The Imperative Criteria of HAS Certification: Why They Decide Everything

In the certification framework for French health-care establishments, not all criteria are equal. Some are assessed within a whole, where a weak point can be balanced by a strong one. Others are not: these are the imperative criteria, and they decide the essentials.

The 6th cycle, applicable to visits from September 2025, raises their number from seventeen to twenty-one. Four further requirements therefore switch from a logic of progress to a logic of threshold. For a quality director, that is not a nuance of vocabulary.

Three levels of requirement, only one that does not forgive

The 6th-cycle framework contains one hundred and eighteen criteria, across three chapters — the patient, the care teams, the establishment — and twelve objectives. Those criteria are distributed over three levels:

Level	What it means
Imperative criterion	Non-negotiable requirement for patient safety; does not offset
Standard criterion	Requirement expected of every establishment, assessed within a whole
Advanced criterion	Requirement rewarding the most committed establishments, not expected of all

Almost all criteria are standards. Advanced ones are few. The imperative ones are those whose failure weighs most directly on the final decision.

What “does not offset” means in practice

An establishment can show a perfectly respectable overall picture — engaged teams, improving indicators, structured quality governance — and see its decision downgraded because one imperative requirement is not met.

This is the point management teams often take on board too late. The intuitive logic of “we are good overall” does not apply to this subset. An imperative is a threshold: it is crossed or it is not.

The consequence is methodological, and simple: imperative criteria must not be buried in the annual quality plan. They deserve a separate dashboard, tracked at management level, with a named owner per criterion.

The method: three moves

First move — map. Rebuild the list of imperative criteria applicable to your scope from the official framework published by the HAS. That list depends on your activities: an acute-care establishment, a psychiatric establishment and a home-hospitalisation provider are not exposed to the same requirements in the same way.

Second move — look for the evidence, not the procedure. This is the nuance separating effective preparation from expensive preparation. On an imperative criterion, the question is not “do we have a protocol?” but “what proves it is applied, by everyone, including at night, at weekends and under pressure?”. A perfectly drafted procedure unknown to the night teams does not survive a patient tracer.

Third move — dry-run it. An internal assessment run on an imperative criterion using the visit’s own method — patient tracer, targeted tracer — beats ten preparation meetings. It is also the only reliable way of finding gaps while there is still time to fix them. We set out those methods in our guide on the HAS certification visit and its five assessment methods.

The trap of the criterion “handled on paper”

There is a way of failing an imperative criterion while believing you have handled it: producing the expected document without changing practice.

The mechanism is familiar to every quality scheme. You identify the requirement, draft the procedure, circulate it, tick the line. Nobody is lying; simply, nothing has moved on the ground. And external assessment does not assess the ticked line.

The literature on hospital accreditation describes this risk precisely. The systematic review by Brubakk and colleagues, published in 2015 in BMC Health Services Research, underlines how hard it is to establish a robust link between accreditation and improved outcomes, and counsels caution about the effects expected of such schemes (see the study). The interrupted time series analysis by Devkaran and O’Farrell, published the same year in the same journal, adds a frequently cited complement: measured performance on quality criteria varies with position in the accreditation cycle, with a preparation effect ahead of the visit (see the study).

In other words: the spike of effort before the visit is a documented phenomenon. An establishment that works its imperatives only in the months before the deadline gets a flattering snapshot and returns to where it started. That is not a fatality, it is a steering choice.

What changes between seventeen and twenty-one

Four more imperative criteria means four subjects on which the establishment no longer has room to offset. Three reflexes are called for when moving from one cycle to the next:

1. Compare the two lists. Newly imperative criteria are, by definition, subjects the establishment had been handling in standard mode. That is where the nasty surprises hide.
2. Check how far back the evidence goes. A criterion that becomes imperative often calls for traceability that cannot be improvised — a history, a periodicity, minutes. If the evidence must span several months, you must start several months ahead.
3. Reallocate resources. A dashboard of imperatives with no dedicated working time is a wish. Going from seventeen to twenty-one criteria has to show up in the trade-offs, not only in the slides.

The general context of the 6th cycle — framework structure, stated priorities, what does not change — is set out in our article on the HAS 2025 framework.

Take action

If you do one thing this year, do this one: pull out the list of the twenty-one imperative criteria applicable to your scope, assign an owner to each, and set for each the evidence expected rather than the procedure to be drafted. Then check, through an internal assessment run with the visit’s own methods, that this evidence genuinely exists on the ground. For the whole scheme — legal obligation, visit methods, decision levels, four-year cycle — see our guide to HAS certification of health-care establishments.