Table 2 Key principles from the experience in Thailand in how to create a culture of continuous quality [23]

I.

Describe the ingredients needed in the early days to start on the right path

II.

Work closely with professional associations (with roles of setting guidance, giving advice, and information sharing)

III.

Demonstrate benefits of accreditation and quality improvement for staff

IV.

Make it voluntary. Offer opportunities for doctors and hospitals to participate; don't tell them that it is mandatory.

V.

Focus on coaching/learning, not inspection/audit. Don't focus too much on pass/fail, but instead, what needs to be done to improve.

VI.

Focus also on knowledge activities (e.g., large Thai annual quality educational meeting).

VII.

Use recognition of hospital staff as well as offer opportunities to optimize their potential.

VIII.

Make it fun, inspiring!

IX.

Have payer organizations provide incentives (e.g., health insurance and social security pays more to accredited hospitals).

X.

Treat the organization/hospital as living system - self-organizing, learning.