HOSPITAL ACCREDITATION IN THE BRAZILIAN CONTEXT

Introduction: Hospital accreditation aims to promote patient care and assistance and quality in the institution's sectors, aiming at process safety, integrated management and continuous improvement. Objective: to identify in Brazil in 2021 the types of establishments certified in the country, as well as their respective states, type of management and certification seals in force in the national territory. Method: Descriptive and retrospective study with a quantitative approach. The search was carried out on the website of the National Accreditation Organization in October 2021. Variables of interest were considered: types of accredited health establishments, types of certifications in force in the national territory, type of management of the accredited establishment, state and city of establishments. Results: The analyzes identified that in the month of October 2021 there are 906 certifications in the Brazilian territory. Of these, 760 (84%) of the accreditations in the national territory are private institutions and 337 (37.2%) are hospital institutions. As for the certification seal, 201 (22.1%) of the institutions are accredited (level I) and 341 (37.6%) are located in the state of São Paulo. Conclusions : It was possible to obtain a view of the accreditation certifications in force in Brazil through their characterization, in order to visualize which types of seals, establishments and states are covered with health establishments committed to quality and excellence in care. (37,2%) son instituciones hospitalarias. En cuanto al sello de certificación, 201 (22,1%) de las instituciones están acreditadas (nivel I) y 341 (37,6%) están ubicadas en el estado de São Paulo. Conclusiones: fue posible obtener una visión de las certificaciones de acreditación vigentes en Brasil a través de su caracterización, con el fin de visualizar qué tipos de sellos, establecimientos y estados están cubiertos por establecimientos de salud comprometidos con la calidad y la excelencia en la atención.


INTRODUCTION
Thus, the Join Commission on Accreditation of Hospitals seeks to establish an international standard of safety and quality in care, besides aiming at continuously improving patient care through a high level of excellence and reliability in its processes 2-3 .
The history of quality care in Brazil began with the World Health Organization (WHO), which in 1989 began to address the subject and estimated that the accreditation process would be the strategy to encourage quality in health services 3 . Hospital accreditation is a method used to promote patient care and assistance and quality in the institution's sectors, aiming at process safety, integrated management (customers and suppliers) and continuous improvement. For this, a process is developed in which the healthcare institution attests its technical competence to provide a service following strict protocols and requirements through standardized evaluations and certification by the ONA (National Accreditation Organization). This certification evaluates if the place, the product, and the service meet the requirements it has set itself to fulfill, followed by good practices regarding quality and standardization. The ONA is a private, non-profit organization of collective interest that is recognized internationally 5 .

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Organizations of various sizes and complexity may be accredited according to the standards required by ONA, that is, to have been legally constituted for at least one year, to have an operating license, to have a health license, to have a license pertinent to the nature of the activity, and to have the registration of the technical manager according to the organization's profile. When health institutions undergo the accreditation process, it is estimated that the institution must have responsibility and commitment to safety, professional ethics in the procedures performed and the guarantee of quality care to users 6,7 .
The accreditation brings the benefit and stimulus to the health care institution that undergoes this voluntary and periodic evaluation, without the restriction of techniques and tools to be developed during the management process and organization to be accredited 7 .
Hospital accreditation has three levels with guiding principles, the first referring to safety and structure, the second referring to organization, and the third referring to quality management practices.
This way, its classification is also divided into three levels: accredited, fully accredited and accredited with excellence 8 . The objective of this study was to identify the types of certified establishments in Brazil, as well as their respective states, management type and certification seals in force in the national territory.

METHOD
Type of study: Descriptive and retrospective study with a quantitative approach.

Procedures for data collection
The search will be on the ONA website for the period July 2021 in the session Accreditation

Data analysis
The data collected will be entered into Microsoft Excel® version 2016 and analyzed using the Statistical Package for the Social Sciences (SPSS) ® version 20 for Windows®. A descriptive analysis of the data will be performed using simple and relative frequencies, presented in tables and/or graphs. health services. Figure 1 shows the accreditations in effect in October 2021 in Brazil.   Accreditation is of great importance and is necessary for the hospital field because it is through the standards that underlie it that one can achieve quality improvement in hospital medical care and a risk-free environment 9 . The corporate growth, competition and consumer expectations (patient, customer) regarding quality of care make hospitals pay attention to management and management in qualitative standards of health safety 10 .

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The impact caused by the hospital accreditation process is felt by everyone, because the benefits reach since the leaderships, direct collaborators and outsourced collaborators, patients and the community itself, where it is centralized; thus, it is seen that the accreditation is fundamental for the credibility, development and recognition in hospital care in all sectors, having its greatest coverage in the state of São Paulo [9][10] .

CONCLUSIONS
The data demonstrated that in the national territory, in the second half of 2021, most Brazilian health accreditations contemplated private hospital services, with excellence certification (level II) in the state of São Paulo.
The findings provide a vision of the current accreditation certifications in Brazil through its characterization, in order to visualize which types of seals, establishments and states are contemplated with health establishments committed to quality and excellence in care.