{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:31:32Z","timestamp":1793302292100,"version":"4.5.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healthcare quality certification models are fundamental for ensuring patient safety and continuous improvement. The appearance of nonconformities (NC) during external audits reflects implementation difficulties. This study analyzes factors associated with the presence of NC in the certification of hospital clinical management units (CMU) in Andalusia over two decades.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective observational study of 811 hospital CMU certification projects from the Andalusian Health Service registered between April 2003 and June 2023. Data were obtained from the Andalusian Agency for Healthcare Quality ME_jora C platform. Variables included certification level, project type, standard compliance percentages, temporal metrics, and territorial distribution. Descriptive statistics, bivariate analyses (Chi-square, Mann\u2013Whitney U), and multivariate logistic regression were performed to identify factors associated with the presence of NC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 811 projects were certified, with 27.7% (225\/811) achieving certification without any NC. The majority (86.4%) reached advanced level, 12.5% optimal level, and only 1.1% excellent level. Seville (25.1%) and M\u00e1laga (18.7%) concentrated the highest number of projects. Multivariate analysis identified five independent factors: each additional year between registration and certification increased the odds of NC (OR = 3.3; 95% CI: 2.4\u20134.9; P\u2009&amp;lt;\u2009.001); each additional year devoted to self-assessment reduced the odds of NC by \u223c70% (OR = 0.3; 95% CI: 0.2\u20130.4; P\u2009&amp;lt;\u2009.001); higher final self-assessment percentage reduced risk (OR = 0.92; 95% CI: 0.87\u20130.97; P\u2009=\u2009.006); more recent certification years were associated with higher odds of NC (OR = 1.25; 95% CI: 1.10\u20131.43; P\u2009&amp;lt;\u2009.001); and higher number of self-assessors was associated with a slightly increased likelihood of NC. (OR = 1.06; 95% CI: 1.00\u20131.13; P\u2009=\u2009.049).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Longer self-assessment periods were associated with lower odds of NC, whereas longer overall certification processes were associated with higher odds of NC. These findings provide quantitative evidence to optimize certification planning and support healthcare units in achieving successful certification outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzag145","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:28:34Z","timestamp":1789756114000},"source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with the presence of nonconformities in the certification of hospital clinical management units in Andalusian"],"prefix":"10.1093","volume":"38","author":[{"given":"Patricia","family":"Bonachela-Sol\u00e1s","sequence":"first","affiliation":[{"name":"Quality Unit, Virgen del Roc\u00edo University Hospital , Seville,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"L\u00f3pez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Seville , Seville,","place":["Spain"]},{"name":"Quality\u2019s Unit, Virgen del Roc\u00edo University Hospital , Seville,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9539-1774","authenticated-orcid":false,"given":"Antonio","family":"Cervera-Barajas","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Seville , Seville,","place":["Spain"]},{"name":"Quality\u2019s Unit, Virgen del Roc\u00edo University Hospital , Seville,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Varela-Rubio","sequence":"additional","affiliation":[{"name":"Quality Unit, Virgen del Roc\u00edo University Hospital , Seville,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rub\u00e9n","family":"Morilla-Romero de la Osa","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Seville , Seville,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"2026102914444803600_mzag145-B1","volume-title":"The Global Challenge for Patient Safety","author":"World Health Organization","year":"2023"},{"key":"2026102914444803600_mzag145-B2","volume-title":"Handbook for National Quality Policy and Strategy: A Practical Approach for Developing Policy and Strategy to Improve Quality of Care","author":"World Health Organization","year":"2018"},{"key":"2026102914444803600_mzag145-B3","doi-asserted-by":"publisher","first-page":"50","DOI":"10.5553\/HYIEL\/266627012023011001005","article-title":"Prior and subsequent authorization of cross-border healthcare under Directive 2011\/24\/EU","volume":"11","author":"Gell\u00e9rn\u00e9","year":"2023","journal-title":"Hung Yearb Int Law Eur Law"},{"key":"2026102914444803600_mzag145-B4","volume-title":"Law 16\/2003, of 28 May, on Cohesion and Quality of the National Health System","author":"BOE","year":"2003"},{"key":"2026102914444803600_mzag145-B5","volume-title":"Real Decreto 1277\/2003, de 10 de Octubre, Por el Que se Establecen Las Bases Generales Sobre la Autorizaci\u00f3n de Centros, Servicios y Establecimientos Sanitarios","author":"BOE","year":"2003"},{"key":"2026102914444803600_mzag145-B6","volume-title":"Ley 44\/2003, de 21 de Noviembre, de Ordenaci\u00f3n de Las Profesiones Sanitarias","author":"BOE","year":"2003"},{"key":"2026102914444803600_mzag145-B7","volume-title":"Who We Are.","author":"Andalusian Health Quality Agency"},{"key":"2026102914444803600_mzag145-B8","volume-title":"Standards Certified by the International Society for Quality in Health Care External Evaluation Association (Isqua-IEEA).","author":"Andalusian Health Quality Agency. 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