HAS itself  is monitored by ISQua (International Society for Quality in Health Care), an international body that overseas healthcare certifiers, including JCAHO, the accreditation body of American Hospitals.

HAS gained its second accreditation in 2014, while receiving  the maximum rating in 7 standards out of 10.

1. Rankings published in various media
2. Context of hospitals surveys and rankings

There are two key differences between the French and US:

1. 1. 1. In France advertising for healthcare providers of any kind is forbidden (doctors, hospitals, dentists, medical labs, etc.) Surveys are therefore conducted in total independence and providers have a vested interest in participating in order to appear in the results. Additionally, results are sponsored and published by highly popular print and TV media outlets.
      2. To complete their investigation journalists may request access to public data on hospitals operational statistics, such as those provided by PMSI
2. Methodology
   1. A questionnnaire is sent to hospitals. The weekly “Le Point” (?) sent over 1100 questionnaires and received more than 600 responses during the most recent survey.
   2. Questions are mostly about human and material resources available to the hospital to guarantee the required level of patient safety and quality of care. Assessments are specific to each medical specialty, such as surgery, cardiology or oncology, and associated medical services: reanimation for surgery of arteries, intensive cardiac care for heart attack cases, neuro-radiology, physiotherapy or speech therapy for brain strokes, rehabilitation medicine, psychological or psychiatrical care for multiple sclerosis, etc.
   3. The survey also relies on the access to the more than 25 million (and growing) anonymous medical records representing all hospitalized patients in the most recent year available, of which about 2/3^rd come from public hospitals and 1/3^rd from the private sector.
   4. This approach allows for a very fine analysis of medical and surgical services provided in each hospital. On a case by case basis additional information will complement the study: center of excellence for pulmonary arterial hypertension, center of reference for rare endocrinological diseases, directory of the society for infectious pathology, directory of the European federation for emergency services for the hand, annual report on organ removal and transplant, etc.

A series of criteria was then defined:

• Volume of services
• Notoriety
• Outpatient vs. Inpatient treatments
• Technological sophistication
• Laparoscopic surgery
• Severity index of treated cases
• Evaluation of mortality. Raw data relating to mortality have to be taken cautiously, in any country, as stated in a study published late 2017 by JAMA: the best hospitals, to which some desperate cases are transferred, might consequently show increased mortality rates because they are used as a last recourse by hospitals with fewer relevant resources for these grave cases.

Every piece of equipment, every specialist, available or missing, every criteria are allocated a specific weight and a grade on 20 is given to every hospital providing a specific medical service. The top performing hospitals are then included in the publication of the survey result with their ranking.

This criteria is relevant to assess state of the art practices that would leave the least possible sequels. These state of the art facilities often use laparoscopic surgery, preventing from opening through large cuts – a few “buttonholes” cuts being sufficient. Methods like these minimize pain in the days following surgery and greatly reduce scars. They are precursors to outpatient surgery.

1. Specific safety metrics, such as KPIs in place to prevent hospital-acquired infections,

Special attention is devoted in recent years to the fight against nosocomial infection vectors and each institution must contribute to an database called ICALIN (Composite index of activities in the fight against Nosocomial Infections). The results are published annually and a ranking is attributed (data validated by the ECDC (European Centre for Disease Prevention and Control, based in Stockholm).)

HAS makes the results of its monitoring public on a site (Scope santé), which everyone can access (some expertise is however needed to interpret the information). The results of the ICALIN study are also listed.