What are the types of hospital accreditation and the ONA levels?

Although it is not mandatory, hospital accreditation is increasingly valuable in the private healthcare environment. Besides being a concrete competitive edge and building the hospital’s reputation, it underpins value-based contracts, pay-for-performance models and financial sustainability strategies.

Hospitals operating on squeezed margins need to demonstrate care maturity, standardized processes and documentation traceability.

Given the different accreditation methodologies, it is essential to distinguish two concepts:
the types of accreditation in Brazil (the methodologies adopted) and the certification levels, which, in ONA’s case, structure the institution’s progression in three stages of maturity.

What is hospital accreditation?

Accreditation is a voluntary, periodic process conducted by an independent institution that assesses compliance with previously defined quality and safety standards.

It differs from the health license, which is mandatory and regulatory. Accreditation examines factors such as:

• clinical governance;

• risk management;

• patient safety;

• integration of care and administrative processes;

• organizational culture and continuous improvement.

By earning the seal, the institution demonstrates adherence to nationally or internationally recognized standards. In practice, this translates into:

• less variability in care;

• fewer adverse events;

• more consistent documentation;

• greater predictability in billing.

What are the three main types of hospital accreditation in Brazil?

In Brazil, there are three main types (methodologies) of accreditation: ONA, Qmentum International and Joint Commission International. Each has its own approval criteria. Among them, only ONA formally adopts a progressive three‑level structure.

1. National Accreditation Organization (ONA)

ONA is the Brazilian accreditation model and the most widespread in the country. Unlike the other methodologies, it structures certification in three progressive levels of organizational maturity, allowing the hospital to evolve gradually.

The model is divided into:

• Level 1 – Accredited: a focus on patient safety and compliance with basic structural and care requirements.

• Level 2 – Fully Accredited: an emphasis on integrated process management and systemic interaction between departments.

• Level 3 – Accredited with Excellence: a consolidated culture of continuous improvement, results assessment and mature governance.

Important technical note: ONA requires the institution to prove full compliance with the standards of each level in order to move on to the next.

2. Qmentum International

Qmentum is a methodology that originated in Canada and is applied in Brazil by IQG. What sets it apart is its strong emphasis on clinical governance and systemic risk management.

The assessment is structured around organizational standards and the so-called Required Organizational Practices (ROPs), which deal directly with:

• safe communication;

• infection prevention;

• safe medication use;

• safety culture.

The model favors leadership, team engagement and the analysis of critical processes. It is often chosen by hospitals that already have organizational maturity and want to move toward high‑reliability standards.

3. Joint Commission International (JCI)

JCI is the international division of the Joint Commission, the U.S. organization responsible for hospital accreditation in the United States. Its standards are revised periodically and applied globally.

Its standards emphasize:

• International Patient Safety Goals;

• correct patient identification;

• safe surgery;

• prevention of care errors;

• rigorous documentation traceability.

It is common in high-complexity hospitals, institutions with international operations or organizations seeking global recognition.

The process is detailed, involves an extensive on-site assessment and requires strong governance and documentation structure.

Which is the best model?

No methodology is superior in absolute terms. The choice depends on the institution’s level of maturity and strategic positioning. In addition, in ONA’s case, the institution also needs to define which certification level it intends to achieve.

In practical terms:

• Hospitals starting their journey usually pursue ONA Level 1.

• More structured institutions can move up to ONA Level 2 or 3, or opt for Qmentum.

• Organizations with an international strategy or a high degree of care complexity often choose JCI.

How does accreditation affect the revenue cycle?

Accreditation directly influences financial performance. Among the most frequently observed impacts are:

Fewer denials

Standardized protocols and consistent records reduce inconsistencies in the hospital claim.

Better negotiation with payers

Accredited hospitals have greater contractual leverage in pay‑for‑performance models.

Less waste in care

Defined processes reduce redundancies, rework and inappropriate use of resources.

Financial predictability

Structured governance increases control over operational and care indicators. Accreditation therefore brings together quality and economic sustainability.

The Rivio view

Obtaining any accreditation requires something fundamental: accurate, traceable data. There is no certification (whether ONA Level 3, Qmentum or JCI) without consistency between the medical record, clinical protocols and the hospital claim.

Rivio uses artificial intelligence to analyze care records and identify documentation inconsistencies, protocol deviations and denial risks before the claim is submitted. In this way, technology turns the pursuit of accreditation into a continuous operational routine, protecting the revenue cycle and sustaining high standards of quality of care.