Figure 1
At the center, a large dashed diamond labelled “Manifest and implicit meanings” acts as the interpretive hub. From, and to, this hub the framework organizes three main categories: 1. Accreditation or quality? Exploring the conceptual tensions (left theme). 2. One person does not make quality (right theme). 3. But … Accreditation leaves a trace behind (bottom outcomes). Flow through the hub: From the hub and from Theme 2, arrows descend to an intermediate node: “2.3. Bearing the weight: leadership overload and emotional strain”. From 2.3, arrows descend to the outcomes level: “3. But … Accreditation leaves a trace behind”. Subcategories by main category (verbatim): Category 1 — Accreditation or quality? Exploring the conceptual tensions: 1.1 Dual Role: Accreditation Management and Quality Culture Leadership 1.2 Accreditation as a Pathway to Ongoing Improvement 1.3 Accreditation as a Strategic Management Tool 1.4 When Accreditation and Quality Diverge. Category 2 — One person does not make quality: 2.1 Building a culture of quality: collective efforts and leadership 2.2 Navigating tensions: barriers to embedding quality in daily practice 2.3 Bearing the weight: leadership overload and emotional strain (intermediate node that precedes the outcomes). Category 3 — But … Accreditation leaves a trace behind: 3.1 Perceived value: personal and professional rewards 3.2 External recognition: shaping the unit’s public image 3.3 Emotional impact: pride, unity, and renewed motivation 3.4 Tangible outcomes: visible improvements in care delivery. Relation to PRECEDE factors: Predisposing: A dashed rounded rectangle labelled “Predisposing” sits above the hub and feeds both Theme 1 and Theme 2, indicating how motivation, beliefs, values and perceived needs shape conceptual tensions and collective leadership. Enabling: A dashed rectangle labelled “Enabling” on the right points to Theme 2, highlighting resources, skills and organisational supports that facilitate embedding quality in daily practice. Reinforcing: A dashed rectangle labelled “Reinforcing” on the left points to Category 3 and loops back to Theme 1, signalling feedback (emotional, social, material) that consolidates outcomes and can recalibrate the accreditation–quality understanding.Explanatory framework of results with patterns and categories