Licensure, accreditation, and certification: approaches to health service quality

In the past decade, the quality movement that has been embraced by the service and manufacturing sectors has spilled into the health care sector. Most health care managers and policy makers now view as imperatives the evaluation and control of quality and improvements in quality. Less agreement exists, however, as to a quality evaluation approach that will meet the needs of a particular health care organisation, regulatory agencies, those who pay for health care services, or those who purchase services. This paper, produced by the Quality Assurance Project, is aimed at decision-makers and analyses various approaches to health services quality evaluation and management.

The paper overviews the steps in assessing the needs for quality evaluation and provides a description of the various approaches appropriate for meeting these needs. This includes the strengths and weaknesses of a standards approach and an outcome measurement approach. Finally, the factors that decision-makers should consider in the design and implementation of the quality evaluation approach that they select are reviewed. The paper also includes a case study illustration describing the development and implementation of a hospital accreditation program in Zambia, and a comparison of health sector accreditation programs around the world. [adapted from authors]