Accreditation

Encouraging Benchmarking

Accreditation is an external review of quality with four principal components:

Examples of indicators from different accreditation evaluation methods
Inputs
  • Facilities
  • Equipment
  • Number and training of personnel
  • Stocks of materials
Outcomes
  • Incidence of infection
  • Number of procedures performed/year
  • Patient satisfaction
  • Continuity of care
  • Accuracy of physician diagnosis
Process
  • Documented procedures (eg how to check-in new patients or a list of screening questions for potential blood donors)
  • Chain of responsibility for all activities
  • Regular meetings to bring up and address quality issues

Accreditation provides achievable quality standards, supportive consulting, and benchmarking scores, all of which assist facilities to improve the quality of their operations. Accreditation is often confused with licensure and certification, however they are quite different. Think of a hotel:

Because accreditation, unlike certification, requires regular and process-focused evaluations that are participatory, accreditation is both times-taking and expensive. Provider accreditation initiatives were begun in India in the mid-2000s, and in New Jersey State, USA, in the late 1990s. Both attempts failed.

The complexity and expense of accreditation makes it applicable only for hospitals and large clinics.

Accreditation is usually based on voluntary participation by the facility, however in most successful cases, access to funding (insurance payments for example) are conditional upon accreditation, thereby providing a strong incentive for participation.

Strengths

  • proven track record
  • limited or one time subsidy
  • compares current practice with “best possible”
  • dynamic, adaptive to changing standards
  • focuses on processes and outcomes
  • stamp of quality provides incentive for participation

Weaknesses

  • needs an external payer
  • expensive for participating institution
  • time intensive
  • some institutions do not want transparency
  • most effective where strong regulation exists
  • not possible for individual providers
Another Point of View

high cost, questionable value

Accreditation is very attractive for developing countries, however there is little evidence that this model of external quality assurance can be applied in countries that do not have widespread insurance. in South Africa’s COHSASA has been very successful at promoting hospital accreditation for both private and public facilities, but they remain extremely expensive and very dependent on one charismatic leader. USAID’s attempts to develop accreditation programs in Zambia and elsewhere have failed due to the lack of guaranteed government funding or private financial payment mechanisms that would make participation valuable to the facilities targeted for accreditation.

Although gaining in popularity in middle income countries, and romantically talked about every four or five years for individual providers in India (before being quietly dropped), there is little reason to believe that accreditation will soon be a core part of quality improvement systems in low income countries.

Current Programs and Resources - Accreditation