Evaluation is the process by which a specially trained commission of independent surveyors validates the compliance of the processes in the health unit with the requirements of the standards.
What are the objectives of the evaluation?
The surveyors aim to identify:
– whether the way in which the concept of quality management is understood and accepted by the heads of structures and employees;
– if the concern for quality is effective, real, or is a formal one expressed by completing some documents, without actually being respected;
– whether procedures and protocols are developed to address identified issues or have been formally developed to simulate compliance with the requirements of the standards;
– whether there is a system of self-assessment of the activity in order to continuously improve it;
– what are the nonconformities and establish together with the management of the health unit a compliance plan;
What are the stages of the evaluation process?
The evaluation has three stages:
Stage I – pre-visit, in which the surveyors analyze the documents requested by ANMCS and submitted by the medical units in the CaPeSaRo application and request clarifications from the management, when appropriate.
Stage II – the visit, in which the Evaluation Commission travels to the headquarters of the health unit and to validate the data on the basis of which the conformity with the requirements of the standards is established, following the objectives mentioned above.
Stage III – post-visit, in which the evaluation report is drafted, any objections or ambiguities raised by the management of the unit are answered and the evaluation report is prepared, on the basis of which the accreditation report is elaborated
