Policy issues in accreditation

Since the 1990s the structure and financing of many health care systems have been reformed and, for the first time, a number of governments have accepted that quality assurance of health care systems should become a government responsibility and not left, as in the past, to professionals and health service managers. Pressure had been increasing during the previous decade for governments to become more involved in health care quality. In 1984, for example, a regional committee of the World Health Organisation (WHO) adopted 38 targets for attainment of health for all by the year 2000. One target required that by 1990 all member states should have built effective mechanisms for ensuring quality of patient care within their heakh care systems. The target recommended establishing methods and procedures for systematically monitoring the quality of care given to patients, by making assessment and regulation permanent components of health professionals' regular activities, and by providing all health care personnel with training in quality assurance 1. Slowly, governments have begun to respond, reviewing processes for promoting quality achievement. In some countries, for example The Netherlands, Switzerland, Spain, Italy and France, this responsibility has been stated in legislation and has placed a requirement upon governments to devise systems in order to demonstrate that quality is being pursued and achieved. Systematic monitoring of health care quality is easy to demand, and much harder to implement. The options available to governments accepting this role are few. The choice usually falls between accreditation systems, ISO 9000-based systems, self-assessment systems or an outcomes-based approach which attempts to monitor the impact of health care. Each has its own merits and disadvantages. This article focuses on the issues which need to be considered by governments as they examine the possibility of adopting accreditation systems to fulfil the requirements for monitoring quality in health care. services has created great interest on behalf of the public