[Thalassemia Reports 2018; 8:7486] [page 67] Thalassemia Reports 2018; volume 8:7486 In today’s health care arena, a number of issues are being raised that have received more attention either from the health care consumers or the media. The 1990s can easily be dubbed the peri- od of “performance measurement”. Whether as a provider, a con- sumer or a purchaser, each was looking for ways to satisfy the other through measuring and reporting on care outcomes. Accountability was at stake in that period. Several third-party organizations attempted to produce certain measure to report on these care outcomes. A number of “indicators” were developed and measured and “report cards” were assembled. All of these activities were done in the effort to measure per- formance. WHO organized and facilitated a number of activities related to quality assessment, performance improvement and out- come measurement. A large number of countries and institutions participated in these activities and initiatives. And at the end, all agreed there had to be an organized mechanism to account for quality, continuous measurement and improved performance in health care organizations. In order to do this, a mechanism for cer- tification, licensure or accreditation should be put in place. This trend continued in the 2000’s and until now where per- formance measurements and improvement as on the top of the agenda of any healthcare organization and country healthcare sys- tem. Related to performance is accountability. In particular profes- sional accountability both at the individual and the institutional levels became extremely important when dealing with issues relat- ed to performance. Certification and licensure It is very easy for a layperson to get confused with the terms and mechanisms of certification, licensure and accreditation. In general, certification, licensure and accreditation are all methods of evalua- tion and are also methods of assessing and rewarding organizations (and individuals) for healthcare quality. Accreditation is the only method however that requires a health care organization to comply with a rigorous set of performance standards and be subjected to a comprehensive process of self-assessment in addition to external evaluation. Both licensure and certification follow the same princi- ple of assessment whereby an organization must demonstrate to the granting agency its capability and proof that it has met the standards prescribed by that granting agency, at least at the minimum levels. The difference between the three is therefore based on the rigor of the assessment process and whether the evaluation is comprehensive to all aspects of the organization. It is believed that in the case of accreditation, the process and the standards are more rigorous and more comprehensive in nature. Therefore, certification can be defined as a process of assess- ing the degree by which a facility, product, unit or professional attains minimum standards. It is specific to the nature of the assess- ment, and the entity is “certified” as a special agency for the pur- pose of providing a specific service or activity. Licensure is somewhat more similar to certification than accreditation. Again it is targeted at all entities, individuals, organ- izations or groups. Licensure can therefore be similarly defined as the process of assessing the extent that a facility, organization, or professional has attained minimum requirements. Unlike certifica- tion, however, without a license, an entity is prohibited from prac- ticing the activity for which a license is needed. Therefore licen- sure is usually a government-sponsored activity that is put in place to control the practice of a profession or an act that has the poten- tial of risk to the recipient or the beneficiary. What is accreditation? Accreditation is a rigorous and comprehensive evaluation process through which an external accrediting body assesses the quality of the key systems and processes that make up a health care organization and is applied primarily to organizations rather than individuals, departments or units. Accreditation was developed in response to the need for stan- dardized, objective information about the quality of health care organizations. Organizations seek accreditation for different rea- sons but most do so in an effort to increase market share and to win customer satisfaction and professional reputation. The International Society of Quality in Health Care (1998) defines accreditation as: “…self-assessment and external peer review process used by health care organizations to accurately assess their level of performance in relation to established stan- dards and to implement ways to continuously improve the health care system. Quality standards and the external peer review process are directed by nationally recognized autonomous, inde- pendent accrediting agencies with a commitment to improve the quality of health care for the public”. Why accreditation? For more than four decades, accreditation has been the highest form of public recognition a health care organization could receive for the quality of care it provides. Accreditation offers quantitative as well as intangible benefits to a health care organi- Global initiatives for improving quality healthcare by the Thalassaemia International Federation Andreas Polynikis, 1 Giangos Lavranos, 2 AF Al Assaf 3 1 Former CEO of the Nicosia General Hospital, Former Quality Director, Cyprus Ministry of Health, Nicosia, Cyprus; 2 Vice-Chairperson, Assistant Professor, Public Health, School of Sciences, European University, Nicosia, Cyprus; 3 Executive Director AIHQ (American Institute for Healthcare Quality) Correspondence: Andreas Polynikis. E-mail: polinik@cytanet.com.cy This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright A. Polynikis et al., 2018 Licensee PAGEPress, Italy Thalassemia Reports 2018; 8:7486 doi:10.4081/thal.2018.7486 Non-commercial use only