Accreditors can provide some leadership, but they can't do it on their own

The admonition “First, do no harm,” paraphrased from the Hippocratic oath,1 has long been a guiding principle for the practice of medicine and the delivery of healthcare services around the world. But harm is done every day in health care. This has been well documented in the medical literature.2 Now public awareness of medical errors and unexpected adverse patient outcomes is growing.3 We have a serious problem, and it cries for timely, effective solutions. No one feels this more keenly than practising physicians, healthcare executives, and the overseers of healthcare quality. Effective solutions, however, are proving to be a daunting challenge.

The oversight of healthcare quality in the United States is accomplished both through professionally based, private sector accrediting bodies and through federal and state regulatory agencies. Many variations of this framework are now increasingly in evidence throughout the world. The initial model for external quality oversight in the United States was created by physicians in 1917. The resulting hospital standardisation programme …