1 Department of Medical Ethics, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

2 Quality Improvement in Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 Social Determinants of Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


Introduction: The application of organizational ethics in hospitalsis one of the novel ways to improve medical ethics. Nowadaysachieving efficient and sufficient ethical hospital indicators seemsto be inevitable. In this connection, the present study aims todetermine the best indicators in hospital accreditation.Methods: 69 indicators in 11 fields to evaluate hospital ethicswere achieved through a five-step qualitative and quantitativestudy including literature review, expert focus group, Likert scalesurvey, 3 rounded Delphi, and content validity measurement.Expert focus group meeting was conducted, employing NominalGroup Technique (NGT). After running NGT, a three roundedDelphi and parallel to Delphi and a Likert scale survey wereperformed to obtain objective indicators for each domain. Theexperts were all healthcare professionals who were also medicalethics researchers, teachers, or Ph.D students. Content validitymeasurements were computed, using the viewpoints of twodifferent expert groups, some ethicists, and some health careprofessionals (n=46).Results: survey, 11 main domains were listed including:Informed consent, Medical confidentiality, Physician-patienteconomic relations, Ethics consultation policy in the hospital,Ethical charter of hospital, Breaking bad medical news protocol,Respect for the patients’ rights, Clinical ethics committee,Spiritual and palliative care unit programs in the hospitals,Healthcare professionals’ communication skills, and Equitableaccess to the healthcare. Also 71 objective indicators for these 11domains were listed in 11 tables with 5 to 8 indicators per table.Content Validity Ratio (CVR) measurements were done and 69indicators were highlighted.Conclusion: The domains listed in this study seem to be themost important ones for evaluating hospital ethics programsand services. Healthcare organizations’ accreditation andranking are crucial for the improvement of healthcare services.Ethics programs would also motivate hospitals to improvetheir services and move towards patients’ satisfaction. In thisregard, more involvement of bioethicists can help healthcareorganizations to develop ethics programs and ensure ethicsbasedpractice in hospitals.Keywords: Hospital; Ethics; Accreditation; Evaluation