L’agrément : un agent moteur de développement des capacités, d’apprentissage collectif et de socialisation. Une étude de cas en profondeur dans un hôpital privé saoudien

The purpose of this thesis is to determine whether accreditation is effective for developing individual’s necessary capacities that improve quality.   In the last decade, accreditation shows that is a valuable tool. Accreditation program implementation has also demonstrated a world wide increased. It is as well used to support health reform. Managerial practices of this type are often criticized. They are adopted with enthusiasm but their implementation is often neglected because there is some difficulties to demonstrate sustainable behaviour changes and better outcomes..   Capacity Building (CB) is a comprehensive process, multidimensional and dynamic that seeks to improve the performance of individuals, teams, the organization and a system.  CB is one of the three foundational elements of institutionalise quality improvement practices a the same level of communication and recognition.   This study happens in Saudi Arabia. The hospital had participated in his first initiative with the Canadian Council of Health Services Accreditation (CCHSA). A single case study to evaluate the implementation of accreditation has been carried using a mix methodology.  For unit of analysis has been studded (individual, team, organization and system) to measure 28 anticipated effects of capacity Building culled from the literature. Semi-structure interviews, focus groups and a documentation review were conducted.  A questionnaire on the quality implementation scale (QIS) was administered in five organizations.  The performance of the case was measured in relation to the others and based on its positioning in the cycle.  Qualitative and quantitative analyses using median polish technique were conducted.       At the individual level, the accreditation motivated participation in new training.  Self-assessment is the stage that encourages learning through self-criticism.  The feeling of pride is the emotional change that was reported the most. The teams improved their communication by establishing a chain of command, which introduced the concept of respect and of clearly defined roles as required by the standards.  Through the QIS measurement, we noted that all those involved position themselves at the minimal level of implementation (Quality Assurance).  The most experienced with accreditation produce the best results very close to the second level.  Finally, the further organizations progress in the cycle, the more the differences in perception between the eight QI domains studied narrowed. The same phenomenon was observed among different job categories.   In conclusion, accreditation has demonstrated effectiveness to develop new capacities most specifically at the individual, team and organizational level.  The accreditation process has also demonstrated significant convergence power to pushes the adoption of new practices dictated by the accreditation standards. Those practices were successful to demonstrated positive quality improvement outcome.

Keyphrases: Accreditation, Capacity Building, Saudi Arabia, Canadian Council on Health Services Accreditation