Accreditation is an external review of quality with four principal components:
- It is based on written and published standards
- Reviews are conducted by professional peers
- The accreditation process is administered by an independent body
- The aim of accreditation is to encourage organizational development.
Examples of indicators from different accreditation evaluation methodsInputs
- Number and training of personnel
- Stocks of materials
- Incidence of infection
- Number of procedures performed/year
- Patient satisfaction
- Continuity of care
- Accuracy of physician diagnosis
- 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:
- Licensure is the government permission to operate the hotel: it is safe, registered with the government as a business, pays taxes, and free of vermin.
- Certification tells you that the hotel has been approved by some external body: Certified for Quality by the American Automobile Association is a common 'mark of excellence'.
- Accreditation tells you how well the hotel compares to other hotels. All are certified, but a one star hotel has a dining room and phones in the bedrooms. A two star hotel has that plus private bathrooms attached to rooms. A three star hotel has that plus 24-hour room service and a bellman who can carry your bags to the room. etc. Certification tells you all these hotels are legally allowed to operate. Accreditation, the stars, tells you, and the hotel management, how well each hotel does compared to other hotels.
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.
- 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
- 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.