Abstract
Background: accreditation would seem to offer added value to health care systems.
Objectives: The study aimed to examine the impact of quality management systems on the hospital maturity within the context of accreditation.
Material and Methods: The study followed a mix – methodmixed–method survey with a cross-sectional approach, where in 21 Tehran hospitals in 2016 were investigated during accreditation. The quality managers of participating hospitalshospitals' responses to the self-assessment questionnaire. Furthermore, we use external auditors for on-site visiting. Three instruments of quality management (QM) in hospital level focusing on quality management system index (QMSI) questionnaire, Quality management compliance index (QMCI) checklist, and clinical quality implementation index checklist (CQII) were measured. VariableThe variable selection for statistical model was guided by the use of a directed acyclic graph (DAG). The association between the QMSI, QMCI, and CQII were investigated using multiple linear regressions and were adjusted for fixed effects at the hospital level ( ownership, size of hospital, and teaching status).
Results: Associations were found between the QMSI, QMCI, and QMCI and CQII. QMSI and CQII are not related. The relationships between adjusted variables and QMS didn’t show any associations.
Conclusions: Tehran hospitals were in different level of the maturity based on existing QM systems within accreditation context.

Keywords: quality management, quality improvement, Accreditation, maturity.