National Strategy for Quality in Health ''Estratégia nacional para a Qualidade na Saúde 2015-2020'', available at https://www.dgs.pt/qualidade-e-seguranca/estrategia-nacional-para-a-qualidade-na-saude.aspx; The certification of health units in Portugal is part of the National Strategy for Quality in Health, within which the National Health Accreditation Program (PNAS) is established. The certification of health units is an attribution of the Department of Quality in Health (DQS) of the Directorate-General for Health (DGS) and is based on health quality references of the Agencia de Calidad Sanitaria de Andalucia (ACSA), which naturally obey the guiding principles of ISO. The adoption of standard manuals allows health units to increase levels of effectiveness (effectiveness) and efficiency (optimization of the use of available resources), contributing to the strengthening of their capacity to provide services oriented to the citizen/user, within the parameters they propose, in a consistent and continuous manner over time and optimizing their cost.