Background: In the past 15 years many countries, with widely differing health systems, have established national accreditation programs. A European survey report on accreditation, which includes data and updates from 2003 that were submitted between January and October 2004, is summarized.
Methods: A one-page questionnaire was circulated, with the summary of the 2002 survey, in February 2004 to known contacts in 44 of the larger states in the European Region of the World Health Organization. Combining the surveys of 2000, 2002, and 2004, responses were received from 36 of the 44 larger countries of the European Region from which information was sought.
Findings: The number of national accreditation programs for health services has continued to grow since the mid-1990s. By 2004, 26 programs were active or in development in 18 countries. The "English-speaking" model of North America remains the leading influence; however, newer programs are increasingly influenced by other models. Governmental programs are more likely to publish findings of accreditation assessments, and more recent programs are more likely to make results public.
Discussion: Accreditation programs are being set up more frequently in Europe than anywhere else; the trend is from voluntary, confidential, and self-financed organizational development toward benign but transparent regulation of stakeholders, governmental support, and public funding. Programs vary widely, yet patient and staff mobility, cross-border purchasing, freedom of trade, and protection of public safety and patients' rights imply the need for a common approach to definition, assessment, and improvement of standards in health care.