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Objective (s): Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and outcomes by an independent professional accreditation body using pre-established optimum standards. Iran national hospital accreditation system (i.e., standards, methods, and surveyors) has changed in 2016. This study aimed to evaluate the efficacy of national hospital accreditation system of Iran. Methods: This cross-sectional study was carried out using a valid and reliable questionnaire covering accreditation standards, methods, surveyors, implementation and effects. The study population consisted of all hospital managers in Zanjan province, Iran. SPSS software was used for data analysis. Results: The mean score of managers’ satisfaction of hospital accreditation system was 3.00±0.27 and 2.98±0.36 out of 5 in 2015 and 2017. Hospital managers’ satisfaction of the new accredtation system has decreased by 0.66 percent in 2017. However, the differences was not statistically significant. Managers’ satisfaction of accreditation standards increased by 1.8% while their satisfaction of accredtation methods and standards implementation has decreased by 11.6 and 8.5 percent respectively. Conclusion: The changes applied to Iran national hospital accreditation system did not satisfy hospital managers. Hospital managers’ and employees’ opinions and concerns should be considered in any attemp to revise the hospital accreditation system.