The DDKM is based on announced surveys and the procedure of pre-announcing the dates for all surveys has been criticised for creating an "arranged reality" and for not reflecting the daily work with quality of care. This criticism is not unique to the Danish setting, but has been raised in a number of countries that operate accreditation systems based upon announced surveys (6,7). Another possible negative effect of announcing the surveys is the considerable amount of time and human resources that are used to prepare for the announced survey which implies that less time is available for patient care in the period of preparations (6). It has been proposed that unannounced accreditation surveys may be instrumental in alleviating these problems. An unannounced survey is an external visit paid to an organisation without prior notice of when the visit will take place (2).