The quality of hospital care in Lebanon has witnessed a paradigm shift since May 2000, from a traditional focus on physical structure and equipment to a broader multidimensional approach, emphasizing managerial processes, performance and output indicators. In the absence of an effective consumer voice, the impetus for change has come from the Ministry of Public Health, which has supported the development of an accreditation programme for hospitals. This paper describes and analyses the experience of Lebanon in introducing this programme. It looks at the application of normative measures on private institutions that have been used to operating in a loosely controlled environment with little accountability.