Accreditation manual for nephrology.

The IRS did not develop a new theory of accreditation but drew up a methodology for assessing public policies, which internalised accreditation philosophy and was based on a theory of the decision-making process. Two questions underlie this theory: 1) whether health is a professional organisation, a company or a public policy, 2) whether accreditation in the internationally accepted meaning of the term is the most effective system of continuous improvement for this sector as it is organised in Italy. According to the IRS, health is all three of these things and accreditation responds adequately to the complexity of the sector. In fact: a) internalises professional knowledge (and is therefore ideal for a professional organisation); b) it triggers a process of continuous improvement of the product/service supplied (and that is ideal for a company that must maintain the competitiveness of its product/service as high as possible); c) it uses a methodology which highlights the mechanisms of interaction between the actors (a methodology underlying decision making theory where there are actors who decide, knowing that they have to find a consensus and who exchange resources in a virtuous circle. The principal qualitative element identified by the IRS methodology was the internalisation by the health system of patients' expectations and patients' satisfaction in the welfare process. The main feature of the accreditation methodology designed by the IRS is that the assessment focuses neither on structures (which would have been useful to measure the degree of reliability) nor on the compilation of behaviour guidelines, but is centred on the assessment of a function, on the quality of the provision of a specialist health service. The decision to assess a specialist function (e.g. nephrology) and not a structure (e.g. a nephrology department or a hospital) gives maximum importance to the figure of the professional.