Frequently Asked Questions
Honest answers to the questions we hear most often — from facilities, health ministries, clinical professionals, and accreditation experts. We welcome every question.
Why only one day for the supervision visit?
This is the question we hear most. The answer is in what happens before the visit day. By the time an ASF supervisor arrives, the facility has submitted four quarterly self-assessments with mandatory evidence declarations, completed two Monitor verification cycles, and maintained a documented Improvement Plan across 12 months. The supervisor is not starting from zero — they are confirming and spot-checking a year of independently verified evidence.
This is structurally the same approach ISO 9001 certification bodies use globally — and ISO 9001 is the most widely adopted quality standard in history. The supervisor audits the internal audit process and samples outcomes. One well-prepared day covers more meaningful ground than several days of cold discovery.
The Monitor is engaged by the facility. Is that independent enough?
This is a fair and important question. The financial audit profession faces the same challenge — auditors are also paid by the organisations they audit. The profession resolved it through three mechanisms: professional certification with personal liability, mandatory rotation, and separation of the audit function from the decision function.
ASF uses all three. Monitors hold credentials they can lose if they sign off inaccurate verifications. Rotation is mandatory — three years maximum for internal Monitors, five years for external. And critically, the Monitor does not make the accreditation decision. That decision rests with the ADC, an independent committee with an external majority and no financial relationship with the facility or the Monitor.
Additionally, 5% of accredited facilities each year receive an unannounced re-verification by an ASF-appointed Monitor who has no connection to the facility — a direct check on the reliability of the system.
How do we know your standards measure what they claim to measure?
Every ASF criterion cites its evidence source — the JCI measurable element, WHO patient safety priority, international accreditation Required Organizational Practice, or peer-reviewed study from which it is derived. The criteria are not invented — they represent the intersection of what all major international bodies agree is foundational for patient safety.
Before launch, all criteria are reviewed by an external Clinical Advisory Panel of named independent experts from different countries and facility types. Their assessment is published in full. The pilot cohort — facilities that go through the full ASF cycle — is evaluated independently by an academic research board, and the results are submitted to a peer-reviewed journal. We are building the evidence base from day one, not after the fact.
Does the word ‘accreditation’ have a specific legal meaning that ASF cannot use?
This is a genuine question that deserves a precise answer. ISO/IEC 17011 and EC Regulation 765/2008 define accreditation in the specific context of product conformity assessment and laboratory testing — not healthcare quality. The word has a parallel, equally well-established tradition in healthcare, documented in over 800 peer-reviewed studies, used by JCI, international accreditation, HAS, and health ministries in 80+ countries.
JCI is not an ISO-conforming accreditation body. international accreditation is not. Neither is HAS. ASF has obtained a legal opinion confirming that its use of the term in the healthcare quality context does not conflict with EC 765/2008 or French implementing legislation. That opinion is published on this site.
ASF is not ISQua EEA accredited. Does that affect legitimacy?
ISQua External Evaluation is a voluntary peer review process for accreditation bodies. It is not mandated by any intergovernmental body — not WHO, not the European Commission, not any professional association. Its authority is self-conferred, and its board answers to fee-paying subscribers rather than to states or governments.
A peer-reviewed study published in the Georgian Medical Journal in 2026 documented that the minimum four-year cost of ISQua EEA for a non-profit organisation is €40,513 — applied against a 5.7:1 income gap between high-income and upper-middle-income countries where ISQua’s own fee ratio is only 1.3:1. The full study is open access: doi:10.66636/gmj.v1.i3.a205
ASF’s legitimacy rests on what is publicly verifiable: standards that are free and openly available, a decision structure with an independent external majority, outcomes data published annually, and a methodology that any expert can read, critique, and engage with. We actively welcome that engagement.
Aren’t 96 criteria too few for a complex hospital?
The number of criteria is not the measure of rigour — it is the measure of burden. Denmark’s DDKM programme had 570 indicators across 82 standards and demonstrated real clinical impact. It was still terminated in 2015 because the administrative burden was unsustainable. The lesson the field has learned is that criteria need to be the right ones, applied consistently and continuously — not that more is always better.
ASF’s 96 hospital criteria represent the evidence-based intersection of requirements that all major accreditation bodies agree are foundational. An independent academic mapping exercise, published on this site, shows the percentage of JCI Required Organizational Practices and WHO Global Patient Safety Challenge priorities covered by ASF criteria. The model is also progressive — cycle two builds depth, and ISO 9001 and ISO 15189 modules extend coverage for facilities that want it.
How do we know ASF will not become what it criticises over time?
This is perhaps the most important question of all, and we think about it seriously. Good intentions at founding are not a sufficient answer — most of the organisations we study started with good intentions too.
ASF’s answer is structural: seven provisions written into our founding statutes that require extraordinary process to change. They include: the fee schedule must always be public, standards must always be free, the non-profit tier cannot be abolished, the ADC’s independence cannot be weakened, ASF can never become for-profit, the annual accountability report cannot be discontinued, and a five-year independent external review is mandatory. These are not policies. They are statutory constraints. Read them in full →
What if the self-assessment answers are optimistic or inaccurate?
The self-assessment tool requires a mandatory evidence declaration for every YES answer — the Coordinator cannot mark a criterion as met without stating specifically what document or observation supports it. This turns the submission from a checkbox into an evidence record.
The Monitor then independently verifies those evidence statements in the Q4 in-facility visit. The supervisor spot-checks the Monitor’s work on visit day. And 5% of accredited facilities per year receive an unannounced re-verification by an ASF-appointed Monitor with no connection to the facility. Any facility found to have submitted materially inaccurate information has its accreditation reviewed and the relevant professionals’ credentials investigated.
We have more questions. Who can we speak to?
We are always glad to hear from facilities, health ministries, clinical professional bodies, accreditation experts, and researchers. Every substantive question we receive improves the model.
Write to us at info@accreditation.ge — we will respond personally.
If you are an accreditation expert who has a critique of the ASF methodology, we especially welcome that conversation. Substantive critiques that improve the model will be acknowledged and incorporated into the next revision cycle.
