Revolutionizing Healthcare: Lessons Learned from an Integrative Approach to Transforming the Hospital Accreditation System in Lebanon

Background: Lebanon was the first country in the Eastern Mediterranean region to develop and implement a national hospital accreditation system, but the system has not been updated since 2011. This study aims to describe the process of developing and piloting context-specific hospital accreditation standards in Lebanon, and share lessons from extensive stakeholder consultations. Methods: Mixed-methods approach was used for development and piloting of standards. This included extensive documentation review, stakeholder and expert consultations, standard review, and capacity building for piloting. Experts were required to review standards using pre-identified criteria and expert sub-group meetings were conducted to discuss changes. Piloting of standards included assessment of feasibility and compliance with standards/guiding measures in addition to implementation considerations. Results: More than 60 experts were consulted. Pilot testing showed a positive outcome for clarity, feasibility, and compliance of hospitals to standards. Managing stakeholders’ expectation was challenging at the policy-political encounter. The rigorous expert review led to the development of context-specific and robust standards that provided guidance for hospitals to improve quality care. Results showed that health system changes at the governance, finance and delivery levels are needed to achieve and sustain the gains of accreditation. Conclusions: The study methodology showed the promising influence of using science in development of accreditation standards. Stakeholder involvement remains critical to push the agenda of accreditation. Continuous follow-up to the survey process is recommended to ensure optimal impact of the accreditation system. The process can be scaled up and replicated in the Eastern Mediterranean Region (EMR) and beyond. Patient or Public Contribution: Patients and public where not involved in this study. While patients and the public bring are key for sharing lived experiences, the development of the standards required deep understanding and expertise especially with regards to healthcare and health systems. Highlights Implications for policy makers • Study can be replicated in contexts without a national accreditation system • Ensuring political commitment is critical for implementation of accreditation • Rigorous approaches are key in managing resistance to change • Stakeholder engagement is pivotal for developing contextualized standards