GHSH · Standards

GHSH Standards

GHSH operates as a Hub of the Hubs — the missing link between global norms adopted by states and the national and sector hubs that must make them work in practice. Our standards family does not replace national standards. It defines what makes a hub credible, how equivalent standards recognise one another across borders, and how the results of the whole network are measured on shared data.


The four-layer architecture of trust

Global health has two layers that do not meet. At the top, WHO and the World Health Assembly set norms addressed to states, and the World Health Summit sets the agenda that connects science, policy and industry. At the bottom, national and sector hubs and their providers deliver actual care. GHSH exists as the meta layer between them.

Normative — WHO / WHA

Norms, resolutions and strategies addressed to states. GHSH translates them into operational requirements through published matrices.

Agenda — World Health Summit

Agenda, theories of change, declarations and policy briefs. GHSH operationalises the topics and contributes to the academic layer.

Meta — GHSH, Hub of the Hubs

Standards for hubs, mutual recognition and a shared scoreboard. This is the layer where the GHSH standards family sits.

Operational — providers and pathways

Providers, facilitators and payers. GHSH reaches this layer only through hubs, never directly, which protects both scalability and neutrality.

Who we federate: national medical-service export agencies and programmes, national hospital federations, medical travel clusters and platforms, national observatories and registries, sector skills councils, and accreditation bodies open to mutual recognition.


Standards register

One register, one status per standard, one named owner. Nothing on this page is presented as approved, endorsed or recommended by WHO or by the World Health Summit.


GHSH-HUB — the Credible Hub Standard

Eight domains define what separates a credible hub from a marketing front for one interest. The requirements below are directional; the full version — measurable elements, non-conformity categories and transition periods — is being built together with the first pilot cohort.

D1 · Governance and neutrality

Separation of management and supervisory functions, disclosure of funding sources, and represented stakeholders: payer, providers, patients and the social side. Anchor: governance good practice, FENSA-compatible.

D2 · Promotion separated from assessment

No commission from patients on the assessing side, a public conflict-of-interest register, and paid visibility kept strictly apart from quality status. Anchor: constitutional principle of GHSH.

D3 · Data and registry

A registry of entities and episodes with published methodology, explicit flagging of estimates, and an annual results report to the Observatory. Anchor: GPW14 logic of measurable targets.

D4 · Quality and patient pathway

A provider standard adopted by the hub — its own or recognised through MRA, for example TQAMS — a complaints mechanism for international patients, and a discharge plan with continuity of care after return. Anchor: Global Patient Safety Action Plan 2021–2030 and the people-centred services framework.

D5 · Workforce and recruitment ethics

Alignment with the Global Code of Practice on International Recruitment, staffing guarantees, and monitoring of the impact of service exports on domestic waiting lists as a reported KPI. Anchor: WHA63.16 and social dialogue.

D6 · Resilience and continuity

Business continuity and disaster recovery at hub level, a continuity requirement for members, and cross-border care procedures for emergencies. Anchor: International Health Regulations and Health EDRM.

D7 · Digital maturity and patient data

Interoperability on HL7 and DICOM, portable bilingual documentation, and a cyber minimum; compliance with the hard law of the jurisdiction — in the EU, GDPR, NIS2 and EHDS. Anchor: Global Strategy on Digital Health 2020–2027.

D8 · Climate and environment

An environmental policy at hub level, footprint reporting, and a supply-chain decarbonisation plan. Anchor: ATACH and COP26 health commitments.


GHSH-MRA — mutual recognition

This is the core of supranational standardisation as GHSH understands it: we do not unify national standards, we recognise their equivalence. One credible signal of trust for the patient and the payer, instead of a race between competing certificates.

Equivalence table

The GHSH standards committee maintains a public mapping of each national or sector standard against GHSH-HUB requirements, in the form requirement → equivalent → gap → condition of recognition.

Passporting

A certificate issued in hub A — for example TQAMS in Poland — is recognised by hub B within the scope of established equivalence.

Joint audits

Cross-audits between two hubs against a shared protocol, used both to build trust and to develop a pipeline of qualified auditors.

Alignment as an entry condition

Only standards that carry a published WHO matrix are eligible for recognition. No matrix, no MRA.


GHSH-OBS — the shared scoreboard

A minimum data dictionary and indicator methodology reported by hubs to the Health Systems Observatory. The Observatory publishes an aggregate report for the whole network — a product no commercial accreditor offers.

Shared definitions

Agreed definitions of an episode, an international patient and an adverse event, so that numbers from different hubs can actually be compared.

Frequency and disclosure

Reporting frequency, rules on publication and anonymisation, and mandatory flagging of estimates against measured values.

Annual network report

Indicators mapped onto the GPW14 and Triple Billion logic, published ahead of the annual summit cycle.


Operational layer — standards a hub can adopt off the shelf

Young hubs should not have to invent a provider standard from scratch. These methodologies already exist, are already audited in practice, and can be licensed by a hub instead of rebuilt. Owner and status are stated for each.

TQAMS — Transborder Quality Audit of Medical Services

A certification system for standardising the quality of cross-border medical services, owned by HCPL through its Centre for Audit and Certification. Four stages, with annual surveillance and recertification every three years.

Stage I · Gap analysis

Review of organisational documentation, formal registration, infrastructure, staff language competence, availability of consultations and bilingual records. Result: a gap report with a corrective action plan.

Stage II · Implementation

A dedicated unit for cross-border care, operating procedures, staff training, bilingual documentation, a pricing system and continuity-of-care safeguards. Result: a facility ready for audit.

Stage III · Certification audit

Documentary audit plus an on-site visit using tracer methodology, verification of infrastructure and competence, patient interviews where possible, and review of emergency procedures.

Stage IV · Surveillance

Annual surveillance audits, KPI monitoring, verification of continued compliance, and recertification every three years.

Requirement domains covered by the standard:

  • Organisation and infrastructure — a dedicated unit not simultaneously delivering publicly contracted care, entry in the provider registry, single rooms with sanitary facilities, a dedicated operating theatre for surgical services, and access to laboratory and imaging diagnostics.
  • Staffing — compliance with guaranteed-services requirements, mandatory English at minimum B2 for physicians, specialist consultations available in English, at least one English-speaking nurse per shift, and photo identifiers with roles in English.
  • Medical documentation — bilingual questionnaires, procedure information sheets, consents describing the procedure, extended consents, discharge summaries and diagnostic reports, plus a patient rights charter, unit rules and a price list covering all procedures and complications.
  • Quality and safety — compliance with Directive 2011/24/EU including continuity of cross-border care and complaint handling with alternative dispute resolution, cybersecurity and continuity under NIS2, and environmental performance under ESG.

CAC Baseline — good governance minimum requirements

The minimum a hospital should meet to be considered a stable, predictable and well-governed institution. Seven domains, applicable to members of any hub, and the natural companion to GHSH-HUB domain D1.

  • Ownership supervision — stakeholder mapping, market communication, and evaluation of the supervisory board.
  • Management — strategic, operational, process, project and service management, with risk management and quality management as distinct disciplines, plus IT, human resources, occupational health and safety, and medical logistics.
  • Fair selling — transparent commercial practice towards patients and payers.
  • Compliance — identification of applicable law, norms and standards, management of non-compliance risk, whistleblower protection, ethics, anti-corruption, and an anti-mobbing framework.
  • Workforce and intellectual capital — competence management and knowledge retention.
  • Environmental sustainability — environmental management and ESG reporting.
  • Supply chain — fair procurement, value-based procurement, open supplier relations, external communication on purchasing, and third-party risk management.

Provider Trust Score — five-pillar readiness rating

A rating of systemic readiness, not a clinical ranking: it does not score treatment outcomes. Each pillar produces a score from zero to five, aggregated into a Trust Score from zero to twenty-five and displayed as a radar chart on the provider profile.

6–10

Bronze

Registered, development required before international patients are accepted.

11–15

Silver

Ready for cross-border patients within the European Union.

16–20

Gold

Full international readiness across global markets.

21–25

Platinum

Reference provider for the GHSH network.

The five pillars: legal status and accreditation; international patient readiness assessed against TQAMS; cybersecurity and data protection assessed against NIS2 and GDPR; digital and European Health Data Space readiness including HL7 FHIR, the International Patient Summary and MyHealth@EU; and ESG performance. A score of five or below means the provider does not qualify for the registry.

Just Council Standard for AI — in development

An ethics and Just Culture code for the use of artificial intelligence in care settings, drafted by HCPL, promoted internationally by GHSH and carried in Poland by the Polish Hospital Federation. Three principles are already agreed; the full text is in consultation and no certification is offered against it yet.

  • Every communication generated by an AI system is labelled as such, in the same way a quotation is attributed.
  • Patients and staff are informed whenever AI is used in a process that concerns them.
  • Each deployed assistant publishes an open register of the sources it draws on.

How our standards are anchored — the matrix rule

Every GHSH requirement is traceable to an instrument that states have already adopted. The rule admits no exceptions: no claim of alignment is published without an annex mapping requirement to instrument to the method of verification in audit. A claim without a matrix does not exist in our register.


Boundaries — what GHSH is not

Assessment functions — accreditation, audit and mutual recognition — are organisationally separated from promotion and matchmaking. No assessing function takes a commission from a patient or from a transaction. We apply domains D1 and D2 to ourselves before we apply them to anyone else.


Accession and accreditation pathway

The same five steps apply whether a ministry, a national federation or a sector cluster is joining. No step is skipped and no status is promised that the GHSH statute does not provide for.

1

Letter of intent

An invitation or letter of intent handled on the GHSH side by the President.

2

Qualification meeting

Sixty minutes covering objective, mapping of what your organisation already does, alignment, governance, intellectual property and data, decision and dated next steps. Without three outcomes — qualification, partnership level and three joint initiatives — the meeting is not considered complete.

3

Partnership level

Selection of a level in the logic of what you bring, what you receive, what you decide and what you commit to.

4

First twelve months

A recommended start with the satellite account and registry work, two services from the relevant segment of the catalogue, and a joint white paper as the shared product.

5

Annual review

Results feed the Observatory report ahead of the annual summit cycle, and the programme is adjusted after each edition.


Service catalogue — scopes of operationalisation

The catalogue follows one principle: subsidiarity. GHSH does not deliver services locally. It sets standards, licenses methodologies, accredits and audits hubs, and keeps the shared scoreboard. Delivery belongs to hubs and their partners. Every service carries a normative anchor, so a client is not buying consultancy — they are buying the operationalisation of commitments their state has already accepted.

For states and administrations

National hub blueprint; WHO alignment review; satellite account and export registry; payer desk and contracting framework; regulatory and operational sandbox for health innovation; systemic resilience for hospital networks; workforce and mobility ethics; health diplomacy and international presence.

For hubs and their members

GHSH-HUB accreditation; off-the-shelf methodology licences; mutual recognition preparation and equivalence assessment; audit package for member entities; implementation of the international patient pathway; living lab and innovation pilots; train-the-trainer education for hub staff.

For individual companies

Facilitator certification across fifteen domains; preparation for conformity assessment under MDR, IVDR and the AI Act; clinical and organisational pilots inside the network; sandbox for AI and digital products; soft landing through the hub network.

For global players

Strategic partnership and five working groups covering patient safety, digital health, climate, workforce and resilience; mutual recognition for accreditors and networks; Observatory data services; multilateral care corridors; insurance products tied to the standard; a shared agenda across the WHO and summit cycles.

Detailed scopes, deliverables and normative anchors for each service are available from the Secretariat on request. International pricing is under development; national reference levels exist and are disclosed during the qualification meeting.


Roadmap for the standards family

0–6 months

GHSH-HUB moves from v0.1 to v1.0 with measurable elements and non-conformity categories; HCPL acts as the founding hub of the pilot; the communication glossary is fixed and WHO matrices are published for TQAMS and the PET/CT modality standard.

6–18 months

GHSH-HUB is piloted with two to three additional hubs recruited through the network, the first mutual recognition equivalence table is published, and the Observatory begins receiving data.

18–36 months

First mutual recognitions are granted, the public register of hubs goes live, and the standards family is prepared against the requirements of an international standard-setting accreditation body as a second, methodological anchor of credibility.


Take part

Every standard in this register is open to comment before it is finalised. Drafts, matrices and the full service catalogue are released on request, and the standards committee reviews the register after each annual summit cycle.

Comments on drafts and requests for the standards register: standards@ghsh.org. Applications for hub accreditation, audits and certification: certification@ghsh.org. General institutional enquiries: secretariat@ghsh.org. Government briefings: gov@ghsh.org.

Register version: GHSH-HUB v0.1 · GHSH-MRA v0.1 · GHSH-OBS v0.1 · TQAMS in force · CAC Baseline in force. Last review: August 2026. Working drafts are issued for consultation and are not a basis for any claim of certification until marked LIVE in this register.


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