Hospital accreditation is important

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7287.674/a (Published 17 March 2001) Cite this as: BMJ 2001;322:674
  1. Richard Rawlins (RichardR{at}wlins.demon.co.uk), chairman, Health Quality Service advisory council
  1. Bedford General Hospital, Bedford MK42 9DJ

    EDITOR—Essex believes that awards such as the Charter Mark and the King's Fund organisational audit are merely “administrative baubles” and a waste of time.1 I cannot speak for the Charter Mark award but must point out that the King's Fund organisational audit was reconfigured as the Health Quality Service in 1999; I am chairman of its advisory council.

    The Health Quality Service is just that: a service for those who seek to use modern methods to improve the quality of the health care they provide. We lay emphasis on development and education rather than inspection, by providing a thorough review of all aspects of an institution's structure, systems, and processes, with particular emphasis on what patients experience. We support the groundwork that will enable the adoption of more efficient and effective processes, leading in turn to improved outcomes.

    To provide this service we have the help of staff in the institution being surveyed. It is true that these staff may be away from other duties for a time, but the alternative is to allow healthcare institutions to continue to struggle without the benefit of modern methods of quality improvement.

    I must also disabuse Essex that the King's Fund organisational audit and Health Quality Service were thought up by “an administrative mindset.” The first such scheme was initiated by Dr Ernest Codman in the United States in 1910 and led to the founding of the American College of Surgeons in 1913 and the Hospital Standardization Program in 1917. This programme sought to ensure that “those institutions having the highest ideals may have proper recognition before the profession, and that those of inferior equipment and standard should be stimulated to raise the quality of their work.”

    The Health Quality Service does not seek to control as Essex suggests; on the contrary, we seek to coach. A plaque is on offer for those institutions that are accredited, but it need not be used—nor need the fact of accreditation be announced. Many hospitals are proud of gaining accreditation and use the opportunity to encourage their staff to do better still.

    There is a long history of cynicism about the value of hospital accreditation, but after 90 years it is clearly here to stay. We are encouraged that the government has initiated the Commission for Health Improvement, which will have a statutory responsibility to ensure that NHS hospitals are properly engaged in modern quality improvement.


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