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The purpose of this paper is to develop and describe the symbolic value of quality awards as a key indicator of recognition that public organizations have reached in the scope of quality management and continuous improvement.

The paper provides a description of the evolution of the three series of healthcare quality awards that have been held to‐date in one of the biggest regions of Europe: Andalusia.

Theoretical analysis of an instrument conceived as an institutionalised way of recognizing quality assurance initiatives in the Andalusian Public Health System. At the same time, the article focuses on the importance of using a reference model to ensure that the process of assessing the projects is systematic and rigorous and therefore stands as a guarantee of transparency within a public administration.

The ultimate outcome is dependent of the geographical context and the behaviours and perceptions of people that have participated as assessment panels.

The conceptual framework provides guidance on what methodology is used to assess the quality projects (process to allocate projects to assessment panels and assessment criteria required) in a complex healthcare system. It serves as a managerial framework to enhance the continuous improvement in all health‐related services.

The paper contributes to create a structured debate between researchers and healthcare leaders regarding the assessment criteria to evaluate healthcare quality projects.

This paper aims to describe the participation of health professionals as key agents for the successful definition of skills manuals supporting professional accreditation in Andalusia (Spain).

The increasing extent to which different stakeholders are recognized reflects the importance they hold in all decision‐making processes. The Andalusian Agency for Healthcare Quality's commitment to this process has facilitated the healthcare professionals' participation when professional skills manuals are designed for their respective specialities.

The process involved over 400 healthcare professionals from 58 disciplines between March 2005 and January 2008. Results were conditioned by several factors, some acting as drivers while others represented a barrier.

The experience relates to a specific geographical context. Healthcare professionals eligible to participate had to be in active employment and working for the Andalusian Public Health Service. There was an overrepresentation of members from scientific associations.

Co‐operation based on mutual trust is the essential ingredient accounting for the success of participative involvement.

The paper incorporates all categories of personnel and specialities in a regional healthcare system that covers eight million inhabitants and employs over 90,000 professionals, includes 33 public hospitals, more than 1,500 primary care centres and other healthcare units.