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Research limitations/implications consider future work on gender dynamics in accreditation 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exploration of leadership in clinical units  \nMaria Pilar Mesa-Blanco  \nMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Crdoba, Spain; University Hospital Reina Sofa, Crdoba, Spain and University of Crdoba, Crdoba, Spain  \nPedro E. Ventura-Puertos  \nInterdisciplinary Research Group in Discourse Analysis (HUM380), Crdoba, Spain and  \nDepartment of Nursing, Pharmacology and Physiotherapy, University ofCrdoba,  \nCrdoba, Spain  \nVctor M. Gonzlez-Chord  \nNursing Research Group (GIENF-281), Universitat Jaume I, Castelln de la Plana, Spain; Investn-isciii, Madrid, Spain and  \nBiomedical Research Networking Centre in Respiratory Diseases (CIBERES),  \nMadrid, Spain, and  \nManuel Rich-Ruiz  \nMaimonides Biomedical Research Institute of Cordoba (IMIBIC), Crdoba, Spain; University Hospital Reina Sofa, Crdoba, Spain and Department of Nursing, Pharmacology and Physiotherapy, University ofCrdoba,  \nCrdoba, Spain  \nAbstract  \nPurpose–This study aims to explore the perceptions of clinical management unit leaders regarding their role in healthcare accreditation processes within a European public hospital. It aims to identify the predisposing, enabling and reinforcing factors that shape leadership practices and influence the development of a qualityoriented organisational culture.  \nDesign/methodology/approach – A qualitative hermeneutic approach was employed, combining individual and group semi-structured interviews and participant observation. Six healthcare professionals responsible for accreditation projects under the Andalusian Agency for Health Quality participated. Data were analysed using Ricoeur ’s interpretative framework, guided by the PRECEDE model.  \nFindings – Three themes emerged in this study: (1) conceptual tensions between accreditation and quality culture,(2) leadership as a collective and emotionally demanding endeavour and (3) accreditation as a process that generates both tangible improvements and emotional reinforcement. The study highlights the need to clarify the internal lead’s role and align accreditation language with clinical and managerial realities.  \nResearch limitations/implications – Future research could examine how gender dynamics influence leadership in accreditation processes.  \n© Maria Pilar Mesa-Blanco, Pedro E. Ventura-Puertos, Vctor M. Gonzlez-Chord and Manuel RichRuiz. Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at Link to the terms of the CC BY 4.0 licence.  \nFunding: Funding for open access charge was provided by Universidad de Crdoba / CBUA.  \nInternational Journal of Health Care Quality Assurance  \nReceived 11 October 2025 Revised 3 December 2025 Accepted 3 December 2025  \nInternational Journal of Health Care Quality Assurance  \nEmerald Publishing Limited e-ISSN: 1758-6542  \np-ISSN: 0952-6862 DOI 10.1108/IJHCQA-10-2025-0161  \nIJHCQA  \nPractical implications–Findings support the need for leadership development, institutional investment and theredesign of accreditation standards to better reflect clinical practice and managerial responsibilities.  \nSocial implications – The study underscores the emotional and cultural impact of organisational change, highlighting the importance of supportive environments that foster shared responsibility, team engagement and sustainable quality improvement.  \nOriginality/value–This is the first study to apply the PRECEDE model to explore leadership in accreditation. It offers a novel framework for understanding how internal leads navigate quality improvement within complex healthcare organisations and provides actionable insights for institutional development.  \nK","cbCaif77V8h3J0FP","https://ap.wps.com/l/cbCaif77V8h3J0FP","pdf",1001883,15,"English","# Abstract\n## Purpose\n## Design/methodology/approach\n## Findings\n## Research limitations/implications\n# Introduction\n## Accreditation and quality measurement\n## ACSA accreditation model and CMUs\n## Internal leads and role complexity","[{\"question\":\"What is the main purpose of the study?\",\"answer\":\"The study aims to explore clinical management unit leaders’ perceptions of their role in healthcare accreditation processes in a European public hospital and to identify factors shaping quality-oriented organisational culture.\"},{\"question\":\"How did the researchers conduct the study?\",\"answer\":\"They used a qualitative hermeneutic approach, combining individual and group semi-structured interviews and participant observation, with analysis guided by Ricoeur’s interpretative framework and the PRECEDE model.\"},{\"question\":\"What key themes emerged from the findings?\",\"answer\":\"Three themes emerged: tensions between accreditation and quality culture, leadership as collective and emotionally demanding, and accreditation as a process that produces tangible improvements while reinforcing emotions and commitments.\"},{\"question\":\"What future research direction does the article suggest?\",\"answer\":\"It suggests examining how gender dynamics influence leadership in accreditation processes.\"}]","Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units | PDF",38]