Quality certifications in Andalusian primary care: current status, barriers, and facilitators

Abstract

Background: In recent years, improving healthcare quality and ensuring patient safety have become global priorities. International frameworks such as WHO, JCI, ISO 9001, and the EFQM model-together with European regulations like Directive 2011/24/EU-have established reference standards for evaluating healthcare performance. In Spain, national regulations and regional initiatives, such as those led by the Andalusian Agency for Healthcare Quality (ACSA), shape the certification landscape. This study explores two decades of ACSA certification in Andalusian primary care units, identifying accreditation trends, barriers, and facilitators.

Methods: This retrospective observational study analysed certification projects from 346 primary care units of the Andalusian Health Service between 2003 and 2023. Data were obtained from the ME_jora C platform, focusing on variables such as certification level, project type, standard compliance, and territorial distribution. Descriptive statistics and multivariate logistic regression were used to identify factors associated with certification success. We also incorporated qualitative insights from professional teams involved in the certification process.

Results: A total of 633 projects were certified, representing 80.1% of the potentially certifiable units. Of these, 97.79% of the projects reached the advanced level, while only 2.21% reached the optimal level, and no unit reached the excellent level. The provinces with the highest certification activity were Seville (25.28% of projects) and Cadiz, which stood out with the highest percentage of accredited units (87.93%). Facilitating factors included the use of up-to-date certification guides and high compliance with standards in the first assessment. The main barriers identified were limited resources and administrative burdens. Professionals emphasized that strong leadership, clarity of roles, and peer collaboration were crucial facilitators during the process.

Conclusion: ACSA certification model has significantly advanced primary care quality in Andalusia. However, challenges remain regarding geographical equity and process sustainability. Future strategies should address identified barriers, promote inter-unit collaboration, and encourage the adoption of higher certification levels through tailored support and training.

Keywords: external quality assessment; measurement of quality; quality management; specific accreditation.