Hospital Accreditation - FAQ

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As far as the Audit Organizations who are certified to give ISO certificate for hospitals, is it allowed for these AO to sign contracts with the hospitals that they had a business with or it will be a conflict of interest?

A small consultancy project had been worked upon in one hospital in 2006 by an Audit Organization. Is it allowed for the AO to audit this hospital knowing
that the project had finished in 2006 and no other contact was taking place from that time up to date between the hospital and the AO?

Is it allowed for a hospital to provide surgical services without having an intensive care unit to admit possible complications post surgery?

When certain chapters are not applicable (ex. Cardiac lab or chemotherapy), does this result in losing the hospital grades or does it expose the hospital to lower classification by the MOPH?

Is the presence of a physiotherapy unit critical to the classification of the hospital and if the service is outsourced, should the AO audit the outsourced center or simply the contract between the hospital and the center will be enough?

Is it allowed for an Audit Body to give public training (targeting all hospitals) on management and accreditation topics without any customized training for specific hospitals?

Les consultants peuvent-ils auditer des hôpitaux où ils ont eu des consultations?

Quelles sont les langues à adopter pour la rédaction des rapports d'autoévaluation?

Le rapport d'auto-évaluation doit il être envoyé au CTAH?

Sous quelle forme le rapport d'auto-évaluation doit-il être envoyé?

I would like to ask you if it is allowed to organize a meeting with hospital managers to introduce our organization to them, in particular that we have received a large number of calls for this reason, and if it is allowed, could the agenda of this meeting be to brief the participants about Gates and to remind them of the expected timetable, the content of the audit report and the audit visit process?

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