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Article

Accreditation Process and Employee Well-Being in Healthcare Organizations

by
Viljaras Reigas
* and
Ligita Šimanskienė
Faculty of Social Sciences and Humanities, Klaipėda University, 92294 Klaipeda, Lithuania
*
Author to whom correspondence should be addressed.
Sustainability 2023, 15(12), 9254; https://doi.org/10.3390/su15129254
Submission received: 4 April 2023 / Revised: 3 June 2023 / Accepted: 6 June 2023 / Published: 8 June 2023

Abstract

:
Organizations may choose means for their aim of accomplishing an extensive spectrum of activities. One of the possible choices is performance accreditation—a voluntary undertaking evaluating organizational performance compliance with the determined standards. Accreditation is considered a tool not only for improving the quality of services but also for developing coherence in the organization; such a process contributes to the achievement of the organization members’ well-being. Yet personal healthcare organizations choose accreditation as an alternative to the execution of their quality management system, and accreditation is considered a tool for service quality improvement by these organizations, even though several studies provide data on the impact on employees. This study evaluates the attitudes of employees of personal healthcare organizations toward the effect of accreditation on organizational cohesion and employee well-being. Five hundred sixty-nine employees of healthcare organizations participated in the study. This study revealed that healthcare professionals statistically significantly better evaluate the impact of accreditation on service quality improvement than on organizational performance, which is related to the influence on the employees’ well-being.

1. Introduction

The performance of personal healthcare organizations is multidimensional and specific, characterized by a unique management structure, practices, methods, culture, and expectations of stakeholders. Unlike other organizations, personal healthcare organizations must correspond to high quality and responsibility requirements, and their implementation is directly related to well-being of employees, modeling of their work environment, personnel management methods, and programs for well-being promotion at work.
An employee’s well-being in the work environment is affected by various factors, and their long-term and harmful effects can have negative consequences not only on employees’ emotional or physical well-being but also on the results of personal healthcare services provided by organizations and the productivity of their employees [1]. According to some authors, employee well-being in the work environment is also influenced by the organization’s social responsibility policy [2], while others indicate that sustainability in business is also important. This refers to an effort to implement long-term productivity and the least possible negative impact on the stakeholders’ policy, which also includes personnel management elements [3]. The statistical data reveal a trend that under the influence of work-related negative factors, one out of three workers in Europe report feeling the effects of stress at work, and work-related stress, depression, and anxiety increase costs of many countries’ gross domestic product by 3–4% [4].
Analysis of the concept of employee well-being in the work environment emphasizes the fact that the importance of employment, work, and well-being in the work environment is based on the time employees spend in the work environment (usually a person spends a quarter of his/her time at work), and for many of them, work is the main occupational activity of life. Therefore, feeling good at work is one of the main components of overall human well-being, and high levels of well-being is associated with various positive organizational attitudes [5].
To achieve the well-being of employees in the work environment, the implementation and execution of employee well-being programs must be essential for the managers of organizations. When implementing these programs for ensuring the well-being of employees in organizations, the issue of evaluating effectiveness of the programs becomes relevant. The scientific literature presents examples of various means of ensuring well-being of employees and their effects. For example, group sessions have a positive effect on emotional and physical well-being [6], and participation in the organization’s wellness program significantly reduces the amount of employee absenteeism and increases job satisfaction [7]. Additionally, when implementing training, providing methodological and psychological support to employees, adapting the organizational structure and space to their needs, and ensuring adequate resources and organizational culture improvement, the positive effect of involvement in the organization’s activities is achieved, the anxiety of employees is reduced, and self-esteem, self-confidence, and physical activity are increased [6,7,8]. Attention should be paid to the fact that in order to achieve the goal of ensuring employee well-being in the organization, effective communication in the field of employee well-being is necessary. It is important to create opportunities for all employees to participate in employee well-being programs, ensure appropriate leadership at all stages of activity, use the existing opportunities of the organization, and periodically evaluate the effect of the programs [8].
According to the literature review it is strongly assumed that the links between accreditation and employee well-being is an area requiring more detailed research. So far, answers to the questions related to changes in the psychosocial environment during the accreditation of organizations have not been provided. Additionally, the literature does not discuss issues of how employees’ well-being changes during and after the accreditation procedures. These shortcomings encourage a more detailed analysis of the links between accreditation and employee well-being and require an answer to the question: “Does the accreditation process in health care organizations create employee well-being?”.
The paper is presented in the following structure: the next section presents scientific analysis on the links between accreditation processes and employee well-being. Then, research methods are described, and the main results and findings as well as a discussion of conclusions and some suggestions for future research are presented.

2. Literature Review

The scientific literature presents the data on employee well-being assurance and the connections between the organization’s efforts to ensure quality in various aspects. Some authors indicate accreditation as one of the measures as a voluntary process during which a higher level of service quality is achieved [4] and employee satisfaction on working conditions is improved [7].
In Lithuania, personal healthcare organizations are obliged to improve the quality of the provided personal healthcare services through the necessity of licensing their performance and ensuring the minimal quality requirements of personal healthcare services [9]; organizations can additionally accredit and certify their activities (Table 1).
Currently, the possibility of accreditation is provided only for primary level personal healthcare services such as family medicine service. The national accreditation standards determine the obligatory requirements and ambitions and also reflect the main dimensions of quality healthcare: service availability, safety, continuity, effectiveness, usefulness, and patient orientation. The requirements established in the National Accreditation Standard cover areas such as patient rights and needs (respect for patients and their rights), services provided by the organization (accessibility, coordination, and cooperation with other organizations), health information management (ensuring confidentiality of patient information), safety and quality improvement (implementation of requirements for patient and employee safety, focusing on quality-improvement tasks), and organizational resources (infrastructure management) [10].
After analyzing the connections of this standard and the well-being of employees and the psychosocial work environment, one of the areas that is most often mentioned in scientific research as having a significant impact on employee well-being is protection against psychological distress and verification of workload. This is to be achieved when accrediting personal healthcare institutions, but it is not mandatory (Table 2).
Analyzing the concept of accreditation in the scientific literature, this process could be described as a voluntary [11] activity that is aimed at assessing quality [12], improving it [13], and increasing patient safety [14]. Various concepts of accreditation can be found in the scientific literature. For example, it could be defined as a process during which an external entity, independent of the organization being accredited, evaluates the organization’s compliance with the requirements (standards) that are intended to ensure the safety and quality of healthcare [15]. The accreditation process can affect a healthcare organization through three mechanisms: consistency, organizational management, and collective quality improvement. The organization’s accreditation experience is influenced by various external and internal factors [16]. It is assumed that the real value of accreditation will be achieved if this process is considered as a continuous process that includes capacity building, knowledge improvement, investment, and the use of accreditation as a tool to improve quality and patient safety [13].
The analysis of various literature sources revealed that accreditation has a positive effect on the organization in various aspects. Accreditation, as a quality improvement tool, can positively affect areas related to the organization’s activities, such as a healthcare specialist qualification development [14,17], strategic management, choice of management methods, resource planning [18], improving patient care and initiation of changes [19], formation of organizational culture, standardization of activities and improvement of patient safety policy [20], and promotion of teamwork [21]. Meanwhile, other authors present ideas for discussion or indicate the negative effects of accreditation on the organization, such as excessive financial costs [22], increasing the level of work-related stress [23], and negative effects on employee well-being due to inappropriate communication during the accreditation period [24].
Analysis of literature sources prove that accreditation in healthcare organizations affects such areas of activity as administration, personnel management, and psychosocial work environment; however, the impact on these areas can be diverse. Analysis of the literature sources presented above substantiated the positive impact of accreditation on the administration of the organizational activities and personnel management, but the impact on the psychosocial working environment remains the subject of debate. According to some authors, if certain conditions are not fulfilled, accreditation can negatively affect employees, and at the same time, it probably negatively affects the success of accreditation in the organization.
Employee well-being and psychosocial work environment are two closely related processes. Introducing the concept of the psychosocial work environment, it is essential to emphasize that the psychosocial work environment is considered as a set of working conditions having an impact on employees’ health [25]. Compared to other fields of activity, employees of healthcare organizations experience negative effects of the psychosocial work environment more often because these factors affect workers simultaneously in a healthcare field [26]. In most cases, the scientific literature emphasizes psychosocial work environment factors such as work intensity, clarity of tasks, ability to make work-related decisions, social relations, and physical work environment [20,21,22,27]. Their impact is associated with the loss of 12 billion working days and the loss of 1 trillion USD due to reduced productivity of workers [23].
According to the literature analysis, to achieve better results of personal healthcare service quality during the accreditation procedures, employee well-being is inevitably affected, and it is influenced by the psychosocial work environment. However, it should be noted that research is limited concerning the psychosocial work environment and the impact of accreditation on it. The research is often limited to identifying some psychosocial risk factors without analyzing the whole. Considering this, after evaluating the results of the scientific literature analysis, the goal of this study is to assess the attitude of employees of personal healthcare organizations regarding accreditation’s impact on the main areas of organizational performance: operational administration, personnel management, employee professional development, and psychosocial work environment.
The hypothesis of this research is that accreditation is characterized by a negative impact on the areas of organizational activities affecting well-being of employees.

3. Research Methodology and Design

Whereas this study analyzes complex, multidimensional social relations, a quantitative research method was chosen—a questionnaire survey for employees. The questionnaire used for the research consisted of 52 questions, which were divided into four blocks and covered the analyzed areas:
-
Demographic data of the respondents and the accreditation experience of the organization;
-
Attitude towards the impact of accreditation on the administration of organizational performance, personnel management, and employee psychosocial work environment.
The questions of the research instrument were considered regarding studies by Khazaie, etc. (2021) [28], Eismontienė, etc. (2020) [29], Devkaran, etc. (2019) [22], Hunter, etc. (2019) [30], Masuda, etc. (2017) [31], Sax and Marx (2014) [32], Groenwegen and Jurgutis (2013) [33], Regan, etc. (2015) [34], El-Jardalis (2008) [35], and we sought to summarize the data of these researchers. The statements for the research instrument were formed according to the authors’ data presented, problems raised, and the discussions developed in the literature review. The research instrument was submitted for evaluation by experts (managers of personal healthcare organizations, researchers in the field of quality management, and employees of organizations performing accreditation). Considering the experts’ recommendations, the research instrument was adjusted and then a statistical assessment of the reliability of the research instrument was performed afterwards.
After evaluating the internal coherence of the questionnaire scale—the correlation of the individual questions included in the questionnaire—a Cronbach’s alpha value of 0.969 was obtained (during the correlation analysis of the questions included in the individual blocks of the questionnaire, it was determined that the highest internal reliability value belongs to the impact of accreditation on employee psychosocial work environment; the Cronbach’s alpha value was 0.985).
The study was conducted in organizations providing primary-level personal healthcare services, which are accredited to provide personal healthcare such as family medicine services. According to the valid National Accreditation Standards [Accreditation Standard], institutions that meet the following requirements can be accredited: they have a personal healthcare license, which gives them the right to practice family medicine, they have at least three years of experience in the field of family medicine, and at least 500 patients are registered to one family doctor at the accreditation address. Out of all accredited personal health care organizations in Lithuania, 12 personal healthcare organizations agreed to participate in the study, and the total number of employees in all of them was 1632. In the organizations, the questionnaires were distributed to those participants who agreed to participate in the study (1128 questionnaires were distributed). A total of 631 questionnaires were collected from all the investigated organizations, of which 569 questionnaires were recognized as suitable for analysis (the remaining 62 questionnaires were recognized as unsuitable because less than 50% of the questions were filled in or they were not filled in at all). The calculated return rate of the questionnaires was 50.4 percent.
The collected data were analyzed using SPSS software (version number is 28.0.1.1 (15)), and statistical analysis methods were applied, including determination of χ2 criteria, calculation of averages of statements’ answers (statements were evaluated on a 5-point Likert scale, where 1 point corresponded to “Completely disagree” and 5 points corresponded to “Completely agree”), and a correlational analysis. The distribution of attributes in the general group of subjects corresponded to the law of normality, and the indicators of excess and kurtosis were in the interval [−0.91; +1.54]. A simple random sample was used in the research. A simple random sample is a subset of a statistical population in which each member of the chosen healthcare organization has an equal probability of being chosen.
The research was guided by ethical principles. The principle of goodwill was ensured by the statements of the questionnaire, which was presented in a respectful style without creating preconditions for the respondents to lose privacy. The principle of respect to the individual was also applied, and the purpose of the study was explained to the respondents. Volunteering reflects the free will of study participants to participate or not in the study, and the research participants were guaranteed anonymity and data confidentiality.

4. Results

Analysis of the collected data about socio-demographic characteristics of the respondents portrays the socio-demographic image of the respondent who took part in the study, i.e., a nurse who is more than 43 years old, her work experience was more than 16 years, she does not hold any management position, and, if she had to choose again in which organization to work, her choice would not change. The sociodemographic data of the research participants are presented in Table 3 and Table 4.
During the entire study implementation the following ethical principles were ensured: respect for human dignity, personal rights, freedoms, avoidance of physical, psychological, and social harm or threat to the respondents’ health, selection of a safe and private environment for the respondents, obtaining the informed consent of the respondents to participate in the study, informing them about the most important aspects of the research, the expected benefits, providing the researcher’s contact data, and ensuring the confidentiality of the respondents and the organization.
After evaluating the opinion of the respondents about the impact of accreditation on the administration of the organizational performance, a sufficiently high rating was determined: 4.16 ± 0.58 points (p < 0.001). A somewhat lower rating was recorded in the field of personnel management (4.10 ± 0.62 points (p < 0.001)), and the assessment indicator of the professional growth of employees was 3.62 ± 0.98 points (p < 0.001). The worst-rated area was the impact of accreditation on the psychosocial work environment: 2.63 ± 1.08 points (p < 0.001) (Table 5).
Analyzing the study respondents’ views on the impact of accreditation on the administration of the organizational performance, it was found that in the general investigation group, the highest score was determined in the field of service quality improvement (4.50 ± 0.71 points), and the lowest score was in reduction in unplanned working tasks (3.93 ± 0.86 points) (Table 6).
The respondents’ views on the positive impact of accreditation on the organizational performance showed statistically significant relationships between the statements generated by this scale. The strongest correlation on this scale was identified among improvement in service quality, reduction in adverse events, and reduction in discrepancies (r = 0.786, p < 0.001); ensuring service availability and increasing supply (r = 0.687, p < 0.001), ensuring service supply and timeliness (r = 0.743, p < 0.001); service scope planning and promotion of operational activity development (r = 0.721, p < 0.001); improvement in administration and operational activities (r = 0.702, p < 0.001); promoting change and improvement in operational activities (r = 0.702, p < 0.001); the number of staff required and the provision of equipment (r = 0.642, p < 0.001); ensuring necessary equipment and giving support in understanding the organizational internal documents (r = 689, p < 0.001); and the reduction in unplanned work and ensuring necessary equipment (r = 0.685, p < 0.001).
Evaluation of the respondents’ views on the impact of accreditation on staff management indicated that the respondents gave the highest score to the areas related to the employee interactions and roles, and the lowest impact was indicated on qualification improvement (Table 7).
Analysis of the relationship between the statements about the impact of accreditation on employee management identified a statistically significant relationship between promoting employee communication and understanding of their roles (r = 0.812, p < 0.001), supporting job quality improvement and promoting employee training on quality improvement (r = 0.702, p < 0.001), contributing to understanding of what employees expect from the surrounding people and promoting employee training on quality improvement (r = 0.671, p < 0.001), promoting care of employee well-being and providing employees with necessary of information (r = 0.742, p < 0.001), improving information dissemination among employees and ensuring effective communication (r = 0.740, p < 0.001), providing employees with necessary information and encouraging them to achieve goals of the organization (r = 0.786, p < 0001), ensuring effective communication and providing employees with necessary information (r = 0.778, p < 0.001), encouraging employees to develop and ensuring high-quality qualification assessment (r = 0.689, p < 0.001).
The assessment of the direct impact of accreditation on employees, i.e., their professional development, revealed that in comparison to the positive impact of accreditation on the administration of an organizational performance and personnel management, the assessment of the respondents in this area is lower; the average assessment of the statement ‘Accreditation stimulates teamwork’ was 3.67 points (SD = 1.01), the ‘Accreditation motivates employees’ was 3.64 points (SD = 0.99), and the statement ‘Accreditation stimulates career planning’ was granted an average of 3.56 points (SD = 1.13).
When assessing the respondents’ views on the psychosocial impact of accreditation on psychosocial work environments, this area was indicated to have the lowest value, i.e., the respondents were more likely to question than accept the benefits of accreditation on their psychosocial work environment (Table 8).
Analysis of the respondents‘ views about the accreditation’s impact on the psychosocial work environment revealed strong interconnections between manager promotion of being interested in employee well-being and increasing motivation (r = 0.845, p < 0.001), increasing motivation and ensuring safe working conditions (r = 0.852, p < 0.001), increasing trust in colleagues and ensuring safe working conditions (r = 0.853, p < 0.001), opportunities for anonymous proposals and improvement of work coordination (r = 0.830, p < 0.001), equal attention to all employees and physical strain at work reduction (r = 0.83, p < 001), improving job satisfaction and encouraging a healthy lifestyle (r = 0.860, p < 0.001), the ability to independently make work-related decisions and paying equal attention to the well-being of employees (r = 0.864, p < 0.001), reducing physical (r = 0.885, p < 0.001) and emotional (r = 0.880, p < 0.001) tension at work and providing opportunities to control the pace of work (r = 0.868, p < 0.001), reducing the associated feeling of stress, improving work coordination, and encouraging adherence to established rules (r = 0.844, p < 0.001), reduction in psychological distress at work and positive impact on relationships with others (r = 0.885, p < 0.001), encouraging compliance with the rules set at work and encouraging changes (r = 0.887, p < 0.001), positively affected relationships with others and better relationships between colleagues (r = 0.887, p < 0.001), encouraging the administration to be an example in order to provide quality services and the formation of better relationships between colleagues (r = 0.900, p < 0.001).
During the analysis of the research data, the links between the impact of accreditation on the organization areas of performance and socio-demographic indicators were also analyzed. The obtained data revealed that the evaluations of the accreditation scales are statistically significantly related to the duties, managerial positions, and the willingness to choose this job again.
Nurses more often positively assessed the impact of accreditation on the administration of the organizational performance (r = 0.09, p = 0.033) and personnel management (r = 0.12, p = 0.005), but they more often negatively assessed the impact on the professional growth of employees (r = −0.10, p = 0.014) and psychosocial work environment (r = −0.27, p < 0.001) in comparison to other specialists and doctors. Meanwhile, other specialists significantly more often positively assessed the impact of accreditation on the psychosocial work environment (r = 0.26, p < 0.001) and more negatively assessed the impact on activity administration (r = −0.10, p = 0.024) and personnel management (r = −0.11, p = 0.011) in comparison to nurses and doctors (Table 9).
The analysis of the opinion of those holding managerial positions and those who, if needed, would choose to work in the organization again revealed that they positively assessed the impact of accreditation on all the investigated areas of the organizational performance.

5. Discussion

The results of our study supported the research hypothesis, but it is important to emphasize that there are not many studies that can be used to compare the results of the analysis of the links between accreditation and employee well-being.
It should be noted that accreditation is considered as a tool that can help improve the quality of services provided [4], and this is particularly important in ensuring safe personal health care services. During this research, we found that the employees almost always positively assessed the benefits of accreditation for improving the provided services quality and reducing inconsistencies.
Joyce et al. (2018) [7] indicated that accreditation can improve employee satisfaction with working conditions. The results of our research complement these data, and it can be assumed that accreditation improves the understanding of the roles and functions of employees, serves as a means of improving the work quality, promotes employee development, and increases the care for the well-being of employees.
The results of the study reveal that the accreditation process in the personal healthcare organizations has a statistically significant positive effect on the processes related to the administration of the organizational performance and personnel management, while according to the participants of the study, accreditation does not have a positive effect on the psychosocial work environment.
During our research, we found that the employees of the researched organizations, who consider accreditation to positively affect the quality of services, also consider accreditation to help reduce the probability of adverse events and non-conformities. The scientific literature presents a lot of data on the prevention of adverse events and the links to accreditation. For example, after examining the experience of accredited personal healthcare organizations in the field of adverse event management, it is indicated that somewhat more than 6 out of 10 nurses report registered adverse events in the established order and draw attention to the necessity of conducting employee training in the areas of safety and culture [36]. The scientific literature also emphasizes that the positive aspects of accreditation have an impact on leadership and patient safety but not on clinical practice [37].
Accreditation of primary healthcare organizations positively affects areas such as teamwork, patient safety, and the quality of personal healthcare services provided [38]. The results of our research complement these data because our research indicates that accreditation positively affects not only teamwork but also the dissemination of information between employees and communication.
Healthcare organizations seeking high-quality human resource management recognize accreditation as an opportunity, i.e., these organizations use accreditation not only as a tool for feedback on their performance but as improvement of personnel management [25]. After examining the opinion of managers of healthcare organizations about the benefits of accreditation, it was found that accreditation has a positive effect on the delegation of functions in organizations [39]. Our research indicates that the employees of the investigated healthcare organizations positively assess the impact of accreditation on areas related to personnel management; from the employees’ point of view, accreditation positively affects areas such as communication within the organization, distribution of roles and functions, development, and feeling of community inside the organization.
The results of the study revealed that the participants of the study assessed the positive effects of accreditation most favorably in activities such as improving the quality of services, reducing the probability of non-conformities, improving the availability of services, increasing the supply of services, ensuring timeliness, improving operational procedures, in personnel management activities, communication between employees, improving the understanding of roles and functions, the quality of work, the quality of learning, caring for the well-being of employees, and promoting the feeling of community within the organization.
Summarizing the results of our research, we can state that the research participants tended to disagree with the positive impact of accreditation on such areas of ensuring employee well-being as ensuring safe and healthy working conditions, job satisfaction, reducing the feeling of stress at work and manifestations of stress at work as well as reducing physical and emotional tension at work. Considering the obtained results, it becomes necessary to analyze the causes of this phenomenon, because according to the data of other research, accreditation can negatively affect the psychosocial work environment. For example, accreditation procedures can increase employees’ perceived stress and are possibly related to their emotional and physical well-being [23]. Additionally, research confirmed a higher level of stress at work during the accreditation period; it was found that most of the participants in their study felt moderate to high levels of stress during the accreditation processes [37]. Accreditation in healthcare organizations is associated with burnout syndrome, social support is important for employees, and the links between professionals in clinical work and accreditation requirements are quite clear [26]. The debatable question is formulated by the fact that the aim of accreditation is to improve the quality of services and, of course, to ensure the well-being of employees [16], but the results of the study presuppose the result of accreditation—the increasing level of stress at work during the process.

6. Conclusions

It is necessary to state that accreditation is a crucial quality-improvement tool in personal healthcare organizations; however, as shown by both this and previous research, it is essential to properly organize, implement, and maintain accreditation since it can not only be beneficial to the organization, but it can also cause of damage to the organization’s assets, i.e., its employees.
Accreditation has a significant positive impact on the organization’s facets of performance, namely its activity administration and personnel management. These areas experience improved quality of services, their availability, supply, promotion of teamwork, and communication. However, despite the positive results obtained during accreditation, one of the essential criteria important for organizational performance—the psychosocial condition of employees—indicates that accreditation does not have a positive effect on the psychosocial well-being of employees. Employees experience stress during the accreditation process, so the management needs to pay more attention to promote accreditation process advantages by assigning tasks, predicting stages, and communicating about new process developments. Although the psychosocial factors of the research participants were evaluated quite moderately, the respondents revealed that accreditation improves the quality of services and promotes better information transfer while increasing understanding between colleagues, which is also vital for the well-being of employees in organizations.
The obtained research results partly coincide with the results of other authors analyzing similar topics of psychosocial well-being of employees. However, the issues identified serve as a call for additional research aimed at enhancing the well-being of employees in the face of organizational changes. This could include research on managers’ abilities to manage change, communication disturbances with managers, etc.
This study is characterized by certain limitations, which are its focus on one professional group (employees of personal health care organizations) and the examination of only a part of the indicators reflecting the links between accreditation and employee well-being. It is appropriate to carry out further research to analyze and clarify such areas as economic stability of the organization, micro- and macro-organizational environment, management style, and political decisions. In conclusion, we can point out the practical significance of this study for both its readers and researchers. This research adds to the understanding of the links between accreditation and employee well-being. Therefore, it offers insights on improving the working conditions experienced by employees during and after the accreditation period.

Author Contributions

Formal analysis, investigation, resources, data curation, writing—original draft preparation, V.R. Conceptualization, methodology, writing—review and editing, supervision L.Š. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethical review and approval of this study was waived because an expression of consent was obtained from the participants. Respondents are aware that the data are used exclusively for academic purposes. In turn, each participant had to read the reason for this research and then confirm their participation and consent.

Informed Consent Statement

Consent was obtained from all subjects involved in the study.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

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Table 1. Quality assurance measures in Lithuanian personal healthcare organizations.
Table 1. Quality assurance measures in Lithuanian personal healthcare organizations.
Quality Assurance Measures in Lithuanian Personal Healthcare Organizations
LicensingEnsuring Minimal Quality RequirementsAccreditationCertification
Mandatory activityMandatory activityVoluntary activityVoluntary activity
Before starting the activity, the government-authorized institution issues a license.At the start of the activity, the minimum quality requirements indicated in the legal act are ensured.Compliance with the standard is assessed every 5 years. Accreditation is carried out by an institution authorized by the government.The certification is carried out by an independent organization that issues the certificate. Mostly certified according to ISO standards
Table 2. Measures to ensure employee well-being indicated in The National Accreditation Standards for family medicine activities.
Table 2. Measures to ensure employee well-being indicated in The National Accreditation Standards for family medicine activities.
Mandatory CriteriaCriteria to be Achieved
A person responsible for employee safety and health has been appointed.
The installation of premises, including physical risk factors, in accordance with the provisions of legal acts is ensured.
Employees are trained to use the equipment.
Accidents are registered and investigated.
Fire safety requirements are ensured, and employees are instructed on fire safety issues.
An emergency management outline has been prepared.
The workload complies with the provisions of legal acts.
Employees are protected from psychological distress.
Employee immune prophylaxis is ensured.
Table 3. Distribution of respondents according to their positions.
Table 3. Distribution of respondents according to their positions.
PositionPercentN
Doctors2.112
Nurses88.8505
Other personnel9.152
Table 4. Distribution of respondents according to work experience.
Table 4. Distribution of respondents according to work experience.
Work ExperiencePercentN
Up to 5 years13.979
6–10 years19.7112
11–15 years27.2154
More than 16 years39.2224
Table 5. Statistical indicators on the scales of the questionnaire.
Table 5. Statistical indicators on the scales of the questionnaire.
Area Affected by AccreditationMinimum RatingMaximum RatingAverageSDp Level of Significance
Administration of activities1.775.004.110.58<0.0010.004<0.001
Professional growth of employees1.335.003.620.98<0.001<0.001<0.001
Management of personnel1.835.004.100.62=0.004<0.001<0.001
Psychosocial environment1.274.322.631.08<0.001<0.001<0.001
Table 6. Impact of accreditation on the management of organizational performance.
Table 6. Impact of accreditation on the management of organizational performance.
StatementsAverageSD 1
Improves the quality of services4.500.71
Reduces probability of discrepancies4.380.73
Ensures availability of services4.220.74
Increases supply of services4.180.74
Assists in planning the scope of services4.170.75
Ensures timeliness of services4.160.74
Encourages improvement of operational procedures4.140.76
Ensures staff resources4.070.79
Provides equipment resources4.050.78
Contributes to understanding of internal documents4.050.83
Reduces scope of unplanned work3.930.86
1 SD—standard deviation.
Table 7. Impact of accreditation on organizational personnel management.
Table 7. Impact of accreditation on organizational personnel management.
StatementsAverageSD 1
Encourages interpersonal communication between employees4.410.78
Assists in understanding the roles and functions of employees4.350.76
Contributes to improving the quality of work4.150.75
Promotes regular training of staff on improving job quality4.150.74
Contributes to understanding of what employees expect from the surrounding people4.120.74
Encourages care of employee well-being4.080.78
Improves dissemination of information between employees4.050.76
Encourages employees to achieve the objectives of the institution4.050.77
Provides employees with the necessary information4.040.77
Ensures effective communication4.010.78
Ensures high-quality employee qualification assessment3.960.80
1 SD—standard deviation.
Table 8. Impact of accreditation on the psychosocial work environment of the organization.
Table 8. Impact of accreditation on the psychosocial work environment of the organization.
StatementsAverageSN 1
Encourages a manager to take care of your well-being 3.001.04
Increases motivation2.901.06
Provides opportunities for anonymous proposals2.831.29
Ensures safe and healthy working conditions2.791.09
Increases trust in colleagues2.751.11
Improves coordination of your work2.651.36
Encourages to provide equal attention to your and your colleagues’ well-being2.641.21
Fosters change and innovation2.641.38
Improves your job satisfaction2.621.20
Promotes compliance with labor rules2.621.33
Provides opportunity for autonomous work-related decisions2.591.20
Contributes to promotion of a healthy life for you2.571.20
Allows you to control the pace of your work2.551.26
Positively influences relations with surrounding people2.531.26
Reduces work-related stress2.501.19
Reduces the occurrence of psychological violence at work2.501.27
Reduces physical strain at work2.491.20
Reduces emotional tensions at work2.481.20
Contribute to better relations between colleagues2.471.26
Motivates the institution’s administration to become the example2.461.32
1 SD—standard deviation.
Table 9. Statistical indicators of questionnaire scales.
Table 9. Statistical indicators of questionnaire scales.
IndicatorsAgeExperienceDoctors aNurses aOther aGender bAt Managerial Positions aWill Choose the Organization Again a
Performance administration−0.05 (0.266)−0.04 (0.342)−0.01 (0.886)0.09 (0.033)−0.10 (0.024)−0.05 (0.252)0.15 (<0.001)0.32 (<0.001)
Employee professional development−0.00 (0.970)0.02 (0.675)0.07 (0.082)−0.10 (0.014)0.08 (0.070)−0.04 (0.308)0.20 (<0.001)0.28 (<0.001)
Personnel management−0.02 (0.638)0.01 (0.840)−0.05 (0.270)0.12 (0.005)−0.11 (0.011)−0.05 (0.247)0.13 (0.003)0.24 (<0.001)
Psycho-social environment−0.01 (0.809)−0.01 (0.886)0.06 (0.156)−0.27 (<0.001)0.26 (<0.001)−0.02 (0.715)0.30 (<0.001)0.16 (<0.001)
Pearson’s correlation method applied; data presented—r(p); a—nominal attribute, where “No” = 0, “Yes” = 1; b—nominal attribute, where “Male” = 1, “Female” = 2.
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Reigas, V.; Šimanskienė, L. Accreditation Process and Employee Well-Being in Healthcare Organizations. Sustainability 2023, 15, 9254. https://doi.org/10.3390/su15129254

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Reigas V, Šimanskienė L. Accreditation Process and Employee Well-Being in Healthcare Organizations. Sustainability. 2023; 15(12):9254. https://doi.org/10.3390/su15129254

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Reigas, Viljaras, and Ligita Šimanskienė. 2023. "Accreditation Process and Employee Well-Being in Healthcare Organizations" Sustainability 15, no. 12: 9254. https://doi.org/10.3390/su15129254

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