[The accreditation procedure: An external recognition of quality in public and private health centres in France. ]

Since early 1990, the structures and financing of various health systems have been reformed. For the first time, some western Europe countries have admitted that quality insurance within the health system can become a governmental responsibility and, as in the past, simply the responsibility of the professionals and/or the health service administrators. During the last decade of the XXth century, pressure has gradually been increased for governments to become more involved in health system quality. This focus on quality was linked to human safety. In this historical perspective, the emergence of AIDS and the difficulty to control this epidemic, and the consequences of contamination by injection needles have probably played a part in this collective awareness. In this context, quality has become a major concern in Europe.

[Accreditation of health care organizations]

The order No. 96-346 dated April 27, 1996 introduced in French Law, made it compulsory for all private and public health care organizations to be granted an official approval, the 'certificate of accredication'. This article aims at describing the main principles of a process which will surely profoundly modify quality management of health care in sanitary bodies. The first part is a reminder of the main concepts used in quality management which help us to understand and use the guidelines of accreditation distributed by the National French Agency for Accreditation and Assessement of Health Care (Agence Nationale pour l'Accréditation et l'Evaluation des établissements de santé--ANAES). The second part of this article presents the procedure for granting the certificate of accreditation, especially its successive steps (the procedure launching, the self-evaluation phase, the visit of experts sent by ANAES, the report written by the experts and its aim). Beyond this procedure, a third part briefly underlines the main directions for developing efficient quality control and safety management of health care in sanitary bodies.

The evolution of volunteerism and professional staff within hospice care in North Carolina

Although the pursuit of Medicare certification has been one of the most controversial events in hospice history no study has examined its impact using data from a defined population of hospices before, during, and after federal legislation was enacted. This paper revisits the debate over the changing role of volunteers using such a longitudinal data source. Over time, as the patient population grew, aggregate levels of volunteers and professional staff increased. However, the ratios of professional staff and volunteers to patients reveal that regardless of certification status, hospices retained more professional staff per patient and fewer volunteers per patient over time. These data suggest hospices, particularly certified organizations, have transitioned from voluntary organizations to professionally staffed organizations with a strong volunteer component. The most important issue for future research is whether the observed changes have affected the quality of hospice care.

Cultural competence is a must for all hospitals

It makes sense to move your facility to an attitude of cultural competency, not only because there are certain minimum requirements from the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, and other watchdogs, but also because it's the right thing to do, according to Beth Remus, an expert in the field of cultural awareness and competency in health care.

Beyond hospital walls

The Health Care Financing Administration plans to expand hospital response boundaries to a 250-yard radius of the facility. Learn how this will affect you, then check your answers at http://www.nursingmanagement.com.

[Licensure in the practice of the medical profession in Chile: experience of the Re-valuation Committee of the Medical School of the University of Chile period 1984-1999]

We report the experience of the re-valuation committee of the University of Chile Medical School, in the period 1984-1999. This experience is relevant to the licensing processes in Latin America. We report the political, legal and regulatory backup and the academic criteria used to establish different evaluation methodologies. We also communicate the main results obtained. Factors such as the country and University conferring a title, nationality and length of service of the applicant, influence in the percentage of licensure examination approval. Some modifications to the licensure process should be incorporated but, the overall results obtained, fully justify the existence of this licensure committee.

[Genuine medical accreditation systems in the USA according to standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--reflections on the transferability of the procedures to Germany]

In a number of anglophone countries in parallel to the industrial trend accreditation systems have been developed for health care organizations and specially for hospitals. These systems were introduced and instituted as a part of the health care system in the countries. Central elements and central procedures of these genuine-medical accreditation systems for hospitals in the United States, in Australia, Canada, France and in Great Britain are mostly identical. They focus primarily on the patient and his way from access to post discharge in a hospital. Core of the systems is a catalogue with standards, which in a systematic and comprehensive way gives ideas of good professional performance in hospitals. The catalogues can be used internally to develop and improve quality and quality management in a hospital. Primarily, however, the accreditation systems are designed to provide most objective measures for external evaluation of quality and quality management.