How ASF Standards Are Developed

Minimum 7 members. Required seats: at least one clinician, one quality scientist, one public health specialist, one health economist, one research methodologist, and one mandatory patient/lay representative (lived-experience seat). Minimum two countries on every Revision Panel.

Fixed three-year terms, renewable once. A member who has served two consecutive terms must wait three years before reappointment. Appointments and reappointments are recorded in the Annual Activity Report.

Quorum: two-thirds of serving members. Decisions by simple majority of members present; Chair has a casting vote. Standards approval and retirement require a two-thirds majority. Recused members are excluded from the count.

Article 8 of ASF’s founding statutes, registered in Paris in 2020, establishes the International Standards Council as a body distinct from the Board of Directors and from the operational accreditation function. No individual may hold a role in more than one pillar simultaneously.

Section 2.4 of ASF-MAN-001-v4 states the formal prohibition: a Council or Revision Panel member may not be appointed as a surveyor, and a certified surveyor may not be appointed to the Council. There is no exception clause.

ASF-SURV-STD-v2 Domain A repeats the prohibition from the opposite direction: a candidate surveyor who holds or seeks a Council role is ineligible for surveyor certification.

• Writes, reviews, revises and retires all published standards
• Sets the criteria and the evidence base
• Never visits a facility
• Never makes an accreditation decision
• Never employs or appoints surveyors
• Reports through the Annual Activity Report, not through the accreditation function

• Certified surveyors conduct on-site and document assessments
• An independent review panel makes the accreditation decision
• Neither group writes, reviews or revises any standard
• Neither group may propose a criterion change outside the formal revision procedure
• Surveyor feedback on criteria is channelled through the formal revision proposal process, not through the accreditation function

• Employment or consulting fees from any facility that could be affected by the standard under revision
• Equity or financial interest in any relevant commercial entity
• Authorship of a clinical guideline that the standard relies on or conflicts with
• Prior public positions or publications on the specific clinical question
• Personal or family relationships with any party with a material interest

• Severity grading: none / advisory-only / recusal / removal
• Chair makes the grading decision; conflicts about the Chair’s own interests are decided by the full Council
• Recused member may not vote, draft or receive confidential working documents on that revision
• All severity decisions are recorded in the revision file and disclosed in the published standard’s document history

ASF is funded through facility membership fees (published, fixed by facility type and size) and a fixed, published assessment fee — never a fee contingent on, or scaled to, the outcome of the accreditation decision. A facility that does not meet the standard pays the same published fee as one that does. No assessor, Council member, or ASF staff member receives remuneration tied to the accreditation outcome of any facility they assess or whose standard they review.

This structure follows established practice among international accreditation and certification bodies: fee schedules are public, fixed in advance of assessment, and structurally separated from the decision itself.

Completed — 2021–2023 Pilot (Legacy Adapted Georgian Standard)

Run jointly by ASF and PHIG with David Tvildiani Medical University. More than 50 healthcare facilities in Georgia voluntarily enrolled in 2021, during the COVID-19 pandemic; outcomes were finalised in 2023. This cohort tested ASF’s earlier, Georgia-adapted standard — not the current ASF Standard architecture (current edition — Hospital Standards v8.0 in the Public Standards Register above) published on this site.

Outcome: four facilities accredited; ten assessed and did not meet the standard. The remaining enrolled facilities did not complete the pilot. Source: ASF/PHIG pilot records, 2021–2023.

Facilities accredited: Hebe Ltd (dental clinic) · Dental Line (dental clinic) · Ultramedi Ltd (ambulatory clinic) · Smile Gallery Ltd (dental clinic). Also published at publichealth.ge/accreditation.

In Progress — 2025 Full-Model Pilot (ASF Standard v4.0)

A new round began in February 2025 with seven healthcare facilities in Georgia enrolled to test the current ASF Standard architecture (current edition — Hospital Standards v8.0 in the Public Standards Register above) across applicable modules. Three facilities did not complete the process; four continued through to the accreditation assessment stage and are listed below.

Current Field Testing Status

ASF publishes openly while field testing is still under way, consistent with the Open Access and Intellectual Property Policy (ASF-IP-001-v1): the standard is available for use, review and challenge from day one, rather than held back until piloting concludes. The current full-model cohort consists of four active facilities — two in Kutaisi and two in Tbilisi — all in Georgia, ASF’s founding market, with on-site assessment concluding within the month and certification decisions expected by end of November 2026. The names of all four participating facilities are withheld pending finalisation of their certification decisions, consistent with ASF’s duty of confidentiality toward facilities undergoing assessment.

Standards with an open pilot in progress carry the Active · Field Testing status in the Public Standards Register above. The tag is removed, and the pilot formally recorded as concluded, once the current cohort’s findings are reviewed by the Council.

Every published standard is formally reviewed within three years of its publication date. At scheduled review the Council must reach one of three decisions: Reaffirm (no substantive change), Revise (amend or replace one or more criteria), or Retire (withdraw the standard from active use with a published retirement notice).

A standard that cannot be reaffirmed or amended and is no longer fit for purpose is retired, not left in indefinite use. The retirement notice states the reason and, where applicable, the successor standard.

Between scheduled reviews, any person may submit a revision proposal with supporting evidence. The Council is required to respond in writing within 60 days: accept for immediate revision; defer to next scheduled review with reasons; or reject with reasons. A sentinel event — a patient-safety incident directly connected to a criterion — triggers an unscheduled review within 30 days.

Submit a proposal →

ASF accreditation is granted for a period of three years from the date of award, consistent with established international practice. Validity is conditional on the facility maintaining Non-Negotiable and Core criteria compliance throughout the period, not solely at the point of award.

Rather than a single fixed-format visit at the end of the three-year period, the schedule and format of verification activity within the cycle is agreed directly between ASF and the facility’s director — proportionate to risk, prior findings, and any criteria flagged for follow-up — rather than imposed as a uniform calendar event.

Major international accreditors are designed around well-resourced health systems. ASF’s Crisis (CR) and Transitional (TR) facility classifications exist because a solo rural practitioner, a conflict-affected clinic, or a facility operating under chronic resource constraint needs a verification schedule that reflects its real operating conditions — not a format built for a well-staffed urban hospital. The continuous-engagement model is what makes this possible: schedule and format of verification activity are agreed with the facility director in view of its classification and actual circumstances, rather than imposed as one uniform calendar regardless of context.

Adaptability applies strictly to scheduling and verification format — never to the Non-Negotiable criteria themselves. A Crisis or Transitional classification adapts how a criterion is evidenced, never whether a Non-Negotiable patient-safety requirement must be met. Context changes the path to verification; it never changes what must be verified.