Systems assessment and evaluation are variable and critical processes, especially when they were compared with standards. Lack of this processes would cause serious menaces for organizations and recipients of services. This process is vital, especially for hospitals and health delivery systems because of the importance of the community health. In fact, all over the world, accreditation and related programs are systematic and structured evaluation process to investigate meeting compliance of desirable standards. These processes are performed by authentic and non-beneficiary centers that accredit various organizations based on their types, characterizations and goals. Under these circumstances, the given validity is genuine and coherence in all aspects including structure, process and the consequence which can be felt. Recipients of services can vividly distinguish accredited centers from others, based on their quality of the services. In the field of health care, one of the most important administrative functions and policies is hospital accreditation. Hospitals provide comprehensive health care services including diagnosis, treatment and rehabilitation, therefore they are considered as the key role in the health care system of a country. Accreditation of hospitals takes place in various countries, including Iran. From prominent characteristics of successful hospital accreditation we can mention the established standards which must be comprehensive, genuine, coherent, aligned and clear. These standards should associate with appropriate methods for targeted assessment and also they need coherence with general policies, appropriate channels for implementation and proper opportunity for assessment by impartial experts. The central issue in this topic is the concept of the quality, which is not static, but it is a dynamic concept and makes clear that continuous improvement of quality is considered. Through accreditation of hospitals, the dynamic concept of quality assurance and continuous improvement of quality are associated with all the process which is related to the maintenance and improvement of standards caring for patients. These are the most obvious examples as follow; generation and adequate use of information and data, teamworks and cooperations, reducing unwarranted variations in healthcare, application of evidence-based practice, safety and effectiveness of health services, satisfaction of patients, staff and principals, Increasing productivity and efficiency in hospitals and etc. If in a program a desirable sense of the quality, continuous improvement and satisfaction is not tangibly distinguished by the individuals both by (the provider and the recipient of the services), then we should seek the reason in structure, framework and components of the process. One of the points to consider is the "established standards" itself. Experiences of successful quality improvement and implementation of standards in the world reflect that the correct formulation of standards is very important. The standard book contains a set of requirements, and makes the evaluated individual to implement and execute standards, but does not provide an explanation for accomplishment (This section is assigned to secondary systems and complimentary structures), and its features include; comprehensiveness, obviousness in conceptual conception, lack of overlapping in content and lack of contradictions in the definitions. These features act in exactly the same direction for a particular purpose and often emphasize on key results of hospital performance and outcomes, not just on the structural and process factors. The lack of integrity through evaluation of an organization as an interconnected system is similar to the separated evaluation of a living organism with huge foot, small heart and no brain that while expected to solve the problem. The standards and the manner of evaluation form the standpoint and performance of organizations as well as the manner of the educational assessment that determines the study style of the students. Comprehensive organizational vision eliminates unhealthy competition between hospital departments and replaces it with interaction and consultation that facilitates the system management and induces a sense of confidence to anxious managesr. Functional and outcome-oriented attitude makes the result of the evaluation closer to the reality. Conceptual harmonization of the standard and its implementation and evaluation path, compliance with other standards and other monitoring programs, accommodation with international standards and standards related to the subordinate units of the hospital (like laboratories) is also very effective in achieving the desired outcome of the validation program. The other group is the structure and method of accreditation. For example, accreditation should be optional. However, accommodation with minimum standards for obtaining permission to work in the health system of the country is necessary, but validation, which is based on maximum standards, should be voluntary. It means that hospitals that claim high quality should perform voluntary and if they get successful in receiving the credit they should also receive major and great encouragements, and thus the market for healthy competition in the country will be flourished. The final important point is about the accreditation system's assessors and surveyors. The (ethical and professional) competence of assessors and their impartiality are the critical issues involved in the implementation and achievement of the desired outcome in the credibility of a program. The assessor, while possessing ethical features and knowledge in the area of assessment, must have sufficient knowledge of the evaluation, a deep understanding of the standards, and good practical experience (sufficient apprenticeship) of the assessment. Impartiality not only for the assessor but also for the organization responsible for the evaluation process is crucial, so that there should be no conflict or common benefit between the evaluated systems. The sum total of the factors mentioned above will provide face viability, executive credibility, and comparative validity of the accreditation process.

AboTaleb Saremi, MD
Head of Sarem Research Center