france

Not only is France one of the largest countries in Western Europe and a very popular destination for tourists and expats from all over the world, it is also a world leader in medical science. Its health care system is one of the world’s best, and hospitals in France are generally clean, easily accessible, efficient, and well-equipped with modern technology. Medical specialists are experienced and plentiful, and waiting lists for treatments are relatively short.

All French providers belonging to the INDIGOMED network are rigorously certified by HAS (Haute Aurorité de Santé), the most-important, independent French health care agency. Moreover, INDIGOMED’s selected providers are among France’s consistently best-in-class institutions, according to the independent rankings of French magazines such as Le Point and Challenges. The information and criteria used to arrive at those rankings are similar to those used by US News for its annual hospital ranking in the United States.

For more information about accreditation methods and convergence among all methodologies, please read INDIGOMED providers’ accreditation and certification.

The Haute Autorité de Santé (HAS), the French National Authority for Health, was established by the French Government in August 2004 in order to create a single authority for a number of activities designed to improve the quality of patient care and to guarantee equity within the health care system. The activities of HAS are diverse, ranging from the assessment of drugs, medical devices, and procedures to publications of guidelines to accreditation of health care organizations and certification of doctors. All are based on rigorously acquired scientific expertise. Training in quality issues and information provision are also key components of its work program.

HAS is not a government body; it is an independent public body with financial autonomy. It is a legal requirement to carry out specific missions, about which it reports to the French Government and Parliament. It liaises closely with government health agencies, national health insurance funds, health technology research organizations, health care professional associations, and patient representatives.

HAS is built on three founding principles:

  • a very broad field of activity, which means that it can compare a wide range of health care initiatives
  • a high degree of scientific rigor
  • independence

 The purpose of this certification process is to improve the quality of care provided by health organizations and to make information about this quality of care available to the public.

The certification includes private as well as public hospitals. It also concerns health care cooperation between health care institutions (groupements de cooperation sanitaire) and the inter-hospital unions authorized to provide health care activities, as well as the health networks (“réseaux de santé”) and the installations for aesthetic surgery.

Its annual budget is 60 million euros. HAS has a permanent staff but can call upon experts when necessary.

The HAS certification process has four steps: self-assessment by the health care provider itself before HAS inspection, inspection of the provider, production of a certification report, and finally, the publication of results on the HAS website. Certification is valid for a duration of four years, and is now mandatory for all health facilities in France. But more importantly, it implies acceptance of the concept that quality health care in a safe environment is a process of continuously seeking perfection.

Three clinical evaluation standards linked to physicians’ clinical practices have been added to the requirements for certification:

  • Pertinence of care (“référence 40”): prescriptions, hospital stay, risky interventions, laboratory tests, etc.
  • Evaluation of risks for the patient and the personnel linked to medical and medico-technical activities (“référence 41”)
  • Evaluation of clinical practice guidelines (“référence 42”)

Where the old accreditation procedure aimed essentially at installing and assessing quality dynamics in hospitals, the new certification procedure also focuses on the evaluation of the actual situation (at the moment of the visit) in each hospital in terms of quality management and results.

The standards used in the latest version of the methodology:

  • were inspired by CCHSA, ACHS, and JCAHO
  • were submitted for the consultation of the stakeholder organizations
  • are generic for all types of hospitals
  • cover clinical, internal support, and governance processes

More specifically, the Manuel de certification des établissements de santé et guide de cotation includes 44 standards (“références”) and 138 criteria divided into four chapters:

  • Policy and quality management comprises seven themes, including strategic orientation of the organization, human resources policy, risk management, and quality improvement policy
  • Transversal resources, organized in five fields, including human resources, logistics, information systems, etc.;
  • Patient care, covering the patient’s rights and trajectory; and
  • Evaluation and dynamics of improvement, covering professional practices, users and external correspondents, and policies and management.

The scoring scale (used in self-assessment as well as external assessment procedures) includes 4 levels. First, one has to evaluate whether each element of appreciation per criterion has been fulfilled. In a second phase, the spatial/temporal approach has to be assessed, considering the regularity and the diffusion of the levels of satisfaction in the sectors of the establishment.

 

All

elements of appreciation

Most of the

elements of appreciation

Few

elements of appreciation

Too few

of the significant elements of appreciation

In all sectors and/or

always

A

B

C

D

In most of the sectors

and/or most of the time

B

C

C

In some sectors and/or

sometimes

C

C

D

Nowhere and/or never

The surveyors have to evaluate results from the self-assessment round based on the current factual situation. For each criterion, they have to award a score from A to D.

If the C and D scores are applied, the institution must propose a set of future actions (type 1 to 3, depending on the situation) and a synthesis of the comments (frequency and gravity, dynamics, previous issues), context (for instance, a fire hazard in an establishment that treats or cares for people with reduced mobility) of the unmet criterion and the existence a plan for the hospital to undertake measures to improve these points. Proposed decisions are harmonized by the project manager (a member of HAS guiding the hospital) and the coordinator responsible for the visit. A reviewing commission composed of experts in the different domains of health care votes on the decisions made by the experts. Afterwards, these decisions are sent to the president of HAS for validation. The decisions include full certification without any conditions, certification under conditions (some actions have to be taken to improve an already good situation), « pending » certification (actions must be taken to improve some serious recurrent situations before full certification,’ and ‘ANY certification.’

Non-certification is a secondary decision that is made if the conditional certification is not acceptable.

INDIGOMED’s French Providers