Transformation of approaches to accreditation as a factor for building an effective quality management system in a medical organization: a comparative analysis of the experience of initial and repeated cycles
Avdeeva O.V., Kan N.E., Nikolaeva A.V., Khilkevich E.G., Gazheva A.V.
Background: The accreditation of medical organizations in Russia is transformed from a voluntary procedure into an obligatory element of the healthcare system. However, its perception as a formal bureaucratic barrier often outweighs the potential benefits of implementing quality management systems (QMS).
Objective: To conduct a comparative analysis of the organizational models used in the preparation for initial accreditation and re-accreditation, and to evaluate their effectiveness in integrating standards into clinical practice and involving staff.
Materials and methods: A longitudinal observational study was conducted at a multidisciplinary hospital with 597 beds over the period from 2022 to 2025. The following methods were used: participant observation, document analysis, staff questionnaires (n=220) on culture safety scales (based on the AHRQ Hospital Survey on Patient Safety Culture), semi-structured interviews with managers (n=15), analysis of key performance indicators (KPIs) of processes.
Results: The initial accreditation which was implemented through a temporary “headquarters”, resulted in obtaining a certificate, but did not form a functional QMS. There was an increase in negative perception of the changes: 78% of the staff assessed the innovations as “an additional bureaucratic burden”. A repeated cycle based on a process-oriented approach (appointing process owners, creating a quality project office) allowed standards to be integrated into the daily work. The introduction of tools focused on solving the acute problems of staff (unified electronic check-lists, five-minute meetings on quality) led to statistically significant changes: reduction in time for unproductive documentation by 35% (p<0.05), increase in the number of reports of risks and undesirable events by 4.2 times, increase in indicators on the scales of “Learning from mistakes” and “Openness of communications” by an average of 40%.
Conclusion: The effectiveness of accreditation as a tool for development is not determined by formal compliance with standards, but rather by the depth of organizational transformation. The transition from a project-based approach to a more system-oriented one, based on process management and the proactive involvement of staff by solving their operational issues, is a critical success factor. This approach transforms accreditation from a costly process into an investment that ensures the long-term viability and competitiveness of the organization.
Authors’ contributions: Avdeeva O.V., Kan N.E., Nikolaeva A.V., Gazheva A.V. – developing the concept and design of the study; Avdeeva O.V. – developing the program and collecting the material; Avdeeva O.V., Gazheva A.V. – processing the material and writing the text; Avdeeva O.V., Khilkevich E.G. Gazheva A.V. – editing the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interest.
Funding: The study was conducted without sponsorship.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Avdeeva O.V., Kan N.E., Nikolaeva A.V., Khilkevich E.G., Gazheva A.V. Transformation of approaches to accreditation as a factor for building an effective quality management system in a medical organization:
a comparative analysis of the experience of initial and repeated cycles.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (12): 139-144 (in Russian)
https://dx.doi.org/10.18565/aig.2025.358
Keywords
accreditation of medical organizations
quality management system
process-oriented approach
organizational changes
patient safety
staff involvement
clinical effectiveness
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Received 05.12.2025
Accepted 15.12.2025
About the Authors
Oksana V. Avdeeva, Chief Nurse, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, 117997, Russia, Moscow, Ac. Oparina str., 4, o_avdeeva@oparina4.ruNatalia E. Kan, Professor, Dr. Med. Sci., Honored Scientist of the Russian Federation, Deputy Director General for Research – Director of the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russia, 117997, Russia, Moscow,
Ac. Oparina str. 4, +7(926)220-86-55, kan-med@mail.ru, Scopus Author ID: 57008835600, Researcher ID: B-2370-2015, SPIN-code: 5378-8437, Authors ID: 624900,
https://orcid.org/0000-0001-5087-5946
Anastasia V. Nikolaeva, Chief Physician, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health
of the Russian Federation, 117997, Russia, Moscow, Ac. Oparina str., 4, a_nikolaeva@oparina4.ru, https://orcid.org/0000-0002-0012-6688
Elena G. Khilkevich, Dr. Med. Sci., Professor, Advisor, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of the Russian Federation, 117997, Russia, Moscow, Ac. Oparina str., 4, e_khilkevich@oparina4.ru, https://orcid.org/0000-0001-8826-8439
Anastasia V. Gazheva, PhD, Associate Professor, Department of Nursing Management, Medical Institute, Peoples’ Friendship University of Russia, 117198, Russia, Moscow, Miklukho-Maklaya str., 8, gazheva-av@pfur.ru
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