PSFHI Assessment Process — Complete Overview

The Patient Safety Friendly Hospital Initiative (PSFHI) is led in Egypt by WHO Egypt in partnership with the Ministry of Health and Population. Based on the WHO framework launched in 2011, it provides a comprehensive set of standards — the Patient Safety Friendly Hospital Framework (PSFHF) — through which hospitals can assess and improve the safety of care they deliver.

The assessment process is a voluntary, supportive peer review — not an audit or accreditation exercise. The focus is on continuous improvement, capacity building, and collaborative learning. Hospitals are scored against all 134 criteria, and their performance determines a certification level (1–4).

The 3rd Edition (2020) updates the criteria to align with current best practice and WHO guidance. It applies to all hospitals — public or private — and uses a peer review methodology triangulating three sources of evidence: documents, interviews, and direct observation.

The PSFHF is organized into 5 domains. Each domain contains several standards, each with a set of criteria that are individually scored. Each criterion may have Measurable Elements — granular evidence points that help assessors determine the correct score.

Source: WHO Patient Safety Assessment Manual, 3rd Edition — Table 1

Each of the 134 criteria is classified as Critical, Core, or Developmental. This classification is fixed — it is a property of the criterion itself, independent of which domain or standard it belongs to.

Each criterion receives a single score per assessment. The PSFHI uses a 3-point rating scale plus Not Applicable. Ratings are agreed by the whole survey team and based on evidence from three sources: documents, interviews, and observation.

Source: WHO Patient Safety Assessment Manual, 3rd Edition — Table 4

The digital platform calculates scores in real time as each criterion is scored. Two parallel aggregation paths run simultaneously:

Path 1 — Hierarchical (structure-based):

// Each criterion scored →
ME Scores (avg, optional)
      ↓
Criteria Score  [0 / 0.5 / 1 / NA]
      ↓  avg of applicable Criteria (excl. NA)
Standard Score  [0–100%]
      ↓  avg of applicable Standards
Domain Score    [0–100%]  ×5 domains
      ↓  avg of applicable Domains
Hospital Overall Score  [0–100%]

Path 2 — Cross-cutting (by criteria type):

All 25 Critical Criteria  →  Critical Score      [0–100%]
All 94 Core Criteria      →  Core Score          [0–100%]
All 15 Developmental      →  Developmental Score [0–100%]

// Each = avg of applicable criteria of that type across ALL domains
// NA criteria excluded from numerator and denominator

Why two paths? The hierarchical path gives the structural breakdown (how well is Domain C performing?). The cross-cutting path answers the certification question (have all Critical criteria been met?). Both update live on every score entry.

The percentage compliance for Core and Developmental criteria is calculated as: sum of all applicable scores ÷ maximum possible score (number of applicable criteria × 1). For example: 3 criteria scoring 1, 0.5, 0.5 → total 2.0 ÷ max 3.0 = 67%.

Achievement is assessed in three stages: (1) Have all Critical criteria been met? (2) What is Core compliance? (3) What is Developmental compliance?

Source: WHO Patient Safety Assessment Manual, 3rd Edition — Table 5

Scores must be based on evidence from at least three sources. The PSFHF uses a peer review — not an audit — so the survey team uses experience and judgment to triangulate findings. Ratings are agreed by the whole team.

The PSFHI Digital Assessment Tool replaces the paper-and-Excel workflow end-to-end. Here is how to use it across the three assessment phases.