File your evidence by section and element of NHRA's standards, start with the Required (REQ) and Essential (ESS) standards that set your category, and send it electronically before the survey. Documents created after the closing meeting are not accepted, so the evidence has to exist before the surveyors arrive.
How evidence becomes a score
Surveyors rate each standard from the documentation and evidence they verify in interviews and observation. Fully Met means every requirement is implemented and consistently maintained, Met is 70 to 99%, Partially Met 30 to 69% and Not Met under 30%.1 The category comes from the REQ and ESS scores, and the share of Enhanced Quality Practice (EQP) standards achieved is reported in the award letter.1
| Category | Share of standards achieved |
|---|---|
| Diamond | 95% or above |
| Platinum | 90% to 94% |
| Gold | 80% to 89% |
| Silver | 70% to 79% |
How the standards are built
The hospital standards hold 41 elements in 8 sections, with the first five core for every hospital. The centre standards hold 29 elements in 7 sections, with the first three core for every centre.2 Key indicators are requested for each element. They stay out of the final report, and surveyors use them to question more deeply.1
| Hospitals, 8 sections | Medical centres, 7 sections |
|---|---|
| Management and Leadership | Management and Leadership |
| Governance | Governance and Safety |
| Health and Safety | Patient-Centered Care |
| Management of Property, Estate and Non-Clinical Services | Diagnostic and Support Services |
| Patient-Centered Care | Acute Services |
| Diagnostic and Support Services | Specialist Services |
| Acute Services | Therapies |
| Specialist Services |
- Build the index. One line per element and standard, with its tag and the evidence that proves it.
- Start with REQ and ESS. These set the category, so close their gaps first.
- Use live records. Pull evidence from the systems staff use every day, for a stated period.
- Gather the indicators. Have the key indicators for each element ready for the surveyors' questions.
- Submit before the visit. Electronically, keeping confidential documents for the survey room.
- Keep the plan running. After the award, update the Quality Improvement Plan and send it to NHRA every year.
- Section ______ Element ______
- Standard ______ Tag REQ, ESS or EQP ______
- Evidence ______ Period covered ______
- Owner ______ Submitted on ______
- Self-rating ______ Action needed ______
What surveyors will not accept
After the closing meeting the facility may email documents that were missing or not shown, by 5 pm that day, to accreditation@nhra.bh. Newly established documents and corrective actions taken in response to the surveyors' feedback are not accepted, and the recommendation stays in the report as observed.1
Questions
Which standards decide the category?
The Required (REQ) and Essential (ESS) standards. EQP standards are reported as a percentage in the award letter.
Can we send documents after the survey?
Only documents that already existed and were missing or not shown, by 5 pm on the day of the closing meeting.
Do indicators count in the score?
No, NHRA uses the key indicators to inform the surveyors' questions, and they are left out of the final report.
Sources
- 1National Health Regulatory Authority, 2026NHRA Accreditation Policy V3.0, issued 7 April 2026Read source
- 2National Health Regulatory Authority, 2026Tackling the Accreditation Process (4 years cycle), Accreditation & Quality GroupRead source
Written by the wai team from National Health Regulatory Authority guidance, checked on 16 October 2026. This is guidance, not legal advice. NHRA does not endorse wai or any software.