Accreditation across borders: the introduction of Joint Commission accreditation in Spain.
BACKGROUND: Introducing accreditation as conducted by the Joint Commission on Accreditation of Healthcare Organizations (Oakbrook Terrace, III) into Spain has raised many issues regarding the internationalization of accreditation. CHARACTERISTICS OF ACCREDITATION: In recent years more and more countries have considered accreditation a useful tool for the improvement of health care quality. In spite of the differences in the health care systems of the countries where accreditation has been introduced, many of the original characteristics of accreditation as seen in the United States largely remain: peer review evaluation, support of professional associations, voluntary participation, and a national approach. These similarities reflect the fact that the majority of the programs are based on models created by the Joint Commission. THE EXPERIENCE OF THE AVEDIS DONABEDIAN FOUNDATION: In 1994 the Avedis Donabedian Foundation (FAD), a nonprofit organization founded in Barcelona in 1988, broadened its scope to include accreditation. Having rejected the idea of creating de novo its own standards and accreditation program, FAD worked out an agreement with the Joint Commission whereby FAD would become a Spanish accrediting body to accredit Spanish hospitals but would collaborate with Joint Commission International to adopt the Joint Commission's accreditation standards and processes. DISCUSSION: The development of accreditation continues. As of spring 1998, seven hospitals and two ambulatory care centers are preparing for accreditation. FAD's experience with adapting the Joint Commission model of accreditation should be instructive to other countries considering health care accreditation.