Kingdom Accreditation
Service (2025) clearly distinguishes between
accreditation and certification. Accreditation is
the formal recognition of organisations or
individuals’ competence (certification, testing,
or inspection). Certification is a third-party
confirmation of compliance with specified
requirements. Over the past 30 years, improving
the quality of medical services from a service
delivery perspective has become a priority for
healthcare organisations. The Institute of
Medicine (IOM) defines healthcare quality as
the extent to which services improve health
outcomes in line with professional knowledge.
(Alhawajreh et al., 2023). Hospital accreditation
is not a simple process; numerous challenges
arise when introducing innovations into
operational processes and applying them.
Accreditation in healthcare is regarded as
one of the oldest and most widely used
instruments for strategic external quality
assessment. Accreditation is an external
evaluation of healthcare organisations against
predefined standards to improve quality.
(Hussein et al., 2021).
Accreditation is a form of engagement
that facilitates the integration of standards into
daily practice. This process is continuous and
continually renewed. According to the World
Bank’s 2017 classification, Georgia is a lower-
middle-income country (World Bank, 2017).
Among the causes of mortality, non-
communicable diseases are the leading cause.
In 2016, diseases of the circulatory system and
malignant neoplasms accounted for 35% and
13% of all deaths, respectively. In addition, a
substantial share of the national disease burden
is attributable to respiratory diseases,
accounting for approximately 38-40% of the
total incidence (National Center for Disease
Control and Public Health, 2017).
1.2. Accreditation Systems, Policy
Evolution, and Healthcare System
Challenges.
Traditionally, accreditation is a voluntary
process; however, in many countries, it has
become mandatory and a prerequisite for
receiving funding from both the state and
insurance companies (Nicklin at al., 2020).
Accreditation may also serve as an external
inspection for the independent assessment of
compliance with regulatory requirements.
Given that the accreditation process
requires substantial staff involvement and
significant financial investment, its purpose
remains a subject of debate among
stakeholders (Petrović, 2018). Considering that
accreditation outcomes may be discussed in
terms of their potential to improve patient
safety, research describing changes in these
areas before and after the accreditation process
is particularly important, as are the differences
that may arise from monitoring the quality of
medical services in accredited versus non-
accredited hospitals (Petrović, 2018).
In 2013, Saudi Arabia made accreditation
mandatory for both medical institutions and
primary healthcare centres, with the objective of
accrediting 502 primary healthcare centres by
2020. The Kingdom of Saudi Arabia was one of
the first countries in the Middle East to adopt
healthcare accreditation programs to improve
the quality of medical services and ensure a safe
working environment. Saudi Arabia is currently
undergoing large-scale reforms aligned with the
Saudi Vision 2030 (2016), announced in 2016.
The Saudi Ministry of Health defined four main
objectives: promoting access to healthcare
services, improving the quality and efficiency of
healthcare, preventing health risks, and
increasing road traffic safety (Alotaibi, 2023).
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Accreditation has gained a reputation as a
key driver of quality and patient safety,
providing public recognition that a healthcare
organisation has met national quality standards
or benchmarks. Notably, the quality of
healthcare, sustainability, and economic
development are interlinked. Effective
healthcare services contribute to a healthier
population, enhance labour productivity, and
support sustainable economic growth.
Sustainability in healthcare systems extends
beyond short-term performance and enables the
continuous delivery of high-quality, accessible,
and efficient services.
Processes that ensure quality
standardisation, such as hospital accreditation,
play a central role. By promoting structured
processes, accountability, and continuous
improvement, accreditation supports not only
immediate quality outcomes but also the long-
term capacity of healthcare institutions to adapt,
evolve, and meet the changing needs of the
population. Therefore, improving healthcare
quality through accreditation represents an
important component of sustainable socio-
economic development. Population health is of
great importance for the socio-economic
development of countries. This requires the
effective and smooth functioning of the so-
called six “systemic building blocks” of the
health system. These building blocks include
medical services, human resources,
technologies, health financing systems,
information systems, and leadership and
governance. The launch of the Universal
Healthcare Programme (Government of
Georgia, 2013) laid the foundation for
universal access to medical services.
However, the current regulatory
framework for the healthcare sector does not
adequately ensure the quality, continuity,
consistency, or efficiency of medical services.
The assessment of medical service quality is
currently underdeveloped. The uneven
geographical distribution of highly qualified
staff creates a significant barrier to accessing
quality medical services, as the ratio of
physicians to mid-level medical personnel
remains unbalanced. In Georgia, the number of
nursing staff has declined significantly owing
to various factors.
Self-medication and “pharmaceutical
abuse” represent systemic challenges. In this
regard, the dispensing of medicines classified in
Group II without a prescription was prohibited
as of 1 September 2014 (Minister of Labour,
Health, and Social Affairs of Georgia, 2014),
and an electronic prescription system was
launched. Since 2023, a new financing model
based on Diagnosis-Related Groups (DRGs) has
been in place, well-adapted to the country’s
socio-economic conditions (Minister of Labour,
Health, and Social Affairs of Georgia, 2023a).
Since 2013, the foundation for a unified
electronic healthcare system has been
established. Particular attention should be given
to introducing a personal data protection system,
which entails the storage of patients’ personal
information, the protection of their rights, and
the transfer of patient-related information to
third parties with the patient’s consent. The
application of accreditation standards will assist
clinics in ensuring well-organised processes that
assure patient safety and enhance patient
satisfaction.
However, numerous variables influence
service quality. The aim is for healthcare
institutions to understand and comply with
international standards to obtain international
accreditations. Closely related to this goal is the
identification and analysis of variables that
affect the quality of medical services, such as
organisational management style, clinical
vision, and the use of technology. Accordingly,
these variables affect service quality.
2. Literature Review.
2.1. Disparities in Accreditation
Resources and Development across
Countries.
Healthcare service providers may
voluntarily assess themselves or be evaluated
according to clearly defined performance
standards. Assessments were based on
transparent framework guidelines. Several
countries, especially Scandinavian countries,
have introduced their own national quality
awards based on the European framework
(Shaw, 2003). Some countries possess greater
knowledge, experience, and resources for
accreditation than others.
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For example, in low- and middle-income
countries (LMICs), limited resources represent a
major challenge to accreditation development
and its sustainability (Alotaibi, 2023).
General accreditation programs improve
treatment processes and therapeutic solutions
for diseases. Accreditation programs have been
shown to improve clinical outcomes. The most
robust research in this field is the Quality
Assurance Programme (QAP). This study
monitored key factors affecting a hospital's
ability to maintain and achieve accreditation
standards, including hospital capacity, staff
levels, staff qualifications, and budget capacity
(Alkhenizan & Shaw, 2011).
In 2011, a study found that one of the
most significant obstacles to implementing
accreditation standards was healthcare
professionals’ scepticism about accreditation’s
positive impact (Alkhenizan & Shaw, 2011). In
this regard, promoting awareness of the
importance of accreditation is paramount
(Abdurabuh et al., 2024; Sperling & Pikkel,
2020). Efforts to promote the importance of
accreditation have worked well and have
significantly reduced scepticism (at least in
Georgia) over the past 15 years.
The frequency and scale of medical errors
remain a constant focus of public interest. In
response to issues related to quality, rising costs,
and government-regulated accountability
standards, healthcare leaders began seeking
scientific methods to improve hospital quality.
However, this has proven to be neither simple
nor cost-effective (Devkaran & O’Farrell,
2015). Patient safety and harm prevention are
key priorities in the implementation of
accreditation programs. The World Health
Organization (2018) has identified patient
safety as a central issue.
In 2005, the European Union (EU)
expanded its framework to make patient safety
a priority, encouraging continuous
improvement in the quality of healthcare
provided to patients (Abdurabuh, 2024). One
important indicator of improved service
quality is reduced mortality. According to the
World Health Organization (2023), the quality
of medical care provided to patients must be
safe, effective, timely, efficient, fair, and
people-centred (Avia & Hariyati, 2019).
The accreditation process involves
assessing the standards implemented in
healthcare institutions and a constant drive for
improvement, which guarantees high-quality
medical services (Hasiu et al., 2025).
Implementing accreditation is associated with
difficulties, including a shortage of human
resources, high costs, and insufficient
experience with the accreditation process.
Accredited healthcare facilities have been
shown to have higher patient satisfaction levels
than non-accredited facilities.
Patient safety is of utmost importance in
all accreditation programs. Integrating standards
into the work process helps minimise medical
errors and prevent nosocomial infections.
Hospital accreditation is an important tool for
assessing the quality of healthcare service.
Implementing accreditation programs positively
impacts quality, improves risk management, and
increases healthcare efficiency (Hasiu et al.,
2025). A complex combination of factors
determines the quality improvement that
accreditation enhances, including clinical risk
mitigation, financial efficiency, and quality of
care in private and public clinics (Abdurabuh et
al., 2024).
Successful accreditation requires strong
leadership, effective change management, and
continuous management support. Accreditation
enhances patient safety and risk management by
enabling effective documentation and
medication management. Accreditation
facilitates the setting of plans and the ongoing
involvement of staff in processes, which, in
turn, leads to improvements in patient safety
and organisational culture (Hasiu et al., 2025).
Recent studies conducted in the Georgian
healthcare sector also emphasise the strong
relationship between employee job satisfaction,
motivation, and service quality outcomes
(Paresashvili et al., 2024).
2.2. Theoretical Perspectives and
Evaluation Approaches.
The most commonly used approach to
evaluate accreditation systems is the benefit-
perception approach, which allows individuals
to record their perceptions of improvements in
service quality and satisfaction with the process
(Devkaran & O’Farrell, 2015).
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Hospitals are complex, bureaucratic, and
multidisciplinary organisations that play a
significant role in delivering healthcare services.
Currently, healthcare professionals focus on
improving various indicators, including quality
(Rasouli et al., 2024). Hospital accreditation is a
complex process characterised by quality
improvement and ongoing difficulties in
standard implementation. Scholars and
researchers in many countries have discussed
ways to improve the quality of services.
Healthcare providers can voluntarily assess their
standards or be assessed against clearly defined
performance standards based on transparent
framework guidelines. For example,
Scandinavian countries have introduced their
own national quality awards based on the
European framework (Shaw, 2003).
2.3. Debates on the Effectiveness of
Accreditation.
Recent evidence has raised critical
objections to the extent to which accreditation
affects clinical outcomes (Alkhenizan & Shaw,
2011), with a growing body of critical analyses
suggesting that the relationship between
accreditation and clinical health outcomes may
not always be linear (Greenfield & Braithwaite,
2008). Hasiu et al. (2025) and Hussein et al.
(2021) argue that while accreditation
significantly improves organisational processes
and standard operating procedures (SOPs), its
direct impact on reducing mortality remains a
matter of intense debate.
Critics argue that accreditation often leads
to “ritual obedience”, in which healthcare
professionals are more focused on
documentation and “checking boxes” than on
the patient’s actual condition (Devkaran &
O’Farrell, 2015). To reduce this risk, the
Ministry of Health of Georgia (2023b) requires
clinic management to continuously monitor
compliance with accreditation standards. This
includes reaccreditation every three years, and it
is recommended that this process be
strengthened by introducing unplanned
monitoring. The implementation of hospital
accreditation in Georgia should be analysed in
the broader context of transition economies,
especially Central and Eastern Europe and the
post-Soviet space.
Healthcare systems in these regions have
undergone significant restructuring since the
collapse of the Soviet Union. Recent literature
highlights that post-Soviet healthcare systems
have developed unevenly, driven by persistent,
structural and institutional challenges. Although
several reforms aimed at improving quality
were implemented, the results were mixed due
to differences in governance, funding, and
institutional capacity (Antoun et al., 2011).
According to Manukyan et al. (2025), the
healthcare quality management system in the
Caucasus region remains underdeveloped and
fragmented. Data from Georgia and Armenia
indicate that healthcare quality is strongly
influenced by patient-provider interactions,
communication gaps, and weak primary
healthcare management (Manukyan et al.,
2025).
The International Society for Healthcare
Quality (ISQua) is working to make the core
requirements of accreditation programs the
mainstay for implementing standards. Experts
offered recommendations, including active
involvement of healthcare providers in the
development of standards, assessment of
accreditation results, and ongoing monitoring
(Hussein et al., 2025).
Central Asian countries, such as
Kazakhstan, have made significant progress in
developing national quality standards,
particularly for infection control. As a result, an
increasing use of quality indicators, such as
nosocomial infection rates, is being employed to
monitor health system performance (Tabrizi &
Gharibi, 2019).
Significant disparities between urban and
rural healthcare systems persist, limiting access
to quality services in these regions. Studies have
shown that improvements in service quality do
not accompany infrastructure development.
Compared to Caucasus and Central Asia,
Eastern European countries such as Romania
have more institutionalised healthcare quality
management systems. These systems include
accreditation bodies, standardised quality
indicators, and regulatory frameworks aligned
with EU standards. For example, healthcare
quality management in Romania is hampered by
fragmented data systems, a lack of integration
between institutions, and limited digitalisation.
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This hinders effective monitoring and
continuous improvement of healthcare quality
(Nițescu et al., 2025).
Unlike developed Western systems,
countries with transitional economies often
face a “top-down” mandatory transition period
(Alotaibi, 2023; World Health Organization,
2023). Research conducted in countries in
transition, such as Serbia, Kazakhstan, and
Poland, has revealed common structural
obstacles (Markovic-Petrovic et al., 2018).
Abdurabuh et al. (2024) and Devkaran et
al. (2019) indicated that while accreditation
improves safety protocols, financial
constraints often create an imbalance between
large, well-funded urban clinics and small
regional facilities. This trend is also reflected
in the Georgian healthcare system.
Comparisons with countries such as Estonia
and the Czech Republic show that success
depends on a change in the organisational
mind-set (Tabrizi & Gharibi, 2019). In many
countries, accreditation is initially perceived as
a “regulatory obstacle” (Mansour et al., 2020).
However, a comparative analysis (Rasouli et al.,
2024) indicates that for accreditation systems to
be effective, a shift from “paper-based
compliance” to patient-centred service delivery,
supported by facility governance and staff
engagement, is essential (Hasiu et al., 2025).
Despite the challenges of implementing
standards, studies consistently show a positive
correlation between accreditation status and the
quality of care patients receive (Bogh et al.,
2015). Accredited healthcare facilities typically
exhibit higher patient satisfaction than non-
accredited facilities. Accreditation supports
strategic planning, enhances risk management
by improving documentation handling, and
contributes to organisational culture shifts
(Desveaux et al., 2017).
The most commonly used approach to
evaluate these systems remains the “benefit
perception approach”, which allows individuals
to record their interpretations of improvements
in service quality and satisfaction (Devkaran &
O’Farrell, 2015; Rasouli et al., 2024).
Environmental factors are important for
receiving medical services. Providing quality
healthcare implies minimising the impact of
environmental factors.
Environmental management systems
(EMS), such as ISO 14001, aim to prevent
pollution, comply with regulatory requirements,
and achieve resource efficiency. While both
frameworks contribute to improving the
performance of management systems, their use
in isolation often results in incomplete
implementation of work processes and the need
to find additional work resources (Simion
Ludușanu et al., 2025).
One of the key challenges in healthcare is
managing medical and infectious waste
generated by hospitals. The segregation,
treatment, and disposal of these wastes require
strict control (Simion Ludușanu et al. 2025).
Environmental protection and improvement of
indoor ventilation systems have a positive
impact on the environment and on the
management and control of nosocomial
infections (Simion Ludușanu et al., 2025).
3. Methodology.
Tailored questionnaires for hospital
managers and medical staff were used to
identify opportunities to improve hospital
medical services. The questionnaire for hospital
managers had 23 questions, while that for
medical personnel had 33 questions. Both
questionnaires included questions regarding
demographic information. The questionnaires
also assessed the need for international
accreditation, its impact on clinics, and their
readiness for accreditation in terms of human
resources and finances. Both questionnaires
were based on those of Gorgadze & Vasadze
(2018) and Kazakhashvili (2019), who studied
improvements in healthcare and the quality of
medical services in Georgia. The survey data
were processed and analysed using the SPSS.
For general analysis, frequency tables and
graphical analysis were used, and to test the
hypotheses, we used:
• Correlation analysis was used to
determine the statistical relationships and
strength of associations between parametric and
parametric–ordinal variables (where ordinal
variables were assessed using scores).
• The Kruskal–Wallis test was used to
identify statistical relationships among non-
parametric variables (across all categories of the
grouping variable).
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• The Mann–Whitney test was used to
determine statistical relationships between non-
parametric variables (across two categories of
the grouping variable).
• Crosstabulation analysis.
Participants were recruited through
convenience sampling. The survey was
distributed to all staff members across the
private clinic chain, and participation was
voluntary. The employees of the clinic network
participated in the survey. Geographically, the
sample included employees working in branches
in Tbilisi and other Georgian regions. A total of
336 valid responses were collected. The
demographic characteristics of the study
participants are presented in Table 1.
Table 1. Demographic Characteristics of Respondents.
Characteristic Category N (Count) Percentage (%)
Gender Female 274 81.5
Male 62 18.5
Age 18–25 years 28 8.3
26–35 years 66 19.6
36–45 years 94 28.0
46–55 years 97 28.9
55+ years 51 15.2
Job Title Head of Department 47 14.0
Department Manager 37 11.0
Doctor 97 28.9
Head Nurse 23 6.8
Nurse 49 14.6
Other 83 24.7
Location Tbilisi 306 91.1
Regions 30 8.9
Hospital accreditation has been
implemented and developed in many low- and
middle-income countries (LMICs). The theory
of accreditation policy dissemination is a
useful tool for sharing it across countries and
contexts, including analysing its dissemination
in LMICs. The lack of resources required for
accreditation remains a major challenge to the
development and sustainability of accreditation
policies in LMICs. Analysing accreditation
policy processes can provide context-specific
lessons for both LMICs and international
organisations supporting accreditation
development in these countries (Mansour et al.,
2020). Government support is critically
important for developing and maintaining
national accreditation programmes in resource-
constrained settings (Mansour et al., 2020).
Methodological challenges in measuring
the effects of accreditation/certification are
compounded by the complexity of hospital
organisations and their heterogeneous
components. The elements that should be
assessed remain unclear. The UK Medical
Research Council notes that identifying the
“active ingredient” of complex interventions,
such as fall prevention or hand hygiene
campaigns, is challenging because these
interventions comprise multiple, multi-level,
and parallel components (Brubakk et al., 2015).
As the largest professional group in
hospitals, nurses play a crucial role in
improving healthcare quality. Despite their
contributions, nursing work is not always
adequately reflected in quality measurements
or hospital performance indicators (Gurisch et
al., 2024). Continuous professional
development of nursing staff and their
involvement in hospital operations are vital, as
they directly influence the quality of healthcare
service delivery. Accreditation implementation
can also be analysed in terms of healthcare
sustainability. Improvements in service quality
extend beyond immediate clinical outcomes
and contribute to the long-term efficiency and
functionality of the system.
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Standardised procedures, reduced
medical errors, and improved coordination of
care lead to more effective resource use and
help avoid unnecessary costs.
The accreditation process strengthens
trust in healthcare institutions and enhances
the quality of interactions between providers
and patients. By supporting workforce
development, improving organisational
processes, and promoting accountability,
accreditation contributes to a healthcare
system capable of maintaining performance
over time while adapting to new challenges.
The ability to combine quality improvement
with long-term efficiency and responsiveness
represents a core dimension of sustainable
healthcare development.
The Minister of Labour, Health, and
Social Affairs of Georgia (2023b) requires that
clinics obtain accreditation, thereby improving
the quality of medical services and increasing
the vitality and standard of living of the
population in the future. It is widely
recognised that implementing international
accreditation enhances the quality of
healthcare services, thereby directly improving
population satisfaction levels.
Clinics have the freedom to select from
the listed organisations the one whose
conditions are acceptable to them, and after a
designated preparatory period, obtain the
corresponding certification. The process takes
considerable time and requires both funding
and personnel resources.
Accreditation standards primarily focus
on patient safety, data privacy, infection
prevention, access to advanced technologies,
continuous professional development of
physicians, and information technology
support.
The principle of teamwork is crucial for
ensuring the quality of medical care.
Healthcare institutions regularly conduct
patient satisfaction surveys, incorporating the
perspectives of both patients and their families
(Gorgadze & Vasadze, 2018). Periodic
employee satisfaction surveys should also be
conducted to assess employee satisfaction.
The assessment of technological
infrastructure is a key element of healthcare
accreditation, such as information technology
(IT) systems, which aim to ensure timely access
to patient health information, contributing to the
continuity of medical services and the rapid
receipt of information about a specific patient
(Katukia, 2016). The Ministry of Health of
Georgia recognises six international healthcare
accreditation organisations: Accreditation
Canada, AACI, JCI, KTQ, TEMOS
International Healthcare Accreditation, and
ACHS International (Minister of Labour,
Health, and Social Affairs of Georgia, 2023b).
A total of 336 individuals participated in
the survey to identify statistical relationships.
The research participants were personnel
employed in private clinics across Georgia. The
questionnaire focused on the extent to which the
clinical staffs were aware of accreditation
requirements. The purpose of the data analysis
was to determine the quality of healthcare
services provided by clinics to the population
and to assess the staff's awareness. Additionally,
healthcare employees consider implementing
international accreditation in medical
institutions. General and advanced statistical
analyses were used to explore these issues.
Based on the general analysis, the
following findings were obtained:
1. The implementation of international
accreditation contributes to improving the
quality of healthcare services in Georgian
clinics (Fig. 1).
2. The accreditation process is essential
for improving quality management (Figure 2).
3. Accreditation increases patient inflow
and the visibility of clinics (see Figure 3).
Figure 1 clearly shows that international
accreditation improves the quality of healthcare
services in Georgian clinics.
According to Figure 1, the overwhelming
majority of respondents believed that
accreditation in Georgia would improve
healthcare services in clinics. Figure 2 clearly
shows that the majority of respondents consider
accreditation a necessary condition for
improving quality management.
Economics E
Volume 10
F
Fig.
Figur
(45.8%) b
impacts cli
For
following w
H1:
resulting fr
of engagem
H2:
of the qua
than junior
Ecology Soc
Issue 2 (202
Fig. 1. The
. 2. The Im
re 3 show
believe tha
inic visibilit
a more
were formu
Improvem
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114
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N 2786-8958
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Economics Ecology Socium e-ISSN 2786-8958
Volume 10 Issue 2 (2026) ISSN-L 2616-7107
115
Fig. 3. The Impact of the Accreditation Process on Patient Inflow and Clinic Visibility.
The validity of the first hypothesis was
confirmed through a correlation analysis using
Spearman’s test (Table 2). The correlation is
established between two ordinal variables, the
first variable “Do you think the accreditation
process will help improve the quality of medical
services in Georgian clinics?”. The following
categories represent this: 1 – Completely Agree,
2 – Somewhat Agree, 3 – Completely Disagree,
and the second variable, “Were you actively
involved in the process of preparing for
accreditation?” is rated on a 5-point scale with
the following correspondence: 1 – Always, 2 –
Often, 3 – Rarely, 4 – Never, 5–No Answer.
The correlation revealed a correlation
between the two variables (r=0.216), with a
statistically significant relationship (p<0.01).
Such a low correlation coefficient
explains only a small part of the variation (less
than 5%). This indicates that perceptions of
service quality account for only a small part of
staff engagement, and that other, more
powerful factor may also influence it. This is
important to consider, as organisational
management style and leadership can affect
both quality indicators and employee
motivation.
Table 2 shows a highly reliable and
statistically significant relationship between
service quality improvement and medical staff
engagement at the 0.01 level. Figure 4
illustrates the linear relationship between
medical staff engagement and the impact of
accreditation on service quality.
Table 2. Spearman’s rho Correlation Analysis between Perceived Medical Service
Quality and Medical Staff Engagement Levels (n=336).
Variables Statistical
Indicator
Perceived Improvement in
Healthcare Quality
Involvement in Accreditation
Preparation
Spearman’s rho
Correlation
Coefficient
1.000 0.216**
Sig. (2-tailed) - 0.000
N 324 323
Involvement in
Accreditation
Preparation
Correlation
Coefficient
0.216** 1.000
Sig. (2-tailed) 0.000 -
N 323 335
Note: Correlation is significant at the 0.01 level (2-tailed).
14.9%
11.3%
17%
45.8%
11%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Increased
Patient
Visits
Increased
Visibility
Improved
ervice
Quality
All of the
Above
Other
Accreditation process had a positive impact on the
ongoing processes in the clinic
Economics Ecology Socium e-ISSN 2786-8958
Volume 10 Issue 2 (2026) ISSN-L 2616-7107
116
Fig. 4. Correlation of Accreditation Involvement with Perceived Impact on Georgian Clinics.
The Figure 4 shows that the greater the
improvement in service quality resulting from
accreditation, the higher the level of medical-
staff engagement. Spearman’s test indicated a
positive correlation; however, the correlation
coefficient was not sufficiently high.
This is because individuals who consider
accreditation unnecessary do not participate in
the process, whereas those who consider
accreditation necessary to at least some extent
tend to be almost as active as those who
consider it essential. To test the validity of the
second hypothesis, the Kruskal–Wallis test was
used (Tables 3 and 4) as the variables were
nonparametric.
The variable –“In your opinion, is the
involvement of the quality department important
in the accreditation process?” includes the
following categories: 1 – Very Important, 2 –
Less Important, 3 – Not Important, 4 – Other.
Including the median in the Kruskal-
Wallis test procedure gives us frequency
distributions of Job Title on the left (<= median)
and on the right (> median).
As shown in Table 3, the trend is the same
across all positions, with the majority to the left
of the median, indicating that, especially for
doctors, the majority consider the involvement
of the quality department in the accreditation
process to be very important.
Table 3. Frequencies of Responses by Job Title (Median Split).
Position Job Title
Head of
Dept.
Dept.
Manager
Doctor
Head
Nurse
Nurse Other
In your opinion, is the involvement of the
quality department important in the
accreditation process?
> Median 1 3 3 0 5 2
<= Median 46 34 94 23 44 11
The Kruskal–Wallis test indicated that
there was no statistically significant
relationship between respondents’ positions
and the quality department’s involvement in
the accreditation process (p = 0.118, which
exceeds 0.05).
This suggests that staff across all
positions exhibit a broadly similar tendency
regarding the quality department’s involvement
in the accreditation process; therefore,
Hypothesis 2 was not confirmed.
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
1 Always 2 Often 3 Rarely 4 Never 5 No AnswerD
o
yo
u
t
h
in
k
t
h
e
ac
cr
ed
it
at
io
n
p
ro
ce
ss
w
il
l
h
el
p
im
p
ro
ve
t
h
e
q
u
al
it
y
of
m
ed
ic
al
s
er
vi
ce
s
in
G
eo
rg
ia
n
c
li
n
ic
s?
Were you actively involved in the process of preparing for accreditation?
Completely Agree
Somewhat Agree
Completely Disagree
Economics Ecology Socium e-ISSN 2786-8958
Volume 10 Issue 2 (2026) ISSN-L 2616-7107
117
Table 4. Statistical Parameters Obtained from the Kruskal–Wallis Test.
Statistic Value
N 266
Median 1.00
Chi-Square (χ²) 8.792
df 5
Asymp. Sig. (p-value) 0.118
Grouping Variable: Job Title (position).
Note: 5 cells (35.7%) have expected frequencies less than 5; minimum expected frequency = 0.7.
The hypothesis was tested using a
crosstabulation analysis, as the dependent
variable (familiarity with international
accreditation organisations) and the factor
(location) were nonparametric variables.
Table 5, obtained through
crosstabulation, presents the frequency
distribution of international accreditation
organisations in Tbilisi and the regions.
Table 5. Cross-Tabulation of Familiarity with Accreditation Organisations and Clinic
Location (% within Accreditation Organisation).
Accreditation Organisation Familiarity Tbilisi (%) Region (%) Total (%)
Accreditation Canada 61.9 38.1 100.0
AACI 54.8 45.2 100.0
JCI 55.9 44.1 100.0
KTQ 74.8 25.2 100.0
TEMOS 67.9 32.1 100.0
ACHS 47.1 52.9 100.0
All of the Above 78.3 21.7 100.0
None of the Above 76.5 23.5 100.0
Total 68.2 31.8 100.0
As shown in the frequency distribution
(Table 5), except for the organisation ACHS,
international accreditation organisations are
considered more important in Tbilisi than in
the regions, with a significant difference. Table
6 shows the statistical relationships between
the independent and dependent variables using
the chi-square test.
The results of the chi-square test
indicate that the clinic location significantly
affects awareness of international accreditation
organisations.
Table 6. Chi-Square Test Statistics.
Test Value df Asymptotic Significance (2-sided)
Pearson Chi-Square 14.696 7 0.040
Likelihood Ratio 14.474 7 0.043
Linear-by-Linear Association 4.431 1 0.035
N of Valid Cases 336 - -
Note: 0 cells (0.0%) have expected count less than 5. Minimum expected count = 5.41.
Economics E
Volume 10
The
relationshi
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Fig. 5. In
To
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Ecology Soc
Issue 2 (202
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Economics E
Volume 10
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Ecology Soc
Issue 2 (202
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N 2786-8958
L 2616-7107
tion
eorgia, this
dulated by
Empirical
healthcare
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on broader
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nd targeted
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refore, the
mandatory
d by robust
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care reform
of medical
ent safety
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tate-funded
mework for
sparities in
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Economics Ecology Socium e-ISSN 2786-8958
Volume 10 Issue 2 (2026) ISSN-L 2616-7107
120
The accreditation process also increases
medical institutions’ administrative
responsibilities, improves resource
management, and fosters a culture of data-
driven decision-making. Patient trust increases,
service transparency improves, and the principle
of continuous quality improvement is
established, thereby contributing to the long-
term sustainability and competitiveness of the
Georgian healthcare system.
The main limitation of this study is that it
was conducted in private clinics and did not
include public medical institutions. The sample
had a disproportionately small share of
participants from regions (8.9%), which limit
the generalisability of the conclusions about
geographic differences. Since the accreditation
process is new to the Georgian healthcare
system and there is limited experience, it is
necessary to study in greater depth the impact
of this process on the fundamental principles of
quality in public medical institutions. It is
important to determine how the accreditation
process affects clinical outcomes, particularly
mortality rates, given the current organisational
and economic context in Georgia, which is
relevant to both private and public clinics.
5. Conclusions.
The research analysis examines the
impact of hospital accreditation on the quality
of medical care and presents an evidence-based
argument in favour of implementing modern
quality standards. This study examines both the
theoretical role of accreditation and, based on
empirical data, its impact on clinical processes,
patient safety, and organisational management
efficiency. This direction is especially relevant
at the development stage of the Georgian
healthcare system, when service quality is
being harmonised with international standards.
The study complements the existing
literature by analysing the local context. It lays
the groundwork for further research on the
dynamics of quality indicators across different
stages of the accreditation process.
The results obtained can be shared with
the clinics involved in the study, enabling them
to identify areas for improvement, benchmark
their performance against the established
standards, and plan evidence-based changes.
The practical implementation of the
results is associated with several challenges
that may affect the organisational environment
and staff motivation. Continuous
implementation of accreditation requirements
involves detailed documentation, regular audits
and periodic evaluation of processes.
These circumstances often lead to
increased work stress among employees,
especially when changes are implemented
quickly or lack sufficient training and support.
Among the difficulties are the mobilisation of
financial resources, infrastructure development
and the formation of an organisational culture,
which requires both financial and human
resources.
However, if changes are managed
correctly and consistently, these difficulties can
be turned into development opportunities.
Improving employees’ qualifications,
optimising processes, and establishing a culture
of continuous quality improvement reduce
initial obstacles in the long term and ensure the
sustainable functioning of the system.
Conflict of Interest Statement.
The authors have declared no conflict of
interest.
Funding Disclosure.
This research received no external
funding.
AI Use Statement.
During the preparation of this work the
author(s) used Grammarly in order to improve
the readability and language of the manuscript.
After using this tool/service, the authors
reviewed the content and take full
responsibility for the content of the article.
Economics Ecology Socium e-ISSN 2786-8958
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121
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| spelling | oai:ojs2.www.ees-journal.com:article-3472026-06-30T15:36:43Z Assessing the Impact of Hospital Accreditation on Healthcare Quality Management and Provision of Medical Services Assessing the Impact of Hospital Accreditation on Healthcare Quality Management and Provision of Medical Services Gognadze, Ketevan Paresashvili, Nino Certification, Healthcare, International Accreditation, Medical Personnel, Quality Management. Certification, Healthcare, International Accreditation, Medical Personnel, Quality Management. Background. The healthcare system plays a pivotal role in implementing socio-economic, medical, and public health measures to safeguard fundamental human rights, specifically health protection, disease prevention, timely treatment, and the extension of life expectancy. This study examines the requirements for medical institutions to obtain certification from international organisations, analyses hospital accreditation in Georgia, examines the current state of healthcare quality, and outlines future perspectives. Purpose. The study aims to assess the effectiveness of accreditation as a mechanism for improving hospital medical services through accreditation and was conducted using a structured questionnaire administered to medical personnel. Findings. The objective of the data analysis was to determine the quality of healthcare services provided by clinics to the population and to assess staff awareness of the responsibility of hospital quality management units to ensure service quality, using SPSS software. Additionally, healthcare employees consider implementing international accreditations in medical institutions. General and advanced statistical analyses were used to explore these issues. A total of 336 valid responses from healthcare personnel employed in private clinics in Georgia were included in the analysis. Spearman’s correlation analysis identified a statistically significant positive relationship between perceived improvements in healthcare quality and staff engagement in accreditation-related activities. Furthermore, the chi-square test demonstrated a significant association between clinic location and awareness of international accreditation organisations. The findings also revealed that most respondents perceived accreditation as an important mechanism for improving patient safety, organisational management, and the overall quality of healthcare services. Implications. Hospital executives must establish dedicated institutional support units to structurally reduce the administrative burden on medical personnel during accreditation transitions. Furthermore, healthcare policymakers can use these empirical insights to design targeted financial and mental health incentive frameworks for the staff. Ultimately, integrating these findings into national strategies will optimise the execution of mandatory compliance policies, turning regulatory pressure into a sustainable mechanism for hospital service quality and competitiveness. Background. The healthcare system plays a pivotal role in implementing socio-economic, medical, and public health measures to safeguard fundamental human rights, specifically health protection, disease prevention, timely treatment, and the extension of life expectancy. This study examines the requirements for medical institutions to obtain certification from international organisations, analyses hospital accreditation in Georgia, examines the current state of healthcare quality, and outlines future perspectives. Purpose. The study aims to assess the effectiveness of accreditation as a mechanism for improving hospital medical services through accreditation and was conducted using a structured questionnaire administered to medical personnel. Findings. The objective of the data analysis was to determine the quality of healthcare services provided by clinics to the population and to assess staff awareness of the responsibility of hospital quality management units to ensure service quality, using SPSS software. Additionally, healthcare employees consider implementing international accreditations in medical institutions. General and advanced statistical analyses were used to explore these issues. A total of 336 valid responses from healthcare personnel employed in private clinics in Georgia were included in the analysis. Spearman’s correlation analysis identified a statistically significant positive relationship between perceived improvements in healthcare quality and staff engagement in accreditation-related activities. Furthermore, the chi-square test demonstrated a significant association between clinic location and awareness of international accreditation organisations. The findings also revealed that most respondents perceived accreditation as an important mechanism for improving patient safety, organisational management, and the overall quality of healthcare services. Implications. Hospital executives must establish dedicated institutional support units to structurally reduce the administrative burden on medical personnel during accreditation transitions. Furthermore, healthcare policymakers can use these empirical insights to design targeted financial and mental health incentive frameworks for the staff. Ultimately, integrating these findings into national strategies will optimise the execution of mandatory compliance policies, turning regulatory pressure into a sustainable mechanism for hospital service quality and competitiveness. Dr. Viktor Koval 2026-06-30 Article Article Peer-reviewed Article application/pdf https://ees-journal.com/index.php/journal/article/view/347 10.61954/2616-7107/2026.10.2-8 Economics Ecology Socium; Vol. 10 No. 2 (2026): Economics Ecology Socium; 106-123 Економіка Екологія Соціум; Том 10 № 2 (2026): Economics Ecology Socium; 106-123 2616-7107 2616-7107 10.61954/2616-7107/2026.10.2 en https://ees-journal.com/index.php/journal/article/view/347/299 Copyright (c) 2026 Economics Ecology Socium https://creativecommons.org/licenses/by-nc/4.0 |
| spellingShingle | Certification Healthcare International Accreditation Medical Personnel Quality Management. Gognadze, Ketevan Paresashvili, Nino Assessing the Impact of Hospital Accreditation on Healthcare Quality Management and Provision of Medical Services |
| title | Assessing the Impact of Hospital Accreditation on Healthcare Quality Management and Provision of Medical Services |
| title_alt | Assessing the Impact of Hospital Accreditation on Healthcare Quality Management and Provision of Medical Services |
| title_full | Assessing the Impact of Hospital Accreditation on Healthcare Quality Management and Provision of Medical Services |
| title_fullStr | Assessing the Impact of Hospital Accreditation on Healthcare Quality Management and Provision of Medical Services |
| title_full_unstemmed | Assessing the Impact of Hospital Accreditation on Healthcare Quality Management and Provision of Medical Services |
| title_short | Assessing the Impact of Hospital Accreditation on Healthcare Quality Management and Provision of Medical Services |
| title_sort | assessing the impact of hospital accreditation on healthcare quality management and provision of medical services |
| topic | Certification Healthcare International Accreditation Medical Personnel Quality Management. |
| topic_facet | Certification Healthcare International Accreditation Medical Personnel Quality Management. Certification Healthcare International Accreditation Medical Personnel Quality Management. |
| url | https://ees-journal.com/index.php/journal/article/view/347 |
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