International trends in accreditation.

Accreditation of hospitals began in the early part of the twentieth century in the USA as a mechanism to ensure an appropriate environment in which clinicians could practise effectively. It was adopted in Canada and Australia, where it conformed to the early design of standards to control the hospital environment. In the past decade, these accreditation systems have been forced to change in response to the decline in the role of the hospital in health care delivery; the demands of governments and the public for greater information about quality of health care. They have also responded to pressure for greater knowledge of clinical effectiveness by introducing indicators of clinical performance. Within the past 5 years, accreditation has been adopted in a number of other countries where governments have extended their role into assuring the quality of health care. Accreditation, originally perceived as a vehicle to enable organizational development, is increasingly an agent of government regulation.