Leadership, Accreditation and Building a Quality Culture

This study reports how clinical management unit leaders view their role in accreditation processes at a European public hospital, analysed through the PRECEDE model. Using interviews and observation, researchers identified three themes: tensions between accreditation and quality culture; leadership as a collective, emotionally demanding task; and accreditation as a source of practical improvements and emotional reinforcement. The authors highlight the need to clarify the role of internal leads and to align accreditation language with clinical and managerial realities. Recommendations include leadership development, institutional investment, and redesign of standards to better reflect clinical practice and management responsibilities.

What the study examined

This research explored how leaders of clinical management units understand and experience their role during healthcare accreditation processes in a European public hospital. The team used a qualitative hermeneutic approach, combining individual and group interviews with participant observation, and organised findings with the PRECEDE model to uncover factors that shape leadership practices and the development of a quality-oriented organisational culture.

Key findings

Three main themes emerged from the study:

• Conceptual tensions between accreditation and quality culture. Leaders perceived a gap between the formal language and requirements of accreditation and the everyday realities of clinical and managerial work.
• Leadership as a collective and emotionally demanding endeavour. Leadership responsibilities were described as shared among teams and experienced as emotionally intense, requiring engagement, support and shared commitment.
• Accreditation as both practical and motivating. The process produced tangible improvements in practice while also offering emotional reinforcement that supported team cohesion and a sense of progress.

The analysis pointed to a need for clearer definition of the internal lead role, better alignment between accreditation wording and clinical management realities, and attention to how organisational change affects emotions and culture.

Why it matters

The study offers practical implications for organisations seeking sustained quality improvement. Findings support investment in leadership development, the redesign of standards to reflect clinical practice and managerial responsibilities, and institutional support that promotes shared responsibility and team engagement.

Socially, the research highlights the emotional and cultural dimensions of change processes in healthcare. By framing leadership as collective and emotionally charged, the study underscores the importance of supportive environments that foster team involvement and sustainable improvement.

Methodologically, this work is notable for applying the PRECEDE model to leadership in the context of accreditation, offering a novel framework to understand how internal leads navigate quality improvement within complex healthcare settings.