Accreditation and certification.

In Italy the debate has focused on three different assessment systems: accreditamento autorizzativo (regulatory accreditation), accreditamento di eccellenza (excellence accreditation), and certification. Regulatory accreditation verifies the conformance to a set of quality standards that entitle an organisation to the status of belonging to the NHS. Excellence accreditation attempts to maintain incremental improvement of the quality of services. Certification is a means by which an independent third party declares that a determined product or process conforms to the ISO 9000 set of standards; the main objective of certification is to increase the "credibility" of a company on the market in order to orient and at the same time assure customers. Certification loses meaning in a regulated market, as the Italian NHS, in which there is a distinction between the consumer and the paying body. Regulatory accreditation should be deeply rooted in regional planning; the recognition of accredited organisations should be the result of a demonstrated capacity to co-operate in achieving the goals of regional planning and not of conformance to organisational standards. Regional experiences of regulating accreditation show a high level of contamination between systems for quality assessment. The large number of standards proposed seemed to be redundant with respect to the aims that should be pursued by a regulating accreditation system. The furthering of quality in the NHS requires a complex system of quality assessment within which a plurality of subjects, each with different interests, work together to determine the final result by each one setting up procedures consistent with its own particular problems: the institutions set up regulatory accreditation and the professions develop excellence accreditation in their individual professional associations. What is important is to establish relationships across the various levels so as to give the whole system cohesion and consistency. (Int J Artif Organs