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With the rapid acceleration of changes being experienced throughout the world and in particular within health and health and social care, accreditation programmes must keep pace or go the way of the dinosaur. While accreditation has deep roots in some countries, in the past 30 years, it has spread to a considerably larger range of countries in a mix of mandatory and voluntary systems. Accreditation is a tool to improve the quality of healthcare and social care, and in particular, there is recent recognition of its value in low- and middle-income countries, with promotion by the World Health Organization (WHO). The challenge is that with the rapid pace of change, how does accreditation reframe and reposition itself to ensure relevance in 2030? Accreditation must adapt and be relevant in order to be sustainable. This article outlines the fundamental principles, reviews the global trends’ impact on accreditation and the challenges with the existing model and, through the lens of living in 2030, outlines how accreditation programmes will be structured and applied 10 years from now.

The above manuscript has been retracted from publication. The following reason was stated:The paper described the pathology associated with what was thought to be a nematode parasite, Capillaria hepatica. The figures that appear in the manuscript show another parasite, Eimeria spp and do not show the nematode. While some of the hepatic pathology described might have been attributed to infection with the Capillaria, the absence of definitive proof meant that the possibility of misleading readers was high and it was, with the agreement of the authors, decided to withdraw the manuscript to avoid this possibility. ABSTRACT Capillaria hepatica is a nematode parasite of wild rodents and other mammals. Adult worms inhabit the liver. Recently, during the necropsy examination of a group of 160 rabbits from a commercial supplier, firm pale or cystic areas (1-5 mm) were noted on the liver in thirteen animals. On further investigation, these animals were found to be infected with C. hepatica. The histopathological features of the infection in the rabbit are described for the first time and diagnostic features recorded. Lesions were identified predominantly in portal tracts consisting of dilated bile ducts with luminal debris, peribiliary inflammatory cell infiltrates, and fibrosis. Large granulomas (macrogranulomas) were evident in portal areas and involved the bile ducts. Macrogranulomas contained collections of characteristic C. hepatica eggs, macrophages, eosinophils, and lymphocytes. Small granulomas (microgranulomas), characterized by epithelioid macrophages surrounded by lymphocytes and eosinophils, were also identified. C. hepatica eggs were also observed in the lumina of the bile ducts and gall bladder. No adult C. hepatica worms were identified. Oocysts of Eimeria stiedae were also evident in the biliary epithelium in some animals. The unique characteristics of the C. hepatica life cycle are described, and the differential diagnosis of hepatic capillariasis is discussed.

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Background Healthcare accreditation programs have been adopted internationally to maintain quality and safety of services. Accreditation assesses compliance of organisations to a series of standards. The evidence base supporting benefits of accreditation is mixed, potentially influenced by differences in local implementation and operationalisation of standards. Successful implementation is associated with optimising regulation, funding and government commitment. Implementation of accreditation is a complex intervention that needs to be tailored to meet contextual differences across settings. Comparing why and how accreditation is implemented across countries supports effective implementation of new programs and refinements to existing systems. Methods This article presents four case studies from Australia, Botswana, Denmark and Jordan to consider a geographic spread and mix of high- and upper-middle-income countries. The data were derived from a review of accreditation program documents and follow-up discussions with directors of the accrediting bodies in the countries of interest. Each case study was summarised according to a standardised framework for comparison: 1) goals (why); 2) program implementation (how); 3) outcomes based on pre-post measures (what); and 4) lessons learned (enablers, barriers). Results The accreditation programs were all introduced in the 2000s to improve quality and safety. Documents from each country outlined motivations for introducing an accreditation program, which were predominantly initiated by government. The programs were adopted in demarcated healthcare sectors (e.g., primary care and hospital settings) with a mix of mandatory and voluntary approaches. Implementation support centred on interpretation and operationalisation of standards and follow-up on variation in compliance with standards, after announced surveys. Most standards focused on patient safety, patient-centeredness, and governance, but differed between using standard sets on quality management or supportive processes for patient care. Methods for evaluation of program success and outcomes measured varied. Frequently reported enablers of successful implementation included strong leadership and ownership of the process. A lack of awareness of quality and safety, insufficient training in quality improvement methods and transfer of staff represented the most common challenges. Conclusion This case analysis of accreditation programs in a variety of countries highlights consistent strategies utilised, key enabling factors, barriers, and the influence of contextual differences. Our framework for describing why, how, what, and lessons learned demonstrates innovation and experimentation in approaches used across high- and upper-middle-income countries, hospital and primary care and specialist clinics.