Standards have not the same effect on all of the primary activities in the hospital value chain. The specific impact and degree of impact of the standards is shown in Table 5. A “ no impact ” does not necessarily mean that standards have no effect on an indicator, but rather that the hospital’s performance has already improved through the use of the 2000 edition of the ISO 9001 and that the 2008 edition of the ISO 9001 contributed to maintaining the indicator at that level between 2010 and 2012 as no difference due to the transition to the new edition of ISO 9001 could be found.