Definition
The general definition of the term accreditation encompasses the process of granting credibility, authority, or rights. In health care, accreditation involves the evaluation of healthcare organizations to identify whether they meet the various standards and regulatory requirements set by an authorized accrediting organization (Mumford et al., 2013). Therefore, for instance, an accredited hospital is one that has evaluated itself and received an external evaluation from peers, and has been proven to adhere to the standards of a higher authority with the aim of continuously improving healthcare provision. Other healthcare organizations that may seek accreditation include behavioral health facilities, nursing homes, home care providers, and in-office surgery centers (Mumford et al., 2013).
In the U.S, the Accreditation Commission for Health Care (ACHC) and the Joint Commission, the Healthcare Facilities Accreditation Program (HFAP) are among the major health care accrediting organizations (Bender et al., 2014). Accreditation by the Joint Commission is a significant milestone for healthcare facilities due to the group’s diverse selection of surveyors from various health care segments to help carry out an extensive evaluation of a center by a surveyor with adequate knowledge of the facility’s area of specialization.
The Joint Commission surveys all accredited healthcare organizations and laboratories on a thirty-nine-month and two-year basis respectively. The commission also carries out a certification of its surveyors to ensure that healthcare organizations are accredited through a standardized procedure (Thompson, 2013). Additionally, the commission sets standards for various programs to ensure that each accreditation survey is appropriate for a particular industry. Accreditation can be carried out by state agencies or by professional organizations that are formed by experts in the various health care segments.
Some of the agencies that perform the accreditation surveys include the American Accreditation HealthCare Commission/Utilization Review Accreditation Commission (AAHC/URAC), the National Committee for Quality Assurance (NCQA), the Accreditation Association for Ambulatory health care (AAAHC), the American Medical Accreditation Program (AMAP), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The organizations have unique management structures based on their missions, compositions, and activities. Each develops its accreditation criteria based on its area of interest within the larger health care system. In the recent years, there has been a shift from the process and structural evaluations to outcomes evaluations to improve healthcare delivery (Mumford et al., 2013).
Difference between Accreditation and Licensure
According to Bender et al. (2014), accreditation is the process of evaluating a health care provider’s overall performance to ensure that there is proper care provision. Licensing involves the granting of permissions or rights to an organization or an individual to carry out a particular activity after meeting some preset obligations. In health care, licensing may involve the awarding of permissions to an organization or individual to undertake certain medical care procedures, the granting of permissions to issue certain prescriptions, or the rights to sell products on behalf of another organization. The licensee is usually granted the permission to engage in the activity for a limited duration after which the license may be renewed (Bender et al., 2014). Licensing is done to ensure that the licensee meets the minimum requirements stipulated by the various health oversight organizations for better health care provision.
Thompson (2013) notes that the licensing process requires the licensee to meet various requirements that are largely based on health care knowledge and skills. In the health sector, many requirements involve the regular completion of tests and exams by the licensee to facilitate the maintenance of a license. Normally, professional organizations are more involved in activities that enhance the value of the license as opposed to issuing the licenses. Such activities include liaising with the concerned licensing agencies and promoting the license.
The primary difference between accreditation and licensing is that accreditation affirms that the accredited party can provide healthcare services as stipulated by an oversight body. Licensing, on the other hand, is the granting of permission to an individual or organization to participate in a particular activity for a certain period. Additionally, while accreditation is only possible for a program or an institution, licensing is only possible at an individual level (Zima, 2017). For example, a health facility can get accreditation, but an individual health practitioner cannot get accredited. Similarly, a health care facility seeking a license can only do that as a single entity and not on a departmental or personnel basis. Another difference is that while accreditations are recognized countrywide, licenses are usually granted at a state level (Zima, 2017). Therefore, a practitioner who is licensed to operate in one state can only work in the defined state and may need licensing from other states to work there.
The History of Accreditation in the United States
Healthcare accreditation in the U.S has involved various professional organizations, government agencies, and commissions. Other stakeholders have been corporations, insurance companies, and the market. The accreditation efforts started as quality control efforts to guarantee the provision of standardized health services across the U.S (Thompson, 2013). In the recent years, accreditation has diversified to include the establishment of performance guidelines for hospitals and health practitioners. By the beginning of the 19th century, the medical sector was unregulated, and most products and services were of poor quality. At the time, medical products and education were under the control of the same organizations that manufactured the medicine or other for-profit entities that collaborated in providing unregulated care.
In 1847, the American Medical Association (AMA) was founded to oversee the improvement of health services. By 1910, reports indicated that major hospitals and medical schools around the country were in deplorable conditions. Other concerns raised by stakeholders were the need to make follow ups on patients to establish whether the care given to them was effective and the need to improve the deplorable conditions witnessed in many health facilities. In 1917, for example, the American College of Surgery established its Hospital Standardization Program to implement the recommendations of the stakeholders (Zima, 2017).
The first major standards to be applied in regulating the health care industry comprised of five points known as minimum standards (Bender et al., 2014). The standards focused largely on the provision of care within the hospital the organization of hospital medical staff, the maintenance of records detailing the history, examination, and laboratory results, the creation of rules and regulations to guide clinical reviews and call for frequent staff meetings, They also entailed the limiting of membership to competent, educated, and licensed surgeons and physicians, and the creation of regulated diagnostic and treatment facilities, including laboratories and radiology sections.
In the early 1950s, the American College of Surgeons joined other organizations such as the American Hospital Association, the American College of Physicians, and the American Medical Association to form the Joint Commission on Accreditation of Hospitals, later known as the Joint Commission. The organization abandoned the five-point minimum standards in 1966 in favor of the achievable standards approach that is used to-date in response to the changing healthcare regulations.
Current and Future Challenges with Accreditation
According to Zima (2017), predicting the results of regulatory reforms such as accreditation remains a significant challenge for the accrediting organizations. The healthcare workforce is subject to a myriad of issues that can create challenges for the accreditation process either in the short- or long-term. Therefore, the accreditation process should consider the impacts of its activities on the current and future health care personnel.
Currently, the accreditation process involves the collection of feedback by surveyors and government agencies to assess the adherence to standard practices and procedures. However, there are issues regarding the transparency of such undertakings with some organizations leveling antitrust lawsuits against the accrediting agencies (Mumford et al., 2013). For example, the failure to pass an accreditation may cause the affected party to establish lawsuits that consist of experts and players in the healthcare sector. Despite being a current case, such lawsuits tend to drag for long thus affecting the productivity of the affected parties such as physicians, nurses, and other stakeholders. Consequently, the outcomes create detrimental impacts on the future of the accreditation process. For example, the long duration taken by the Joint Commission between the surveys could affect the level of trust that individuals have in a facility.
Additionally, the fast-evolving technology requires a speedy adoption and implementation procedure to ensure that practitioners and patients benefit from the advanced technologies (Bender et al., 2014). However, the failure to acquire or understand the new advancements could imply that a facility cannot receive accreditation. Therefore, it is crucial to ensure that the process follows balanced criteria that encourages the use of the available resources in addition to seeking accreditation and that all deserving health centers and personnel are recognized to enhance trust between the various stakeholders.
References
Bender, K., Kronstadt, J., Wilcox, R., & Tilson, H. (2014). Public health accreditation addresses issues facing the public health workforce. American Journal of Preventive Medicine, 47(5), S346-S351. http://dx.doi.org/10.1016/j.amepre.2014.07.020
Mumford, V., Forde, K., Greenfield, D., Hinchcliff, R., & Braithwaite, J. (2013). Health services accreditation: what is the evidence that the benefits justify the costs? International Journal for Quality in Health Care, 25(5), 606-620. doi:10.1093/intqhc/mzt059
Thompson, C. A. (2013). Accreditation options broaden for acute care hospitals. American Journal of Health-System Pharmacy, 70(21), 1868-1870. doi:10.2146/news130070
Zima, T. (2017). Accreditation of medical laboratories – system, process, benefits for labs. Journal of Medical Biochemistry, 36(3). doi:10.1515/jomb-2017-0025
