In recent years, the Spanish Association of Surgeons (AEC) has made significant efforts to implement an ambitious accreditation program for Specialized Surgical Units1 in conjunction with various scientific societies, including the Spanish Association of Coloproctology, the Spanish Society of Obesity Surgery, and the Spanish Society of Senology and Breast Pathology. Under the auspices of the AEC, this initiative began in Endocrine Surgery and Trauma-Emergency Surgery Units and was subsequently extended to other specialties, such as Hepatobiliary-Pancreatic, Esophageal-Gastric, Abdominal Wall2 and Breast Surgery.
To date, this effort has involved 3 boards of directors and numerous surgeons committed to the project, who have contributed their knowledge and time to make it a reality. Yet an essential question still arises: what is the purpose of this initiative?
The answers are essentially twofold: to improve the quality of care and subspecialized training of surgeons, and to provide government institutions with assessment tools. Thus, when the healthcare administration finally decides to regionalize the most complex surgical procedures, our association will already have the regulations prepared and “trained”, in addition to being able to offer a list of previously accredited surgery units.
In this context, we should contemplate how an accreditation process would improve the quality of care in Spanish surgery. The RAE (Royal Spanish Academy) dictionary defines quality as “the property or set of properties inherent to something that allow its value to be judged”. Implicit in this definition is the capacity for measurement, and criteria are essential for comparison in order to make assessments, in addition to indicating what is valued.3,4 In healthcare, an audit of outcomes is used to evaluate previously determined parameters (indicators) and objectives (standards) that are considered representative of quality.
The methods that allow us to verify compliance with indicators and standards are accreditation and certification systems.5 Both concepts are similar but differ in scope and purpose.6,7 Accreditation assesses an organization’s ability to meet established standards, while certification verifies the conformity of a product, service, or process with those standards. Both accreditation and certification are carried out by independent bodies, ensuring that the institution operates within a quality management system. Examples include ISO (International Organization for Standardization) certifications and healthcare accreditation systems, such as the JCI (Joint Commission International) for hospitals.
How do these systems contribute to improved healthcare?
1. Implement uniform standards. Accreditation systems define criteria based on good practices and scientific evidence. This encourages the use of uniform standards, assures organizations that their processes are aligned with global best practices, and facilitates the continuous comparison and evaluation of activities.
2. Identify areas for improvement and validate the activity performed. The objective assessment performed with accreditation identifies opportunities for improvement and validates compliance with established standards. This requires organizations to conduct periodic self-assessments, which encourages constant monitoring of the indicators and awareness of potential deficiencies.
3. Trust in teams and transparency. Accreditation certifies that a department meets high quality standards, which creates trust among patients and professionals while consolidating the prestige of the organization. It also guarantees that the service or organization has all the technical or technological materials necessary to perform the accredited activities or procedures, as well as staff with updated training in these procedures.
4. Minimize medical errors and optimize resources. An accredited system includes protocols to reduce medical errors and optimize resources, provide greater patient safety, reduce inefficiencies, minimize unnecessary costs, and use resources more rationally and effectively. Furthermore, accreditation systems are aligned with national or international laws and regulations, ensuring that institutions operate within the legal and ethical framework.
5. Promote innovation and motivate healthcare professionals. Accreditation forces surgical units and organizations to adapt to changing standards and technological advances. This adaptability is essential to remain competitive in a constantly evolving field like healthcare. It also fosters a work environment that values training, professional development, and team participation in improvements. The consequent motivating effect boosts staff morale and commitment to quality, developing a sense of belonging to a medical center that is prestigious due to its excellent work.
In conclusion, the greatest benefit of accreditation systems is the ability to foster a mindset of continuous improvement. Through standardization, self-assessment, external evaluation of the work performed, building trust and adapting to change, minimizing errors, and motivating professionals, accredited organizations are required to maintain compliance with standards and constantly seek ways to innovate and exceed expectations, as accreditation requires constant adjustments and updates to processes, technology, and staff training. All of these factors favor and stimulate a culture of excellence and the creation of value in healthcare.
I would like to thank Drs Eduardo García-Granero Ximénez, Salvador Navarro Soto, José Noguera Aguilar and Mónica Millán Scheiding for their critical review of this manuscript.
