Health Care Accreditation: The Past, Present, and Future in the Middle East

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Article Information:

Group: 2010
Subgroup: Volume 12, Issue 1
Date: January 2010
Type: Letter to Editor
Start Page: 80
End Page: 81


  • A Hojjati
  • Department of Health Management,Iranian Hospital, Dubai, UAE
  • A Vahdani
  • Department of Psychiatry, Iranian Hospital, Dubai, UAE


      Affiliation: Department of Psychiatry, Iranian Hospital
      City, Province: Dubai,
      Country: UAE
      Tel: +971-4-3440321
      Fax: +971-4-3440322

Manuscript Body:

Dear Editor,

The history of health care dates back to the Jundishapur Medical School and Hospital that were established by Khusraw Anushirwan, the Wise in 531-579 AD in Jundishapur City, Khuzistan Province, southern Iran. They were templates used by Abbasid Caliphs for Islamic Hospital in Baghdad, the Capital of the Islamic World at that time (circa 805 AD). After 20 years, more than 30 hospitals were established identically throughout the Islamic world and many great physicians and scientists of that time practiced in these hospitals for a period of a millennium.1,2

They recorded their observations and experimentations as practical sciences to promote the standards of their health care services such as Al-Razi (Rhazes; 841-926 AD), an Iranian scientist and physician who built a hospital in Baghdad. He selected the location of the hospital based on hanging some pieces of meat in different parts of the city and examined the putrefaction rate of the meats in all regions of the town and then considered the least putrefaction rate as the hospital location. He emphasised the role of the surrounding environment in the spread of infection and predated the modern concept of airborne infections.2,3 Al-Zahrawi (Abulcasis; 936–1013) was an Andulasian physician who is considered as the father of modern surgery. He emphasized on learning anatomy and physiology as essential sciences before practicing surgery.1,3 Ibn Sina (Avicenna; 980–1037 AD) was a foremost Iranian physician and philosopher who wrote nearly 450 books, of which just 240 has remained. His Canon of Medicine was used as a reference and teaching guide until the 19th century. He is the father of modern medicine and clinical pharmacology.3,4

In the modern era, implementing health care services’ safety standards began when Joseph Lister (1827-1912) was informed about the results of Louis Pasteur and his germ theory of disease.1 He developed new methods for antisepsis and asepsis in operation theatres considering him as the father of modern antisepsis. Ernest Amory Codman (1869–1940) was the first person who implemented the safety standards in health care services in a structured organised discipline.1 He established an “end result system” to track the outcome of treatment methods. Codman established his own hospital which he called ‘End Result Hospital’. He studied the outcomes of procedures for 337 patients discharged from this hospital between 1911 and 1916 and found 123 errors. He published the results of this study in a book, “A Study in Hospital Efficiency”. He helped the American College of Surgeons (ACS, 1913) in Hospital Standardization Program. In 1918 the ACS surveyed 692 hospitals with its one-page form, and only 89 hospitals met the minimum requirements.5,6

In 1926, the first standard manual for hospitals was published in 18 pages. From this year through to 1950, safety standards improved and in 1950 more than 3200 hospitals received approval. In 1951, the ACS joined with the American College of Physicians (ACP), the American Hospital Association (AHA), the American Medical Association (AMA) and the Canadian Medical Association (CMA) to create the Joint Commission on Accreditation of Hospitals (JCAH) in the USA. In December 1952, JCAH was chosen as the primary hospital standardisation programme. In 1994 the Joint Commission developed Joint Commission International (JCI) for international clients outside the US. 

In 1953, the Canadian Hospital Association, the Royal College of Physicians and Surgeons, the Canadian Medical Association and l'Association des Médecins de Langue Française du Canada jointly established the Canadian Commission on Hospital Accreditation and in 1959 the Canadian Medical Association branched out from JCAH to develop its own accreditation programme for Canada. The name changed to the Canadian Council on Health Facilities Accreditation (CCHFA) in 1988 and in 1995 this council changed its name to the Canadian Council on Health Services Accreditation (CCHSA).

In 2000, the CCHSA launched CCHSA International to serve clients outside of Canada and from 2008, CCHSA changed into Accreditation Canada. The name is new, but the vision and mission for the improvement of quality in health care services and standards, including safety, remain unchanged.5

Besides JCAH and Accreditation Canada, there are several other organisations for health care accreditation. One of them is the Australian Council on Healthcare Standards (ACHS) established in 1974. ACHS International was established in June 2005 and works on advising international clients. In May 2007, the WHO launched “Nine Patient Safety Solutions” to reduce harms from health care which affected people around the world.

Our current knowledge of practicing health care services standards in the Eastern Mediterranean region is mainly the standards of the JCAH or the Canadian accreditation system which are customised and impressed upon Western cultural approaches and health care system policies and are not necessarily in accordance with our needs. It seems that by using current knowledge in this field, health care policy-makers, providers and educational organisations throughout the region can try to structure a proper plan to develop and customise health care standards of excellence in accordance with our region’s geopolitical and cultural issues to cover health care delivery problems and defects in a more focussed and sustainable manner.



Conflict of interest: None declared.

References: (7)

  1. Academy of Gundishapur: +Medical+School+and+Hospital+&go=Go 11 September 2009.
  2. Nagamia HF. Islamic medicine history and current practice. JISHIM 2003;2:19.
  3. Tschanz DW. Arab roots of European medicine. Heart Views 2003;4:69-80.
  4. Tabei SZ, Riazi A. Medical Sciences in the third millennium: An Avicennian Approach. Iranian Red Crescent Med J 2009;11:4-9.
  5. Driving Quality Health Services., 2009.
  6. How to become accredited/certified. The Joint Commission and the Centers for Disease Control and Prevention (CDC).