What is the nature of hospital accreditation in Europe?

Summary of a HEN network member’s report

The issue

Accreditation is an independent external review process that assesses the quality of health care services in order to encourage improved performance. Accreditation standards are traditionally set at what are considered optimal achievable levels.

Since 1980, most European governments have experimented with accrediting their health care systems, but so far only a few have decided to pursue it. Governments and major health care providers have found it difficult to agree on the need for accreditation, not to mention the specific processes to be used. In addition, writing and establishing accreditation standards is a costly and time-consuming process. The most common way to introduce accreditation to a country has been to enlist the help of an organization experienced in developing it elsewhere, and then to translate existing standards from another country.

Findings and discussion

The United Kingdom piloted the continent’s first accreditation programme in 1980. Despite the widespread participation of private hospitals in particular, this voluntary scheme is only one of several initiatives the government has developed to encourage better health care. English accreditation has been exported on an experimental basis to Finland, Portugal and Sweden, which have all developed the model to a limited degree without making it mandatory.

In the Czech Republic, Germany, Hungary, Poland, Portugal, Spain and Switzerland, private health services have pressured the government to introduce accreditation. Generally, however, the interest has been short-lived, and the governments have chosen other methods of improving health care.

Government accreditation is somewhat of a contradiction in terms, since a third party is needed to guarantee independence. In addition, government accreditation tends toward regulation – that is, the traditional emphasis on aspirational standards gives way to an emphasis on compulsory minimum requirements. Only three European governments run their own accreditation systems. In Belgium, planning needs form the basis for national standards, which are then modified and administered locally. France subjects all public and private services to an external review aimed at improving safety as well as quality. And Scotland is developing separate accreditation programmes for clinical priorities such as cancer, strokes and mental health.

Many other European governments have passed health care laws that, while they are designed to improve organizational and clinical quality, fall short of full accreditation.


Health care accreditation is a recent phenomenon in Europe that has taken many forms. The means range from self-regulation to professional review to government inspection. While traditional programmes have been voluntary, aspirational, structurally-oriented and confidential, variations are now found in every major parameter. These divergent efforts mark a growing effort to find the accreditation methods that will improve national health care the most.

The views expressed in this summary are based on a publication of a HEN Network member agency and do not necessarily represent the decisions or stated policy of WHO/Europe.