Abstract
<title>Abstract</title> <p>Introduction: Accreditation is considered one of the key tools for improving quality in prehospital emergency care, and its comprehensive program was implemented for the first time in 2022. The present study aimed to explore the challenges involved in implementing this program from the perspective of executive evaluators at the National Emergency Organization. Methods: This qualitative study was conducted in 2024 using semi-structured interviews with executive evaluators from the National Emergency Organization. Data were collected through purposive sampling until saturation was reached (15 participants) and were analyzed using qualitative content analysis with MAXQDA software. Results: Analysis of the interview data led to the extraction of 937 initial codes, which were later merged and categorized into 115 subthemes and 30 main themes. These themes were classified across three stages—before implementation, during implementation, and after implementation—and within three dimensions: managerial, structural, and evaluation process. The findings showed that managerial issues accounted for the largest share of challenges across all stages, with the greatest concentration of challenges occurring during the implementation phase of the accreditation program. Discussion and Conclusion: The findings indicate that the challenges associated with the prehospital emergency accreditation program are multidimensional and emerge throughout different stages of implementation. Managerial factors and issues arising during the implementation phase represented the most significant challenges. In addition, the mismatch between accreditation indicators and the real-world conditions of operational settings, along with structural and operational limitations, were identified as major factors reducing the program’s effectiveness. Therefore, strengthening organizational preparedness, revising accreditation indicators to better align with the nature of prehospital emergency services, and improving monitoring and feedback mechanisms appear to be essential.</p>