Table 4 Predisposing, enabling, and... | Emerald Publishing

Table 4

Predisposing, enabling, and reinforcing factors

Factors	Role of the internal lead in the accreditation of a clinical management unit
Factors	In favour	In opposition
Predisposing	Accreditation perceived as a tool for continuous improvement and strategic management Quality culture ◦ Continuous improvement identified as the primary motivation ◦ Presence of a committed/engaged team ◦ Quality culture perceived to spread organically at both the micro (CMU) and macro (institutional) levels	Absence of a shared project Negative perceptions and attitudes within the team Cultural dissonances ◦ Use of inaccessible language ◦ Quality not perceived as part of the professional identity ◦ Accreditation perceived as additional or unnecessary work Emotional strain and stress
Enabling	Quality culture ◦ Established body of knowledge through training and experience ◦ Availability of tools and resources (certifying agency, General Services, Quality Unit) ◦ Presence of a trained and engaged team In-house training initiatives Use of management and leadership tools Institutional support and commitment	Actions perceived as superficial or symbolic (“for showing”) Difficulty understanding and applying manual requirements and standards Limitations related to ICT. Bureaucratic burden Care overload limiting available time and energy Lack of time and space for sharing experiences and information Accreditation-related tasks often completed outside regular working hours
Reinforcing	Satisfaction with the accreditation outcome Material reinforcement (e.g. resources, staffing, or recognition) Social reinforcement (e.g. team recognition, institutional visibility) Emotional reinforcement (e.g. pride, motivation, sense of achievement) Perceived advancement in the unit’s quality culture	Dissatisfaction with the accreditation outcome Material reinforcement expected but not received

Factors	Role of the internal lead in the accreditation of a clinical management unit
Factors	In favour	In opposition
Predisposing	Accreditation perceived as a tool for continuous improvement and strategic management Quality culture◦ Continuous improvement identified as the primary motivation ◦ Presence of a committed/engaged team ◦ Quality culture perceived to spread organically at both the micro (CMU) and macro (institutional) levels	Absence of a shared project Negative perceptions and attitudes within the team Cultural dissonances◦ Use of inaccessible language ◦ Quality not perceived as part of the professional identity ◦ Accreditation perceived as additional or unnecessary work Emotional strain and stress
Enabling	Quality culture◦ Established body of knowledge through training and experience ◦ Availability of tools and resources (certifying agency, General Services, Quality Unit) ◦ Presence of a trained and engaged team In-house training initiatives Use of management and leadership tools Institutional support and commitment	Actions perceived as superficial or symbolic (“for showing”) Difficulty understanding and applying manual requirements and standards Limitations related to ICT. Bureaucratic burden Care overload limiting available time and energy Lack of time and space for sharing experiences and information Accreditation-related tasks often completed outside regular working hours
Reinforcing	Satisfaction with the accreditation outcome Material reinforcement (e.g. resources, staffing, or recognition) Social reinforcement (e.g. team recognition, institutional visibility) Emotional reinforcement (e.g. pride, motivation, sense of achievement) Perceived advancement in the unit’s quality culture	Dissatisfaction with the accreditation outcome Material reinforcement expected but not received