External assessment of health care

Box 1: Characteristics of effective external assessment programmes

Give clear framework of values—To describe elements of quality, and their weighting, such as the enablers and results defined by the European Foundation for Quality Management

Publish validated standards—To provide an objective basis for assessment

Focus on patients—To reflect horizontal clinical pathways rather than vertical management units

Include clinical processes and results—To reflect perceptions of patients, staff, and public

Encourage self assessment—To give time and tools to internalise assessment and development

Train the assessors—To promote reliable assessments and reports

Measure systematically—To describe and weight compliance with standards objectively

Provide incentives—To give leverage for improvement and response to recommendations

Communicate with other programmes—To promote consistency and reciprocity and to reduce duplication and burden of inspection

Quantify improvement over time—To demonstrate effectiveness of programme

Give public access to standards, assessment processes, and results—To be transparent and publicly accountable