Table 1 The challenges to successfully implementing Iran’s PHC accreditation program

Organisational culture

The system’s quantitative nature and its conflicts with the implementation of quality improvement initiatives such as accreditation

Considering accreditation as a temporary endeavour and its failure

The negative impact of ineffective implementation of other promotional programs

There needs to be more awareness of the importance of accreditation programs as an essential component in improving performance.

Lack of persistence in implementing and attaining the program’s goals

Doctors steadfastly refused to participate in the program despite their leadership positions at the facilities.

An inadequate organisational culture of transparency and objective accountability

motivational mechanisms

Deficiency in defining the financial, professional, scientific, and spiritual motivations of the program for the participants

Inadequate specification of organisational incentives of the program, such as budget and insurance tariffs for successful centres

Employees and managers’ extreme reliance on external motives and the lack of continuity of these motivators

Some centre workers, particularly the doctors, are on a temporary contract.

Migration of skilled forces from less privileged places to affluent communities

Staff workload

A need for more personnel forces employees to take on various duties and responsibilities.

Due to crises, the COVID-19 pandemic, and the high volume of health programs, employees are under great stress.

Educational system

Training for managers and staff on accreditation and quality improvement needs to be improved at the university level, as pre-service and in-service training.

Accreditation programs in the country need more comprehensive and practical training sets.

Inadequate knowledge of managers and staff of the studies on health systems

System managers and family doctors lack the knowledge and abilities to administer the healthcare system effectively.

Information system

Inefficient design of the SIB system as a health information system

Inaccurate data submission in SIB results in incorrect output.

Lack of a verification method to ensure the accuracy of the submitted data in the SIB system, as well as other performance reports

Macro-executive infrastructure

The Deputy of the Ministry of Health and the University of Medical Sciences, as well as the country’s health networks, lack accreditation and a quality improvement unit

More health management specialists and experts are needed to operate in the health care system.

Lack of participation of international accreditation and quality improvement organisations in the design or implementation of the program

Nationally, there is a deficiency in the training of accreditation assessors.

Failure to appoint a competent and non-governmental entity to oversee accreditation with the cooperation of representatives from all relevant parties

Lack of a clearly defined accreditation procedure in Iran

Excessive system centralisation and a lack of environmental unit authority in the design and execution of health interventions

Failure to approve the program in the form of a law governing its retention in the system