Schyve P M
Joint Commission on Accreditation of Healthcare Organizations, Illinois, USA.
Int J Qual Health Care. 2000 Jun;12(3):255-8. doi: 10.1093/intqhc/12.3.255.
The Joint Commission on Accreditation of Healthcare Organizations, the oldest health care accrediting body in the world, currently accredits almost 20000 organizations in the USA. Although continuing to be professionally-sponsored, accreditation's rapid growth in recent years has been driven by the external users of accreditation--government, purchasers, and public--rather than by the original users, the professionals themselves. This experience in the USA suggests that over time successful external quality evaluation mechanisms throughout the world will involve representatives of the public, purchasers, and government in establishing standards and setting policies. Without this involvement, these stakeholders are unlikely to find the mechanisms credible in addressing their needs, and will seek alternatives--adding cost and duplication to the external quality evaluation system. Successful mechanisms are also likely to provide more detailed information about an organization's performance to the public, purchasers, and the government, while creating evaluation processes that provide for innovation and support improvement in efficiency, as well as quality, through incorporation of aspects of the Baldrige and European Foundation for Quality Management approaches to organizational excellence. Finally, successful evaluation mechanisms are likely to create a special focus on the safety of care, incorporating aspects of the International Organization for Standardization's ISO 9000 approach to quality management. While the specific nature, priority, and timing of these changes will differ from country to country, they are likely to influence the evolution of external quality evaluation throughout the world. External evaluation of health care organizations' quality holds great promise, but its long-term success depends on responding to all those who will want to depend on it.
医疗保健组织认证联合委员会是世界上最古老的医疗保健认证机构，目前对美国近20000个组织进行认证。尽管认证仍由专业机构发起，但近年来其快速发展是由认证的外部使用者——政府、购买方和公众推动的，而非最初的使用者，即专业人士自身。美国的这一经验表明，随着时间的推移，全球成功的外部质量评估机制将让公众、购买方和政府的代表参与标准制定和政策设定。没有这种参与，这些利益相关者不太可能认为这些机制在满足他们的需求方面可信，并会寻求其他途径，从而增加外部质量评估系统的成本和重复性。成功的机制还可能向公众、购买方和政府提供有关组织绩效的更详细信息，同时创建评估流程，通过纳入鲍德里奇奖和欧洲质量管理基金会的卓越组织方法的各个方面，为创新提供支持，并提高效率和质量。最后，成功的评估机制可能会特别关注医疗安全，纳入国际标准化组织ISO 9000质量管理方法的各个方面。虽然这些变化的具体性质、优先事项和时间因国家而异，但它们可能会影响全球外部质量评估的发展。对医疗保健组织质量的外部评估前景广阔，但其长期成功取决于对所有希望依赖它的人的回应。
