Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units

PurposeThis study aims to explore the perceptions of clinical management unit leaders regarding their role in healthcare accreditation processes within a European public hospital. It aims to identify the predisposing, enabling and reinforcing factors that shape leadership practices and influence the...

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Autores: Mesa-Blanco, MP, Ventura-Puertos, PE, González-Chordá, VM, Rich-Ruiz, M
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:dnet:r-fisabio___::c4f0ba56c07b8f3b7cc29792ef599262
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/21035
Access Level:acceso abierto
Palabra clave:Hospitals
Leaders
Organisational culture
Qualitative research
Quality
Transformational leadership
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spelling Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical unitsMesa-Blanco, MPVentura-Puertos, PEGonzález-Chordá, VMRich-Ruiz, MHospitalsLeadersOrganisational cultureQualitative researchQualityTransformational leadershipPurposeThis study aims to explore the perceptions of clinical management unit leaders regarding their role in healthcare accreditation processes within a European public hospital. It aims to identify the predisposing, enabling and reinforcing factors that shape leadership practices and influence the development of a quality-oriented organisational culture.Design/methodology/approachA qualitative hermeneutic approach was employed, combining individual and group semi-structured interviews and participant observation. Six healthcare professionals responsible for accreditation projects under the Andalusian Agency for Health Quality participated. Data were analysed using Ricoeur's interpretative framework, guided by the PRECEDE model.FindingsThree themes emerged in this study: (1) conceptual tensions between accreditation and quality culture, (2) leadership as a collective and emotionally demanding endeavour and (3) accreditation as a process that generates both tangible improvements and emotional reinforcement. The study highlights the need to clarify the internal lead's role and align accreditation language with clinical and managerial realities.Research limitations/implicationsFuture research could examine how gender dynamics influence leadership in accreditation processes.Practical implicationsFindings support the need for leadership development, institutional investment and the redesign of accreditation standards to better reflect clinical practice and managerial responsibilities.Social implicationsThe study underscores the emotional and cultural impact of organisational change, highlighting the importance of supportive environments that foster shared responsibility, team engagement and sustainable quality improvement.Originality/valueThis is the first study to apply the PRECEDE model to explore leadership in accreditation. It offers a novel framework for understanding how internal leads navigate quality improvement within complex healthcare organisations and provides actionable insights for institutional development.EMERALD GROUP PUBLISHING LTD2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/21035INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCEISSN: 09526862ISSNe: 17586542reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:dnet:r-fisabio___::c4f0ba56c07b8f3b7cc29792ef5992622026-06-11T12:45:17Z
dc.title.none.fl_str_mv Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units
title Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units
spellingShingle Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units
Mesa-Blanco, MP
Hospitals
Leaders
Organisational culture
Qualitative research
Quality
Transformational leadership
title_short Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units
title_full Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units
title_fullStr Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units
title_full_unstemmed Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units
title_sort Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units
dc.creator.none.fl_str_mv Mesa-Blanco, MP
Ventura-Puertos, PE
González-Chordá, VM
Rich-Ruiz, M
author Mesa-Blanco, MP
author_facet Mesa-Blanco, MP
Ventura-Puertos, PE
González-Chordá, VM
Rich-Ruiz, M
author_role author
author2 Ventura-Puertos, PE
González-Chordá, VM
Rich-Ruiz, M
author2_role author
author
author
dc.subject.none.fl_str_mv Hospitals
Leaders
Organisational culture
Qualitative research
Quality
Transformational leadership
topic Hospitals
Leaders
Organisational culture
Qualitative research
Quality
Transformational leadership
description PurposeThis study aims to explore the perceptions of clinical management unit leaders regarding their role in healthcare accreditation processes within a European public hospital. It aims to identify the predisposing, enabling and reinforcing factors that shape leadership practices and influence the development of a quality-oriented organisational culture.Design/methodology/approachA qualitative hermeneutic approach was employed, combining individual and group semi-structured interviews and participant observation. Six healthcare professionals responsible for accreditation projects under the Andalusian Agency for Health Quality participated. Data were analysed using Ricoeur's interpretative framework, guided by the PRECEDE model.FindingsThree themes emerged in this study: (1) conceptual tensions between accreditation and quality culture, (2) leadership as a collective and emotionally demanding endeavour and (3) accreditation as a process that generates both tangible improvements and emotional reinforcement. The study highlights the need to clarify the internal lead's role and align accreditation language with clinical and managerial realities.Research limitations/implicationsFuture research could examine how gender dynamics influence leadership in accreditation processes.Practical implicationsFindings support the need for leadership development, institutional investment and the redesign of accreditation standards to better reflect clinical practice and managerial responsibilities.Social implicationsThe study underscores the emotional and cultural impact of organisational change, highlighting the importance of supportive environments that foster shared responsibility, team engagement and sustainable quality improvement.Originality/valueThis is the first study to apply the PRECEDE model to explore leadership in accreditation. It offers a novel framework for understanding how internal leads navigate quality improvement within complex healthcare organisations and provides actionable insights for institutional development.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
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status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/21035
url https://fisabio.portalinvestigacion.com/publicaciones/21035
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv EMERALD GROUP PUBLISHING LTD
publisher.none.fl_str_mv EMERALD GROUP PUBLISHING LTD
dc.source.none.fl_str_mv INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE
ISSN: 09526862
ISSNe: 17586542
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
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