Accreditation: the Argentine experience in the Latin American region.

Abstract

The development of the Latin American hospital accreditation through the International Standards Organization system. programmes had a heterogeneous evolution similar to that This universal model of quality standards for processes of the region itself, despite the existence of previous assessfocused on production or service and now penetrated and ment tools facilitated by the Pan-American Health Orsubdued health care organizations [3], though with few echoes ganization (PAHO). in this region. As interest in quality of care spread globally – supported by Lastly, there was the influence of the regional commercial the universal dissemination of computer and communication agreements, Treaty of the North Atlantic Free Trade Area technologies – in Latin America the process took the form (NAFTA) in North America and the Common Market of of a ‘multifocal’ phenomenon: expanding spontaneously in the Southern Cone (MERCOSUR, in Spanish) in South an unorganized and unplanned fashion. It should be pointed America. Although not focused specifically on health services, out, however, that like the international culture encouraged these agreements will have a significant impact on the deby the Internet, the trend towards quality in health care is velopment of local trends in each signatory country. expanding horizontally, and not as a simple ‘top-down’ regional or national initiative. The influences on the region were also diverse. First, there Some Latin American initiatives was the significant impetus given by PAHO to promote the preparation of a suitable assessment tool designed for the The regional process encouraged by PAHO began in 1990, Latin American Region, which would act as a recommendation after it signed an agreement on technical co-operation with to start accreditation programmes in all countries. To this the Latin American Federation of Hospitals (LAFH). Their end, many regional and subregional meetings were held to aims were to develop quality improvement programmes for exchange experiences and reach a consensus. Unfortunately, the countries of the region and an Argentine team was only a few countries followed this trend. entrusted with the task of studying the issues and writing an Secondly, the international expansion of the Joint Comaccreditation manual, suitable for the Latin American reality. mission on Accreditation of Healthcare Organizations This duty was performed successfully by a group of medical (JCAHO) in the USA, creator of the original accreditation audit experts counselled by different scientific societies. In method, had an impact on the region. Initially, JCAHO May 1991, in Washington DC, the draft paper was analysed started its activities in both American and Canadian hospitals by 22 countries and approved after some formal changes. [1], but later, Canada split off and created its own accrediting The final version was translated into four languages, published body: the Canadian Council of Health Services Accreditation by PAHO [4] and a recommendation made for its application (CCHSA). JCAHO continued only domestic assessments within the region. until the early 1990s. In December of that same year, a working plan was devised After an internal revision of its methodology, focused to promote the implementation of accreditation programmes mainly on results under the ‘Agenda for Change’ [2], JCAHO through subregional meetings of health sector leaders. It is tried to extend its experience and advice to other countries, important to highlight the fact that PAHO is an interand especially to the Latin American region. For these tasks, governmental body. Consequently, the working plan and JCAHO relied on a subsidiary body: the Joint Commission agreement with LAFH implied an opening to local asInternational. Today, CCHSA also performs consulting acsociations and non-governmental organizations. As a very tivities outside Canada. Another influence on the region came from industry important share of the health sector is in the hands of Social