Standards, whether for licensure, accreditation, or certification, are definitions of:
- the services that should be available in a specific type of health care facility or program,
- the professional personnel who should provide the services, including their qualifications and numbers adequate for patient loads,
- how personnel should be organised to provide the services and maintain quality controls (for example, medical staff committees and bylaws in a hospital),
- the policies and administrative organisation and procedures that facilities should have,
- required equipment and physical facilities for and definitions of adequate safety, cleanliness, and sanitation, and
- definitions of other areas of importance to health and safety, such as dietary service, drugs, and medical records.
Thus, standards serve as indicators of the level of quality of medical care an institution or service program is capable of providing.
However, as early as 1916, the American College of Surgeons undertook its first quality survey of hospitals in the United States and Canada. At that time, there were less than 700 hospitals in the two countries with 100 beds or more and 2,000 with 25-99 beds.
The criteria employed in that first survey, and its findings, were never published and have not been preserved in the files of the American College of Surgeons. It is known, however, that only 89 of the 700 hospitals with more than 100 beds could meet any reasonable standards of that time, and it has been said that the facts elicited from the first survey were so shocking that the survey committee ordered the individual survey reports destroyed forthwith. Subsequently, the American College of Surgeons adopted a watered-down version of the quality survey activity which had as objectives, “first, to define a Minimum Standard, second, to enlist the cooperation of the hospitals in the fulfilment of the Standard, this work to be accomplished through personal visits to the hospitals by staff members of the College, and third, to publish from time to time the list of hospitals throughout the two countries (Canada and the United States) which fulfilled the Minimum Standard”. The list was not to be published, however, until the hospitals themselves generally approved of such publication and each hospital had been given full opportunity to meet the standard under normal conditions.
The Minimum Standard Program of the American College of Surgeons continued until the early 1950’s, when functions of professional accreditation of hospitals were taken over by the Joint Commission on Accreditation of Hospitals (JCAH).(1)
In Europe there is no such long experience in hospital accreditation and/or certification. As we have seen from the American experience, it is long way to establish overall „minimum standard“ for all hospitals.
In some EU countries accreditation is a voluntary process, but in some others this is a mandatory.
Even if you do not have a legal or mandatory requirements for accreditation, but have chosen to implement one for your own sake, it is often beneficial for improvement and patient safety purposes to have an external surveyor with a greater breadth of clinical and/or PE experience to look at your processes and make comments in the form of non-conformities and opportunities for improvement .This can help you to further improve your patient system past what you might have been able to do yourself.
Slovenia is a good example how the overall patient safety and quality can be improved in a relatively short time, but the consensus of all interesting parties must be achieved. 7 years after the first hospital has been accredited the country overall quality of care is significantly higher than it was on the beginning of the process.
If the benefits are there, then find the best accreditation body for your organisation and use it to improve your overall system. Survey outcome will show you the direction towards continuous improvement and increase of patient safety.
- JOHN W. CASHMAN, M.D., PEARL BIIERMAN, M.A., and BEVERLEE A. MYERS, M.P.H: The “Why” of Conditions of Participation in the Medicare Program