Box 1.

: Characteristics of effective external assessment programmes

• Give clear framework of values—To describe elements of quality, and their weighting, such as the enablers and results defined by the European Foundation for Quality Management
• Publish validated standards—To provide an objective basis for assessment
• Focus on patients—To reflect horizontal clinical pathways rather than vertical management units
• Include clinical processes and results—To reflect perceptions of patients, staff, and public
• Encourage self assessment—To give time and tools to internalise assessment and development
• Train the assessors—To promote reliable assessments and reports
• Measure systematically—To describe and weight compliance with standards objectively
• Provide incentives—To give leverage for improvement and response to recommendations
• Communicate with other programmes—To promote consistency and reciprocity and to reduce duplication and burden of inspection
• Quantify improvement over time—To demonstrate effectiveness of programme
• Give public access to standards, assessment processes, and results—To be transparent and publicly accountable