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Accreditation of medical organizations is a key process for assessing the quality and safety of services provided, based on strictly defined standards and criteria. This procedure involves a thorough analysis of the medical organization's activities by experts to confirm compliance with established norms and requirements. Accreditation guarantees that the institution possesses the required level of competence, provides high-quality medical care, and adheres to patient safety principles.

The importance of accreditation for medical organizations cannot be overstated. First and foremost, it demonstrates the institution's commitment to high standards of medical practice, which in turn strengthens the trust of patients and the public. Accreditation serves as official recognition of the quality of medical services, making the medical organization more attractive to patients and insurance companies. Furthermore, the accreditation process contributes to the institution's internal efficiency, as it ensures the implementation of best practices and standards in daily operations and encourages continuous improvement in service quality and management.

Thus, accreditation is not only a mechanism for ensuring the safety and quality of medical care but also a powerful incentive for continuous improvement of medical institutions and their competitiveness in the healthcare market.

Accreditation of medical organizations is carried out on the basis of an external comprehensive assessment of compliance with accreditation standards approved by the authorized body, and is taken into account when placing volumes of medical services for the provision of a guaranteed volume of free medical care and (or) medical care in the system of compulsory social health insurance, when allocating a state order for the training and advanced training of personnel in the field of healthcare in clinical specialties in higher colleges and organizations of higher and (or) postgraduate medical education.

To obtain an accreditation certificate, a medical organization submits an application to the accrediting body in accordance with Appendix 9 of the Accreditation Rules.

Accreditation of medical organizations consists of the following stages:
1. Self-assessment
2. External comprehensive assessment
3. Post-accreditation monitoring

The on-site accreditation process for medical organizations takes at least two (2) business days, depending on the size of the assigned population, the number of hospital beds, and the number of structural divisions of the medical organization (branches, representative offices located outside the main facility). The number of expert group members involved in the external comprehensive assessment depends on the structure, capacity, and scope of services provided by the medical organization. Prior to the on-site visit (at least three days in advance), the accrediting body submits a program for the external comprehensive assessment of the medical organization. An office with office equipment and internet access is provided for the expert group.

Three types of tracers are used:

1. Individual

2. Systemic

3. Profile

A tracer is a targeted follow-up of various stages of medical care provided to a patient and/or an assessment of interrelated processes involving staff from various departments of a medical organization. Each tracer lasts from 1 (one) to 3 (three) hours.

During an individual tracer, the stages of treatment and care for a specific patient are tracked through a review of medical records and interviews with staff involved in their care and treatment. For medical organizations undergoing an external comprehensive assessment for compliance with criteria applicable to clinical sites, clinics of healthcare educational organizations, university hospitals, residency sites, and integrated academic medical centers, interviews with staff from clinical departments, as well as interns and residents, are also conducted. The expert selects patients for evaluation using purposive sampling (complex or atypical cases). The medical record of the selected patient serves as the basis for tracking the services provided at the medical organization. The therapeutic, diagnostic, and non-medical processes in which the patient participated during the provision of medical care are assessed. During the external comprehensive assessment, at least three (3) individual patient tracers are conducted.

A systemic tracer inspects all stages of infection control systems, drug handling, building safety, and quality management. Information collection and organizational assessment during a systemic tracer include staff interviews, personal observation, and a review of documents and/or patient medical records. Different stages of the same system are assessed.

A specialized tracer evaluates activities specific to the accredited medical organization, analyzing unique characteristics and relevant issues within the profile.

At medical organizations undergoing an external comprehensive assessment for compliance with the requirements for clinical sites, clinics of healthcare educational institutions, university hospitals, residency sites, and integrated academic medical centers, the clinical training conditions for students, interns, and residents of these educational institutions are additionally assessed. The purpose of the profile tracer is to identify patient safety issues at various stages of medical care, including during the clinical training of students, interns, and residents.

Observation is conducted to confirm information obtained by experts during document review and/or staff interviews. Observation is conducted in parallel with the staff interviews.

Following the accreditation committee meeting, the accrediting body makes the following decisions:
1) Accredit with the assignment of:

Second category - if at least 60% of the standards (criteria) of rank I meet, at least 60% of the standards (criteria) of rank II meet, and at least 60% of the standards (criteria) of rank III meet;

First category - if at least 70% of the standards (criteria) of rank I meet, at least 65% of the standards (criteria) of rank II meet, and at least 60% of the standards (criteria) of rank III meet;

Highest category - if at least 90% of the standards (criteria) of rank I meet, at least 80% of the standards (criteria) of rank II meet, and at least 70% of the standards (criteria) of rank III meet;

2) Do not accredit:
if the result of the external comprehensive assessment is below the threshold required for the second category of accreditation.

INSTITUTE FOR QUALITY AND ACCREDITATION IN HEALTHCARE

INSTITUTE FOR QUALITY AND ACCREDITATION IN HEALTHCARE

INSTITUTE FOR QUALITY AND ACCREDITATION IN HEALTHCARE

ACCREDITATION IS

LEGAL BASIS

ACCREDITATION

MOTIVATION MEASURES

Exemption from proactive monitoring by the Federal Compulsory Medical Insurance Fund

PROCEDURE FOR OBTAINING A STATE SERVICE

DESCRIPTION OF THE ACCREDITATION PROCEDURE

ACCREDITATION RESULTS