MANAGING QUALITY IN HEALTH CARE: PROCESS OF ACCREDITATION IN HEALTHCARE INSTITUTIONS IN REPUBLIC OF NORTH MACEDONIA
Authors: Stefanoski Sasho , Stefanoska Tanja 
Published: February 2023

The quality of health care is a system of measures and activities that, in accordance with the modern achievements of medical, dental, and pharmaceutical science and practice, as well as the knowledge and skills of health professionals, increase the opportunities for the most favorable outcome of the medical treatment and reducing the risk of adverse effects on the health and well-being of the individual and the community. Improving the quality and safety of patients is an integral part of the daily activities of healthcare professionals, healthcare providers and all stakeholders in the healthcare system. Accreditation is the oldest and most widespread independent mechanism for external evaluation of the quality of work of healthcare institutions. The general understanding of the accreditation of healthcare institutions is defined as a procedure for assessing the quality of the work of a healthcare institution, based on the application of the optimal level of the established standards for work of a healthcare institution in a certain area of health care. In response to these challenges, several approaches, activities, measures, and programs have been developed to improve the quality of health care. In the Republic of North Macedonia, the quality of health care is recognized as one of the most important features of the healthcare system, both in the state sector and in the private sector. Continuous improvement of the quality of work and patient safety are an integral part of the daily activities of healthcare professionals and all other employees in the healthcare system. From a formal aspect, accreditation in the Republic of North Macedonia is mandatory and is performed at the request of a healthcare institution. Therefore, a separate institution has been established for this purpose, namely the Agency for Quality and Accreditation of Healthcare Institutions in the Republic of North Macedonia. The accreditation process includes five characteristic stages: 1. Preparation of the healthcare institution 2. Self-evaluation 3. Evaluation made by external evaluators of the adaptation of the institution work with the accreditation standards 4. Preparation of the final report and the decision for granting accreditation by the Agency for Quality and Accreditation of Healthcare Institutions 5. Continuous evaluation and monitoring of the execution of the quality improvement plan. Improving the health care is based on the values that are embedded in the concept of quality of work and the following adopted daily practice of healthcare institutions: patient orientation, safety, effectiveness, timeliness, efficiency, fairness. To achieve and implement each of the principles, it is necessary clearly to define objective, measurable and evidence-based standards, and indicators for the three basic aspects of health care: structure, process, and outcome/result. The standards, which are clustered in six chapters, may be divided into three categories: management standards, patient care standards and support service standards. According to the Law on Health Care, the Agency for Quality and Accreditation of Healthcare Institutions in the Republic of North Macedonia determines the standards for accreditation of healthcare institutions and evaluates the quality of the provided health care. The agency issues a certificate for a certain period, but not longer than five years. Until and including the third quarter of 2022, in the Republic of North Macedonia, a total of 20 healthcare institutions were accredited.