The certification of hospitals for quality of care

Patients, caregivers : shared engagement

Certification has been in place for more than 25 years in France, and is a mandatory independent procedure to assess the quality and safety of care in public and private hospitals. It is conducted every 4 years by peer professionals (surveyors) appointed by the HAS.

In 2020, the certification procedure was radically overhauled to address current quality and safety of care challenges more effectively. The new process of hospital certification for quality of care has been simplified and is more focused on the practices of caregivers and on care outcomes for patients.

 Following on from the changes made in 2020, the sixth hospital certification cycle was launched in 2025. The standard that forms the core of the system sets twelve targets that are decisive for quality of care, meaningful and clear for professionals and users alike.

(Lien en accès restreint)   The information document 

What ambitions?

Development of the new certification procedure was guided by three ambitions :

• Tighten key requirements
  Technological and scientific advances in the field of health require quality criteria to be updated regularly to guarantee continuous improvement in the quality and safety of care. 
•  Adapt to public health priorities
  Certification takes account of recurring issues confirmed by quality measurement tools, such as medication errors or infant mortality and also of emerging concerns addressed by national and international plans, such as resistance to antibiotics, for example.
• Make the patient a partner for health professionals in his or her individual care and for healthcare facilities at the collective level
  The exercise of the patient's rights remains an imperative condition for the quality and safety of care and also fosters the emergence of the patient as a partner in improving the hospital system. 

What challenges?

4 major challenges of certification:

• Develop of patient engagement
• Develop a culture of relevance and outcome assessment
• Develop teamwork, a driving force for improving practices
• Adapt to changes in the healthcare system

What standard?

• A standard comprising 12 shared objectives divided into three chapters : the patient, healthcare teams, and the hospital. The 12 objectives that determine the quality of care are clear and are recognized and shared by health professionals and user representatives;
• A standard including criteria with 3 requirement levels : standard, imperative and advanced;
• A modular standard that can be adapted based on the hopitals activities;
• A standard co-constructed with healthcare professionals, authorities and user representatives.

What type of process?

Certification for quality of care is a process that is:

• Constructed jointly to make it meaningful for both caregivers and patients
• Continuous
• Simplified and care-centric
• Focused above all on outcomes, recognising teams for their organisational autonomy
• Modular, adapting to the facility’s particular profile (types of patients cared for, activities, care methods, etc.)

Who is certified?

All French hospitals, both public and private

The obligation of French hospitals to undertake an accreditation process is governed by a regulatory framework. The certification procedure was introduced from 1996 and is required of all hospitals in application of Articles L. 6113-3 et seq. of the French Public Health Code. The certification procedure is developed and implemented by the HAS (Art. L. 161-37 of the French Social Security Code and R. 161-74 of the French Social Security Code). 

By whom?  

By surveyors, who are professionals working in hospitals, appointed and trained by the HAS. To find out more about their role and become a surveyor.

How?  

During a healthcare facility survey, surveyors assess the level of quality of care. They base their assessment on the certification standard containing 12 objectives broken down into criteria.

Each criterion is assessed by several surveyors, using assessment methods close to the reality on the ground.  

Patient tracer: Meeting with the patient and the care team
This method is in no way an evaluation of the diagnostic and therapeutic decisions of the care team. It is a meeting involving the patient and care team to assess the quality and safety of the care provided to the patient in question.

  Pathway tracer: Assessment of service coordination
This method evaluates the continuity and coordination of patient care, teamwork, and quality and safety culture during the care pathway

 Target tracer: On-the-ground assessment of target process implementation.
The surveyor identifies the target and chooses the tracer. This might be an adverse event, a drug prescription, a patient complaint or a materiovigilance report, for example.
The target tracer method differs from the system audit method in that it starts out from the field and works back to the process.

System audit: Policy assessment down to ground level
The system audit differs from the target tracer in that the investigation starts out from the organisation of the process and then verifies actual implementation on the ground.

Observations: A method implemented throughout the survey
This method provides a complement to the tracers. It allows the general conditions of quality and safety of care to be assessed. 

What results?

The results obtained for each criterion enable an overall score to be calculated. This is obtained from the average results for the criteria, objectives and chapters. The HAS bases its certification decision on this overall score.

High Quality of care. Facility certified with distinction	Quality of care confirmed. Facility certified	Quality of care to be improved. Facility certified subject to conditions	Quality of care insufficient. Facility not certified

What benefits?

For the patient
Being informed about the quality of care in the facility and benefiting from improved care.

For healthcare teams
Seeing their commitment to continuous improvement of quality and safety of care recognised

For the hospital
Promoting the quality and safety of care to all stakeholders: patients, caregivers, institutions.

Reference documents

• The new certification standard for the 6th cycle is composed of:
  • The standard
  • Descriptive data sheets for the criteria to provide a clear understanding of the expectations. They describe the evaluation method used and the level required on each criterion and refer to the supporting documents and practical tools. 
• (Lien en accès restreint)
• The imperative criteria booklet and its posters