Re: ISQua position paper.

The ISQua Position Paper on traditional accreditation systems and the ISO philosophy [1] may be the basis for further development of accreditation and certification of quality management systems in health care. In Switzerland a group of the National Alliance for Quality in Health Care evaluated the possibility of the adaptation of ISO-9001 for institutions of health care. The modified and further developed system called H-9001 may offer the opportunity for purchasers and providers to outline contracts on quality required by law. The H-9001 is based on the ISO-9001 structure due to the internationally accepted compatibility and the integration of innovations. The aim was to develop a nonbureaucratic tool, initially, for hospitals and elderly care centers. In further steps the tool may also be used in other medical institutions, such as doctors' private offices, government administrations and insurance companies. Much of the documentation required in the original ISO system is redundant and is in the H-9001 system replaced by indicators and the principles of continuous quality improvement. In a first step, the difficult ISO terminology designed for industrial use was translated into understandable terms for individuals working in health care and in health care related environments. The first chapter describes the area of fields. The second chapter outlines links to other quality management systems for accreditation. The third chapter defines ah" relevant terms, and the fourth chapter describes what is needed for certification. In the fifth chapter examples for indicators from various areas (management, nursing, medical treatment, indication, process, structure and outcome) are given. During a first trial period institutions make a minimal choice of at least six indicators for evaluation, focusing on relevant topics with emphasis on the indication and outcomes. However, the quality and validity of the indicators, particularly on the quality of outcomes and the indication may need further development and consensus. This is especially true, because even superb outcomes become irrelevant without a properly defined indication. The further development of the first version of H-9001 (German) is now ready to be reviewed by partners. The close collaboration of all partners within such an ambitious project may be instrumental for its adoption.