Introduction and purpose: Accreditation is a process in which a foreign institution systematically measures and evaluates the credibility of an organization in terms of process, outcome, and structural indicators. This study aimed to identify the effective challenges in the implementation of the accreditation process and achieve a comprehensive model to improve and enhance the accreditation process. Methods: This study was performed in two stages. In the first stage, a review of studies was

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... ucted to identify the challenges affecting the implementation of hospital accreditation in Iran. In the second stage, the content validity method was used to recognize the most important challenges affecting the implementation of accreditation. Subsequently, to investigate the relationships among factors and determine the most effective and impressionable variables, quantitative interpretive structural modeling technique was used. Results: The most effective variables with a driving power of 11 and dependence power of 4 were found to be the lack of necessary infrastructure, nurses, clinical staff, and other personnel; limited resources and capital; not considering the appropriate budget for the implementation of the accreditation program; and non-compliance of some standards with national and provincial conditions. On the other hand, the least influential variables on challenges affecting the implementation of hospital accreditation with a driving power of 1 were reported to be the challenge in the degree of independence, impartiality, personal judgments, and differences of evaluatorschr('39') tastes, as well as the poor patient-medical team communication. Conclusion: It is necessary to find the main and effective factors in accreditation and establish a relationship between them to achieve the more effective implementation of accreditation. Therefore, it would be possible to provide a clear framework for determining the best policies to control and manage accreditation and ultimately prevent the waste of resources in the [...]