The essential list of mandatory HAS criteria for the certification of healthcare hospitals 2025

The quality requirement in French healthcare facilities

The quality and safety of care are at the heart of the concerns of modern healthcare systems. In France, the Haute Autorité de santé (HAS) plays a central role in this process, being the organization mandated by the 1996 ordinances for the certification of hospitals. This evaluation procedure, independent of the hospital and its supervisory bodies, focuses specifically on the level of quality and safety of care delivered to patients. It is carried out by professionals, called expert visitors, mandated by the HAS, who evaluate the hospitals on the basis of objectives defined collectively at the national level by professionals and users.

The certification of healthcare facilities goes far beyond mere administrative compliance. It relies on the patients' point of view regarding their experience within the facility, evaluates the results not only in terms of health but also in terms of appreciation of the care pathway (reception, information transmitted, team coordination, discharge), and engages the teams in a pragmatic approach where they have the initiative to organize their practices to achieve the results by the most appropriate methods. It also offers the possibility of relying on the HAS for self-evaluation and constitutes a recognition of the teams' commitment to a continuous improvement approach to the quality and safety of care. Certification is neither an inspection nor a ranking between facilities, and does not interfere with other regulatory evaluations. It is the only national system in France that offers a global framework for analysis and external evaluation of the quality of care and management, acting as a lever for mobilization for healthcare professionals and user representatives.

Within this rigorous framework, certain criteria are considered "imperative." These criteria correspond to fundamental requirements that, if not met, may potentially prevent certification. Understanding these imperative criteria is therefore essential for any hospital wishing to achieve and maintain a high level of quality and safety of care.

The Haute Autorité de Santé (HAS) and the evolution of certification

The certification process for healthcare facilities, initiated 25 years ago, is part of a global effort to secure production processes in the health sector and beyond. It responds to a legitimate expectation of transparency regarding the quality of service provided for patients, public authorities, and healthcare professionals, thereby stimulating a collective approach to continuous improvement.

Since its first version in June 1999, which helped to develop a culture of quality and safety of care, the procedure has constantly evolved. The second iteration in 2005 introduced the evaluation of professional practices in care units, while the 2010 version (V2010) emphasized an increased requirement in terms of patient care and risk management, particularly through priority required practices. V2014 strengthened the ability of hospitals to identify and control their risks continuously, by introducing patient-centered assessment methods, such as the patient tracer method, and by mobilizing hospital management on quality and safety issues.

More recently, from 2021, the certification has profoundly transformed, with three major ambitions set by the HAS College:

• Medicalize certification and better consider the outcome of patient care: The objective is for certification to make sense for care teams by focusing on their practices and the outcome for patients in terms of effectiveness, safety, and satisfaction. The objectives and criteria are defined by consensus, easy to share, and correspond to the requirements of good professional practices.
• Simplify the certification process in all its aspects: To facilitate adoption, certification reinforces the autonomy of hospitals, prioritizes results rather than compliance with processes, and proposes pragmatic and field-based evaluation methods.
• Valuing the territorial integration of healthcare facilities and the construction of care pathways: Certification must recognize the efforts of hospitals to improve the quality and safety of the patient's healthcare pathway within their territory, in coordination with all prevention, healthcare, medico-social, and social stakeholders.

These developments respond to current quality issues, in particular the development of patient engagement as partners in their individual and collective care, the transition from a logic of means to a logic of results (relevance of care), the development of multi-professional teamwork, and adaptation to the structural changes in the health system. The HAS itself is evaluated according to international standards, being accredited by the International Society for Quality in Health Care (ISQua) since February 2023 for its entire certification procedure.

The structure of the 2025 certification framework

The certification framework is the foundation of HAS's system, listing the criteria to be met by the hospital, as well as the elements necessary for their understanding and evaluation. It facilitates self-assessment by professionals and user representatives and serves as a reference document for expert visitors during visits. This framework is the result of a concerted development and shared construction between HAS, healthcare professionals, institutions, and user representatives. It is updated each year to take into account changes in the healthcare system and feedback.

The framework is structured into three main chapters, divided into objectives and criteria:

• Chapter 1: The patient: This chapter focuses on the direct outcome for the patient, ensuring respect for their rights, consideration of their needs and preferences, and their engagement as a partner in their care. It covers objectives such as respecting patient rights (1.1), informing the patient (1.2), engaging the patient in their care plan (1.3), and involving patients and their representatives in the life of the hospital (1.4).
• Chapter 2: Care teams: This chapter assesses the teams' ability to seek relevance, effectiveness, and safety of care, to consult and coordinate throughout the patient's journey, and to control the risks associated with care. Objectives include team coordination (2.1), risk management related to practices (2.2), safety in high-risk areas (2.3), and a culture of relevance and evaluation (2.4).
• Chapter 3: The hospital: This chapter concerns the hospital and its governance, assessing its ability to drive a dynamic of continuous improvement in the quality and safety of care, to manage its professional resources, to enhance its territorial positioning, and to adapt to digital innovations and eco-responsible care. The objectives are overall management through quality and safety of care (3.1), management of professional resources and skills (3.2), territorial positioning (3.3), and adaptation to eco-responsible care and digital innovations (3.4).

This framework is modular, integrating 86 generic criteria applicable to all hospitals and 32 specific criteria adapted to specific populations (children, the elderly), care methods (hospital at home) or sectors of activity (emergency, surgery, maternity, mental health, radiotherapy, etc.).

Methods for evaluating the quality of care

The HAS certification relies on varied and complementary evaluation methods designed to closely reflect field conditions and the reality of practices. These methods are used both by HAS expert visitors during external visits and, if the hospital wishes, by its own internal evaluators as part of self-assessment.

• The Tracer Patient: This method consists of evaluating the quality and safety of care for a given patient within the hospital. It involves collecting, with the consent of the patient and/or their relatives, their experience. The evaluator meets with the patient, then speaks with the team providing their care. For external evaluations, only expert-visitor physicians are mobilized for this method.
• The Tracer Pathway: This method assesses the continuity and coordination of patient care, as well as teamwork and the quality and safety culture of care. The evaluator meets with the teams involved in the patient's care pathway and, accompanied by a professional, traces the patient's physical pathway within the hospital, meeting with the teams involved at the different stages.
• The Targeted Tracer: This involves evaluating on the ground the actual implementation of a specific process. The evaluation starts from the field and, in the event of malfunctions, goes back to the organization of the process. To do this, the evaluator meets with the teams, consults the relevant documents and makes direct observations. Targeted tracers are, for example, carried out on the drug circuit, infection prevention, adverse event management, etc.
• System Audit: This method aims to evaluate a process more holistically to ensure its control and its ability to achieve defined objectives. The evaluation begins with a review of the process's constituent elements, followed by meetings with management, the president of the medical council, the director of nursing, heads of specific structures, and user representatives. Finally, it verifies how the process is implemented in the field with professionals and their supervisors.
• Observations: Observations are carried out continuously during each tracer (patient, pathway, targeted). They are based on a list of points directly observable in the field, such as respect for the patient's dignity and privacy, accessibility of premises, and control of infectious risks.

Each method is broken down into assessment grids that integrate the assessment elements of the generic and specific criteria applicable. The answers to the grids ("Yes", "No", "NA", "RI") are aggregated to calculate a score for each assessment element, then for each criterion, objective, and chapter, leading to an overall score for the hospital. Advanced criteria are not included in this rating. The assessment is also based on quality and safety of care indicators (QSCI) to measure the improvement dynamic of hospitals.

The critical importance of HAS imperative criteria

Among the 86 generic criteria and the 32 specific criteria of the HAS reference system, 21 criteria are classified as "imperative". These criteria represent fundamental requirements for the quality and safety of care. Their particularity lies in their potential impact on the certification decision: "If an evaluation of one of these criteria is negative, the HAS reserves the right not to grant certification to the hospital; it may have an impact on the level of decision". This underlines their critical role in assessing a hospital's compliance with essential standards of care.

The imperative criteria cover a wide range of fundamental areas, from respect for patients' rights and the management of risks associated with professional practices, to the management of emergency situations and the establishment's overall quality and safety of care policy. They reflect the inalienable pillars on which any quality care offering must be based.

Let's take a closer look at each of these imperative criteria, their assessment criteria and the HAS's expectations.

Criterion 1.1-01: Respect for the patient's privacy and dignity

This fundamental imperative criterion ensures that the hospital implements measures to guarantee respect for the patient's privacy and dignity in all circumstances. This includes the cleanliness and maintenance of premises, the vigilance of professionals to avoid inappropriate remarks or attitudes (including infantilization of vulnerable people such as the elderly or those living with a disability), and the effective accessibility of equipment and services.

The evaluation elements for this criterion focus on the patient's perception and direct observations. From the patient's perspective, it is verified that the reception and care conditions have respected their dignity, privacy, and integrity. In addition, access, circulation, premises, and signage must allow for easy movement. The expert-visitors' observations focus on the practices of professionals ensuring the patient's dignity, privacy, and integrity, as well as the conformity of premises and equipment to these principles and safety. Particular attention is paid to accessibility for people with disabilities. This criterion is reinforced by the quality and safety of care indicators (QSCI) e-Satis, which measure patient satisfaction and experience.

Criterion 1.1-02: The environment adapted for the minor patient

The care of children and adolescents requires a framework specifically adapted to their needs. This imperative criterion requires that the hospitalization of minors be avoided in adult sectors, and if this exceptionally occurs, appropriate measures must be put in place (reserved space, trained professionals, secure environment). The presence of parents, essential for the child's support, must be organized taking into account the care plan.

The evaluation elements verify that good practices related to the specificities of the care of minors are applied in the services that receive them. It is imperative that the presence of parents be organized 24 hours a day, unless otherwise medically advised. In addition, hospitalized minors must benefit from recreational and educational activities adapted to their age. Observations are also made to ensure that the environment and premises are adapted to respect the privacy, dignity and safety of minors, including when cared for in an adult service.

Criterion 1.1-05: Anticipation and rapid pain relief

This imperative criterion emphasizes the obligation for all healthcare professionals to regularly and appropriately assess the patient's pain, whether acute or chronic. Anticipating and effectively managing pain is crucial to preserving the patient's dignity, improving their quality of life, and promoting their recovery. Professionals must adapt treatments and use the most appropriate techniques to quickly and lastingly relieve suffering, taking into account the assessment scale adapted to the patient's situation (vulnerability, disability, involvement of those around them).

The evaluation elements include encouraging the patient to express their pain and guaranteeing its relief. For professionals, it is verified that the anticipation and pain relief measures are documented in the record, that pain re-evaluations are documented to adapt the therapy, and that non-drug management methods are offered. This criterion is also linked to the QSCI on the evaluation of pain management.

Criterion 1.1-06: Compassionate care for all patients

Well-treatment is a fundamental principle that encompasses the respect, dignity, and well-being of each individual, involving all actors in the institution. This imperative criterion requires not only quality medical care but also particular attention to communication, personalization of support, and respect for patient autonomy (hydration, nutrition, hygiene, etc.). It includes active listening, the absence of any form of mistreatment, and the creation of a safe environment. The promotion of well-treatment is inseparable from the well-being of professionals.

The evaluation elements focus on the team's ability to assess the patient's autonomy in their basic needs, even during periods of high activity. From the patient's point of view, it is verified that they have received the necessary help for their basic needs, that professional practices are benevolent, and that all those involved introduce themselves. The team must also identify the risks of harm to benevolent care, implement improvement actions, and know how to report potential situations of internal mistreatment.

Criterion 1.3-01: The patient's free and informed consent

The patient's involvement in their care ensures effectiveness and risk reduction. This imperative criterion aims to ensure that the patient expresses their free and informed consent, adheres to and observes their care plan, which requires their participation in defining the objectives, implementation, and follow-up. The care plan, established after a comprehensive assessment and taking into account the patient's needs and preferences, must be a guiding thread readjusted in collaboration with the patient, taking into account a potential deterioration in their mental health.

The evaluation elements focus on presenting the patient with the different therapeutic options, their benefits and risks, so that they can express their preferences and needs and consent to them. On the professional side, it is expected that an initial global assessment (medical, psychological, social, autonomy, rehabilitation) will be carried out by professionals involving the disciplines concerned and support care. The team must build an adapted care project, adapt it according to the evolution of the patient's situation, and document it in the record. This criterion is supported by the QSCI linked to e-Satis.

Criterion 1.4-02: Taking into account patient satisfaction and experience

This imperative criterion is essential for the continuous improvement of the quality of care. The hospital must take into account the results of measuring patient satisfaction and experience to define the orientations of its policy for improving the quality and safety of care. The detailed analysis of the results must be shared with professionals, and regular monitoring must be carried out to ensure that the improvement objectives are achieved.

The evaluation elements for governance include encouraging patients to participate in satisfaction surveys (including e-Satis), monitoring this participation, and integrating improvement actions resulting from the analysis of patient satisfaction and experience results into the quality improvement program. For professionals, it is expected that the results of patient satisfaction and experience evaluations will be shared semi-annually with the care teams. The teams must analyze their own results and implement improvement actions, and the recommendations of the Users' Commission (CDU) must be taken into account.

Criterion 2.1-12: The physical examination of patients hospitalized in psychiatry

This imperative criterion recognizes the importance of integrating the physical examination into psychiatric care. This examination, performed for all patients hospitalized in psychiatry, allows for differential diagnosis and identification of somatic comorbidities that may interfere with psychiatric care. It must be carried out within a short period of time, especially for hospitalizations without consent.

The evaluation elements specify that a somatic examination must be performed within 24 hours for full hospitalizations without consent in psychiatry. For patients hospitalized in free care without going through the emergency room, the somatic examination must be performed within an appropriate period (maximum 3 working days). If the patient has gone through the emergency room, the report must be integrated into the record and the follow-up instructions implemented. Somatic follow-up must be regular and documented in the discharge letter. This criterion is linked to the QSCI on coordination and somatic care in full-time hospitalization.

Criterion 2.2-02: Best practices for prescribing medications

Medication prescription is a critical step in the care pathway. This imperative criterion requires medical teams to adhere to good practices to ensure the safety and effectiveness of treatments. This involves a clear prescription, tailored to the patient's specific characteristics (health status, history, allergies, interactions), and compliant with recommendations. The legibility of the prescription is paramount to avoid any confusion.

The evaluation elements verify that the admission prescription takes into account the patient's usual treatment. The prescription must clearly mention the identification and signature of the prescriber, the date, the time, the name of the molecules in INN (International Nonproprietary Name), the dosage, the solvent and its volume (for injectables), and the route of administration. The patient's self-management capacity (excluding the PAAM program) must be assessed and documented. Any conditional prescription must be justified, and prescriptions must be made in a timely manner by authorized professionals, without transcription by non-medical personnel.

Criterion 2.2-05: Best practices for administering medications

Administration is the last step in the medication circuit, where any undetected error can cause harm to the patient. This imperative criterion requires healthcare teams to rigorously follow medical prescriptions, applying the "5 Rights" (right patient, right medication, right dose, right route, right time). Medication preparation must comply with recommendations (extemporaneous, crushing if necessary, identification until administration).

The evaluation elements require that authorized professionals comply with good preparation practices (avoiding task interruptions) and administration practices. High-risk situations (injectables, chemotherapies, etc.) must be identified and managed with special precautions. The agreement between the product, the patient, and the prescription must be systematically verified before administration, and the administration (or its reason for non-administration) must be documented in the record at the time of administration. The taking of usual treatment by the autonomous patient must also be documented.

Criterion 2.2-06: Preventing medication errors

This imperative criterion emphasizes the proactive prevention of medication errors. It is based on rigorous practices, the vigilance of care teams, and the continuous training of professionals. High-risk medications, which carry a higher risk of harm in the event of an error, must be specifically managed at all stages of the process, and their evolving list must take into account feedback and "never events". Preparations in a controlled atmosphere (chemotherapy, etc.) are crucial to avoid contamination and ensure accurate dosages.

The evaluation elements require that professionals be trained in the prevention of medication risk and know the means of controlling the most high-risk medications. A collegial and adapted list of high-risk medications must be known to professionals. The circuit of preparations in a controlled atmosphere must be controlled (prescription, pharmaceutical analysis, preparation, release, transport, storage, administration). Finally, medication errors must be systematically analyzed as a team and be the subject of a monitored action plan.

Criterion 2.2-08: Adherence to standard hygiene precautions

Standard hygiene precautions are the foundation of preventing healthcare-associated infections and apply to all patients. This imperative criterion covers hand hygiene, the use of personal protective equipment (gloves, masks, gowns), the management of excreta and waste, as well as the maintenance of equipment and surfaces. The use of hydroalcoholic solutions at key moments is essential, as is the absence of jewelry on hands and wrists.

The evaluation elements verify that the team respects the indications for hand hygiene (before/after patient contact, before aseptic procedure, etc.) and favors hydroalcoholic friction. The team must apply good excreta management practices (personal protective equipment, adapted equipment) and know the procedures to follow in the event of a blood exposure accident. The improvement of practices must be based on the regular analysis of indicators in connection with the operational hygiene team (OHT). The observations focus on the prerequisites for hand hygiene (no jewelry, short sleeves, short nails). This criterion is linked to the QSCI on the consumption of hydroalcoholic solutions (ICSHA).

Criterion 2.2-12: Mastering the management of life-threatening emergencies

The management of life-threatening emergencies requires immediate responsiveness and optimal coordination to preserve the patient's life. This imperative criterion requires that healthcare professionals are continuously trained in emergency protocols, and that a clear organization ensures rapid identification of the situation, fluid communication between teams, and the immediate availability of equipment and medications. Emergency simulation exercises are essential to evaluate and improve procedures.

The evaluation elements for professionals include the existence of a single and dedicated phone number to reach a qualified physician in case of a life-threatening emergency, the training of all healthcare professionals in first aid, and the availability and regular inspection of crash carts or bags. The performance of simulation exercises is also verified. The governance must evaluate the effectiveness of the system for managing life-threatening emergencies.

Criterion 2.3-06: Risk management in interventional sectors

In interventional sectors, the risks, particularly infectious, are high and require exemplary rigor. This imperative criterion emphasizes the mastery of hygiene practices, the sterilization of equipment, and the maintenance of premises. Equipment must be disinfected regularly and checked before each intervention. Professionals must follow strict protocols to limit contamination, including aseptic techniques and wearing appropriate attire. Particular attention is paid to traffic flows.

The evaluation elements verify that the team performs all the steps of patient preparation according to the protocol in force (shower, hair removal, cutaneous antisepsis). Professionals must document the conformity of the operating equipment at the opening of the room. Observations concern the wearing of clothing and equipment adapted and strictly dedicated to the interventional sector. This criterion is linked to the QSCI on surgical site infections.

Criterion 2.3-09: Improving practices through the « Patient Safety » checklist

The "Patient Safety" checklist is a crucial tool for enhancing the safety of surgical interventions. This imperative criterion highlights its systematic and exhaustive use at each stage of care (patient identification, verification of the surgical site, equipment control, procedure validation). The HAS encourages professionals to adapt this checklist for better ownership. Regular analysis of its implementation allows for the identification of discrepancies and improvement of communication and coordination.

The evaluation elements require that a checklist, possibly adapted to HAS recommendations, be systematically and exhaustively completed by operating room and interventional sector teams at each stage, in the presence of the professionals concerned. Evaluations of its implementation, including monitoring of Go/No Go (elements to be verified before moving to the next stage), must be followed by the teams, and improvement actions implemented based on the analysis of the results of the monitoring indicators.

Criterion 2.3-10: Preventing major obstetric risks

The care of pregnant women requires particular attention to the prevention of major obstetric risks. This imperative criterion aims to ensure that teams are trained to rapidly detect potential complications (postpartum hemorrhage, pre-eclampsia, dystocic deliveries) and to apply strict protocols to anticipate them. Enhanced prenatal monitoring and effective management of obstetric emergencies are paramount. Emergency simulations and fluid communication contribute to optimal responsiveness.

The evaluation elements for professionals include the availability of all elements of the patient record upon admission, even in emergencies. The team must master the interpretation of the fetal heart rate and obstetric maneuvers through training. The emergency equipment for life-threatening postpartum hemorrhage must be verified and compliant, and the life-threatening emergency procedure must be accessible and known to professionals.

Criterion 2.3-11: Securing the care of the newborn

Birth is a critical moment where securing the care of the newborn is paramount for their health and well-being. This imperative criterion requires care teams to follow protocols for immediate identification of the infant, prevention of infections, and assessment of vital functions (Apgar score). Continuous monitoring allows for rapid detection of any anomalies. Essential care (temperature maintenance, feeding) must be systematically performed, and clear communication with parents is necessary.

The evaluation elements for professionals verify that all professionals caring for newborns are trained through simulation. They must know the management procedures (neonatal resuscitation, neonatal infection). Delayed umbilical cord clamping and skin-to-skin contact must be documented, and the reason given if not performed. The newborn's temperature must be recorded and documented. Breastfeeding support must be part of a formalized quality approach, and professionals must analyze their results to define improvement measures.

Criterion 2.3-14: Best practices for isolation and restraint in psychiatry

This imperative criterion strictly governs the practices of isolation and, where applicable, restraint of hospitalized patients without consent, in order to guarantee respect for their rights and dignity. These measures should only be used as a last resort to prevent imminent danger. Care teams must ensure that each decision is medically justified, proportionate, and regularly re-evaluated.

The evaluation elements require that the decision to isolate, taken by a psychiatrist and possibly accompanied by a prescription for restraint, be documented in the patient's record, specifying the monitoring methods. A psychiatric and somatic examination must be performed at the time of isolation. Isolation must take place in a dedicated space respecting privacy, dignity, and safety, with a means of calling for the patient if restrained. The nurse must monitor the patient's somatic and psychological state and document it. A clinical analysis must be offered to the patient upon release from isolation to prevent recurrence, and the team must analyze the clinical practice indicators related to isolation and restraint.

Criterion 2.4-02: The relevance and re-evaluation of antibiotic prescriptions

The fight against antibiotic resistance is a public health priority, and this mandatory criterion contributes directly to it. Compliance with good antibiotic therapy practices is essential to limit serious complications and prolonged hospital stays. The justification and systematic re-evaluation of antibiotic prescriptions are at the heart of this approach.

The evaluation elements verify that the hospital implements the key elements of a good antibiotic use program (policy, training plan, evaluation strategy). Practitioners must be trained in the proper use of antibiotics. Any prescription of antibiotics and its extension must be justified in the record. Practitioners must refer to a reference and be able to call on an antibiotic therapy referent. Prescriptions must be systematically re-evaluated between the 24th and 72nd hour. The OHT, the teams, the antibiotic therapy referent, the PUI (Pharmacy for Internal Use) and the microbiology laboratory must monitor antibiotic consumption and resistance.

Criterion 3.1-01: The deployment of a quality and safety of care policy by governance

This imperative criterion places the hospital's governance at the center of the approach to improving the quality and safety of care. The policy must set personalized objectives based on an analysis of all available data (patient perspective, indicators, risks). Its development, implementation, and evaluation must be participatory, involving management, the CME (Medical Establishment Commission), supervisors, professionals, the nursing care commission, and user representatives. It must be translated into a single, structured, relevant, and personalized action program.

The evaluation elements require that the CME develop and monitor the quality/safety policy with the stakeholders mentioned. The priority orientations must be based on an analysis of all indicators (QSCI, patient experience) and specific risks. The program for improving the quality and safety of care (PIQSC) must take into account the recommendations of other external evaluation authorities (ARS, ASN, CGLPL, ABM). This PIQSC must be structured, relevant, updated, unique, and evaluated annually. Management and professionals must know the main actions of the PIQSC concerning them.

Criterion 3.1-04: Promoting a culture of reporting adverse events

For a benevolent safety culture that analyzes error rather than condemning it, this imperative criterion calls on governance to actively promote the reporting of adverse events and near misses. Vigilance management and the analysis of AEAS (adverse events associated with care) are seen as opportunities for collective improvement in patient safety.

The evaluation elements require that serious adverse events associated with care be systematically analyzed with the teams concerned, according to HAS methods. A summary of the contributing factors and action plans must be disseminated to professionals and user representatives. SAEs must be systematically reported on the national reporting portal, with a part 2 within three months. The SAEs analyzed as part of the accreditation must be transmitted internally and their improvement actions contribute to the PIQSC. Professionals must be trained in announcing harm related to care.

Criterion 3.1-05: Mastering the management of exceptional health situations

This imperative criterion aims to ensure that the hospital is prepared to deal with exceptional health situations, i.e., events likely to cause significant hospital tensions. This involves identifying threats and implementing a graded management plan (level 1 for limited impact, level 2 or white plan for major impact). The white plan must provide for the activation of a crisis unit, the mobilization of resources, and communication.

The evaluation elements verify that the risk categories (including digital risks) are identified. The tension and exceptional situation management plan(s) must be developed collectively. The crisis unit must be operational within 45 minutes of the alert, with the necessary tools and procedures. Crisis management exercises and real activations must be followed by a feedback (RETEX) leading to improvement actions. The necessary material and human resources must be known and quickly mobilized, and their operational readiness verified. The professionals concerned must know the governance, the methods of alert and implementation of crisis plans.

Criterion 3.2-01: Ensuring continuity of care

Continuity of care is fundamental to ensuring that patients receive prompt and appropriate care at all times. This imperative criterion requires the continuous availability of medical and paramedical professionals, contributing to better emergency management and constant patient monitoring. It is based on rules of presence as well as a system of on-call duty ensuring the permanence of care 24/7.

The evaluation elements focus on the conformity of the medical and paramedical organization to the recommendations and regulations, guaranteeing adequate care. It is verified that caregivers can reach a doctor at any time. In addition, solutions must be mobilized in the event of unforeseeable absenteeism.

Criterion 3.3-05: Preventing avoidable transfers of elderly people

This imperative criterion aims to reduce avoidable visits to general emergency departments for people over 75 years of age. The hospital, in collaboration with its local partners (general practitioners, EHPAD, HAD), must formalize short circuits and/or implement telemedicine networks. The objective is to ensure adapted and coordinated care upstream, thus avoiding unnecessary and potentially harmful travel for this vulnerable population.

The evaluation elements require that specialty departments (cardiology, pulmonology, psychiatry, etc.) and geriatrics and emergency departments participate in the care of unscheduled elderly patients, with an organization of actors in place. Hospitals must identify referral hospitals to contact for advice, and have telemedicine tools (consultation and/or advice). Each specialty department must offer telemedicine solutions to local correspondents to avoid transfers. Specific indicators (number of visits to the emergency room by patients aged 75 and over, whether or not followed by hospitalization, length of stay PMSI MCO) must be measured, and the hospital must establish an improvement program based on these results.

Conclusion: Mandatory criteria, guaranteeing an unwavering quality culture

The imperative criteria of the HAS certification standards for healthcare establishments are not simply requirements to be ticked off; they embody the unshakeable foundations of a culture of quality and care safety in France. By focusing on such crucial aspects as respect for patient dignity and privacy, prevention of medication errors, management of life-threatening emergencies, adaptation of the environment for minors, and prevention of avoidable transfers for the elderly, these criteria push facilities to achieve operational and ethical excellence.

The fact that a negative evaluation on one of these criteria could potentially lead to non-certification highlights their role as an essential safeguard. They represent the red lines not to be crossed, the minimum commitments that any hospital must respect to ensure the safety and well-being of its patients.

Beyond compliance, the rigorous implementation of these mandatory criteria promotes a dynamic of continuous improvement, stimulating collective reflection, professional training, and the adaptation of practices to the best recommendations. They encourage a patient-centered approach, where the patient's experience and satisfaction are not only measured but actively taken into account. Finally, they strengthen team coordination and governance, creating an environment conducive to innovation and comprehensive, integrated care.