Plenary IX – Next Generation Accreditation in Healthcare: Sustainability

The origin of healthcare accreditation can be traced more than 100 years back, and accreditation has been a cornerstone of quality assurance for 50-70 years in some countries. ISQua established its International Accreditation Programme (IAP) in 1999, thus setting the global benchmark for high quality accreditation services by offering accreditation of the accreditors. Currently, the IAP is delivered by a separate, but affiliated organisation: The ISQua EEA.


Naturally, accreditation has not remained the same during this period, and it is time now to take a step back to examine its future.


Several current trends will impact the way in which accreditation is conceptualised and delivered.


Trend 1: The concept of quality concept has broadened considerably. Once, quality was mainly viewed from the perspective of the professionals: Quality meant that the services delivered were meeting accepted professional standards. Several layers have been added: Healthcare services must meet the needs of the population as a whole; the service user perspective has been added (person-centred care); most recently, it has been realised that planetary health, ecological sustainability, is a prerequisite for individual health.


Trend 2: Healthcare delivery is changing, shifting from hospitals to primary care settings and even people's homes. Digital technologies and artificial intelligence are accelerating this shift.


Trend 3: Systems understanding is developing – while standardisation will remain an important part of quality assurance, a highly complex system such as healthcare cannot be managed solely by requiring compliance with prescribed procedures.


Trend 4: New technologies not only transform healthcare delivery; they also provide new options for how to perform external evaluation. 


In the presentation, we will examine how these trends will influence accreditation and how ISQua EEA, as a thought leader and through the IAP, will facilitate, support, and lead the journey towards the next level of healthcare accreditation.

This session will explore the important link between sustainability and patient safety, focusing on how healthcare operations impact environmental health. As climate change progresses, the resilience of healthcare providers becomes increasingly important. 
This session will provide insights into why sustainability is crucial for patient safety and how accreditation bodies are addressing this issue. 
Key Focus Areas: 
1. Sustainability as a Patient Safety Issue: • How healthcare operations contribute to environmental health risks. • The need for healthcare providers to adapt to climate change for better resilience. 
2. Incorporating Sustainability in Hospital Accreditation: • Efforts by the Joint Commission and others to include sustainability in accreditation standards. • Five key elements of future accreditation that are practical and achievable for all organizations. 
3. Support for Advanced Organizations: • Initiatives for organizations that are leading in sustainability practices. 

This presentation will address the importance of accreditation and the rational for countries adapting international standards to national custom and practice.


The World Health Organization's (WHO's) Sustainable Development Goal (SDG) has mandated that we achieve universal health coverage (UHC), for all by 2030. As originally defined, UHC does not mean access to care but access to quality care. Achieving universal health coverage will require effective alignment between governments, payers, providers and service users. Accreditation has the potential to help to guide the way and provides a framework that facilitates the provision of high-quality patient care. 


A report from (WHO), the Organisation for Economic Co-operation and Development (OECD) and the World Bank in 2018 called on governments to urgently create a quality policy at a national level. Each country has multiple and complex needs and must develop its own pathway to UHC, and so there is no 'silver bullet' that will address improving quality in healthcare.


The Joint Commission International (JCI), developed in 1999, were the first international accreditation programme, and were soon followed by Accreditation Canada International and the Australia Council for Hospital Standards International (ACHSI). These three remained the only bodies offering international accreditation until the last decade which has witnessed a proliferation in countries developing their own standards. 


Since 2000 ISQua have monitored the growth in accreditation bodies. The latest in a series of three surveys (2001, 2010 and 2021) was published in 2021 and revealed that there are 53 organisations offering accreditation services nationally or internationally to healthcare provider institutions or networks at primary, secondary or tertiary level. These organisations were located in 97 countries including high, middle and low-income countries. This compared to 44 organisations in 2010 offering accreditation services nationally or internationally to healthcare provider institutions at primary, secondary, or tertiary level. 

Patient safety is always a global challenge. With the increasingly complex clinical services in hospitals, implementation of comprehensive quality management system, incorporating thorough planning of all clinical and management processes, is crucial. One of the effective catalysts is hospital accreditation by an external evaluation organization. 


Early research into accreditation had documented the benefits as supporting change management, multidisciplinary teams and professional development with positive clinical outcomes. Recent studies have affirmed that accreditation programs are recognized globally as an important external driver to improve organizational culture, organizational and clinical processes, leading to better clinical performance, safety and quality outcomes. Furthermore, participation in an accreditation program results in compliance to external standards and continual process improvements. 


With changing societal demands, rapid advances in technology and evolution in services, the scope in hospital accreditation expands. The newly released criteria for certification of hospital accreditation standard by the International Society for Quality in Health Care – External Evaluation Association (ISQua-EEA, 6th Edition) has introduced additional clauses on environmental sustainability, staff safety/benefits, patient data safety and monitoring of artificial intelligence. All these reflect the importance of enhancing patient safety midst all the dynamic changes.


The Shenzhen Hospital Accreditation Research Center (SHARC) was established with the mission of developing the National '3A' Hospital Accreditation System into an internationally recognized system. We have successfully attained ISQua-EEA accreditation for our China's International Hospital Accreditation Standard (CIHA) in 2022, Surveyors Training Program and External Evaluation Organization in 2024. Aiming for continual improvement of the accreditation processes, we are now conducting an in-depth review of CIHA to explore for further optimization through incorporation of these new parameters and adaptation to accomodate different laws/regulations and service demands.


The future trends and potential opportunities for hospital accreditation will be presented.