There is a wide consensus that an external review mechanism, both in the fo
rm of a peer review, accreditation and certification according to the ISO 9
000 series, is more than its standards. The survey process, the role of ins
pectors and standard interpretation contribute to the essence of the progra
mme itself. Above all, the criteria used for the selection, training and ap
praisal of inspectors are of paramount importance. While the ISO norms do n
ot require certification bodies to employ "peer reviewers" for the healthca
re sector, experience in this sector is the main criterion for recruiting i
nspectors in accreditation and peer review programmes. However, the ISO/IEC
Guide 58, for the setting up and operation of a laboratory accreditation b
ody, specifies that inspectors should have appropriate technical knowledge
of the specific calibrations, tests or types of calibration or tests for wh
ich accreditation is sought. Training, updating and assessment of inspector
s are clearly defined under ISO, but are also systematic under accreditatio
n programmes. Part-time inspectors who are professionals currently practisi
ng in a healthcare facility and are in touch with the day-to-day work reali
ty are preferred for accreditation programmes which have self-regulation, e
ducation and quality improvement as their main concerns, while full-time an
d external inspectors are used in external review mechanisms with registrat
ion and certification as their main concerns. As well as harmonising the st
andards for accreditation, it is important to obtain consensus on the crite
ria to use for the selection, training and assessment of inspectors in orde
r to ensure that different national or international programmes gain mutual
recognition. (C) 2001 Elsevier Science B.V. All rights reserved.