Background

As in many industrialised countries, the health care quality movement began in France because of rising health expenditure and the necessity to contain costs¹ but, recently, the public has become more aware of issues relating to quality. Serious public health problems such as the contaminated blood scandal of 1984, when blood that was strongly suspected of being contaminated by HIV was knowingly transfused to haemophiliac patients, and greater visibility of routine medical practice through regular publications in the lay press² has led to a crisis of public confidence in the ethics of the medical and political worlds and a strong demand for accountability and greater transparency. Important reforms in the organisation of health care and public health have therefore been undertaken, of which accreditation is one. Its objectives reflect this historical background—namely, “to assess the quality and safety of health care, to assess a health care organisation's ability to ensure continuous improvement in the quality of overall patient care, to formulate explicit recommendations, to involve professionals at all stages of the quality initiatives, to provide external recognition of the quality of care in health care organisations, to improve public confidence”.³

Accreditation was enacted in France as part of the 1996 health care reform by ordonnance, a government decision that is taken without consulting Parliament. Governments in France under the Fifth Republic use ordonnances when they feel there is an urgent need for reform that could be delayed by parliamentary discussions. Many healthcare reforms have been enacted by ordonnance and, in 1996, it was felt that the magnitude of the deficit of the national health insurance fund and the public health situation was sufficiently serious. The ordonnance of 24 April 1996 reforming public and private hospitalisation stipulates that “in order to ensure continuous quality …