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PubMed2006

Family medicine's search for manpower: the American Osteopathic Association accreditation option.

In recent years, family medicine has encountered problems recruiting and filling its Accreditation Council for Graduate Medical Education (ACGME)-accredited residencies. In addressing these reverses, one increasingly popular strategy has been to acquire American Osteopathic Association (AOA) accreditation as a way to tap into the growing number of osteopathic graduates. This stratagem is founded on assumptions that parallel-accredited postdoctoral programs are attractive to doctor of osteopathy (DO) graduates, that collaboration with sponsoring colleges of osteopathic medicine (COMs) provides direct access to osteopathic students, and that DOs can play an important role in replacing the increasing scarcity of United States medical graduates who are selecting specialty residencies. Within the past 5 years, nearly 10% of all ACGME family medicine residency programs have voluntarily obtained a second level of accreditation to also qualify as AOA-accredited family medicine residency programs. This strategy has produced mixed outcomes, as noted from the results of the osteopathic matching program. The flood of osteopathic graduates into these parallel-accredited programs has not occurred. In addition, recent AOA policy changes now require ACGME-accredited programs to make a deeper educational commitment to osteopathic postdoctoral education. The most successful ACGME/AOA-accredited programs have been those that are closely affiliated with and in near proximity of a COM and also train osteopathic students in required clerkship rotations.

Accreditation↗
PubMed2006

[Validation of the ISO 15189 trial assessment results of clinical laboratories--effects of accreditation and interpretation of ISO 15189].

Japanese Committee for Clinical Laboratory Standards (JCCLS) and the Japan Accreditation Board for Conformity Assessment (JAB) have developed an accreditation program for clinical laboratories using ISO 15189 in Japan. On October 1, 2004, twelve clinical laboratories applied for trial accreditation assessment. Seven laboratories were selected, including a university hospital laboratory, two other hospital-based laboratories, three large private clinical laboratories and an other private clinical laboratory. JAB had given a one week-training course to the candidate technical assessors who were nominated from the Japanese Society of Laboratory Medicine (JSLM) and the Japanese Association of Medical Technologists (JAMT), and candidate system assessors who were nominated from JAB. Thirty-five members had successfully passed the examination. During the period from November 2004 to May 2005, five laboratories were visited for assessment by four to six assessors for two or three days. Final assessment reports were discussed by the program developing committee for the validation of the accreditation program. The conclusions were that the program did not have any critical problems, but the assessment visit would have been more efficient if JAB published an easily understandable guidance document on ISO 15189, and had some training courses for laboratories in Japan in order to understand ISO 15189 more deeply. In addition, JAB should develop a more simplified checklist, mainly describing the important requirements. JAB formally started the clinical laboratory accreditation scheme from August 1, 2005 and five laboratories were accredited by the newly started accreditation committee on August 31, 2005, and four laboratories were additionally accredited on November 28, 2005. The most difficult clauses in ISO 15189:2003 were 5.6.2 and 5.6.3 on uncertainty and traceability, and 5.7.1 on post-examination procedures. Some difficult clauses to understand in the International Standard were discussed.

Accreditation↗
PubMed1989

Accreditation in the allied health professions.

Specialized accreditation in the allied health professions can and will fulfill its basic purpose if its efforts are guided by the principle that evaluation must place its emphasis on the outcome of the educational process, no matter how difficult it may be to assess. This requires the commitment and cooperation of both the accrediting body and the institution and program under review. Accreditation is a vitally important and valuable system in higher education in general, and the allied health professions are no exception. If the system is to be effective, however, every temptation must be resisted by all involved parties to debase it by using it for self-serving purposes. A recognized accrediting agency not only has the right, but indeed the responsibility, to ensure that the graduates of a program under review possess the prerequisite knowledge and skills essential for entrance into a given allied health profession. In cases where that minimal standard is not attained, the program should be required to remove those deficiencies in a timely manner or, if sufficiently serious, have its accreditation withheld or withdrawn. There should be no exceptions to this course of action. Every standard or essential adopted should be defensible on sound educational grounds, and every program should be evaluated according to whether it is in compliance. Accrediting bodies must direct their efforts toward evaluating educational quality. They must respect institutional rights and responsibilities and not even attempt to prescribe what will be taught or by whom, or who will administer a given program. The entire accreditation process must account for institutional diversity and should not discourage experimentation, innovation, or modernization. However, the standards and essentials that are ultimately adopted must be applied uniformly and fairly and not in an arbitrary or capricious manner. Hence, it is imperative that the standards and essentials be stated in such a way that they are clear and understandable. For those programs in which an enhancement or upgrading is deemed necessary for one or more aspects of the educational experience, it would be a genuine service to the institution and its consistuency if the accrediting agency could offer sound advice and suggestions for remedying those factors that may be causing or contributing to the observed deficiencies in the educational outcome. Any responsible institution would welcome such an approach, and the outcome should be an upgrading of the program under review with a concomitant enhancement of the profession involved.(ABSTRACT TRUNCATED AT 400 WORDS)

Accreditation↗
PubMed1998

Health plan accreditation: NCQA, JCAHO, or both?

Currently the National Committee for Quality Assurance (NCQA) and the Joint Commission on the Accreditation of Healthcare Organizations (the Joint Commission) accredit managed care organizations (MCOs), but is competition in the market for plan accreditation beneficial or counterproductive? This paper presents the results from two surveys that were administered to a group of large public and private purchasers, and representatives from the American Association of Health Plans and the Centers for Disease Control, who attended the Lovelace Health System (LHS) "Accreditation Experience" program. The LHS program was designed to inform purchasers about the NCQA and Joint Commission accreditation processes. The surveys captured purchaser views about the advantages and disadvantages of both accreditation processes, the value of accreditation, and the use of plan performance measures.

Accreditation↗
PubMed2000

Understanding the intersection between quality improvement, managed behavioral health accreditation, and the private practitioner.

The many parties, which now possess a role in behavioral health care services, are each concerned about the quality of these services. The concept of accreditation of MBHOs differs little from the board certification and licensure mechanisms used to ensure a minimal standard of care among practitioners. In the same way that behavioral health patients use licensure to seek competent providers, payers use accreditation as a way to ensure that MBHOs, given the task of cost control, are also active in ensuring that cost containment does not translate into decreased quality of care. Accreditation has established standards that fundamentally require MBHOs to implement QI programs directed at assessing and implementing efforts to improve care on a systemic level. NCQA accreditation of MBHOs reflects an effort to both regulate a novel industry as well as establish standards that reflect an ideal of health care. Currently, relatively few MBHOs receive full accreditation. This suggests that NCQA maintains its ideals but also that many MBHOs do not have the quality improvement programs that adequately demonstrate an interest in assessing and improving upon continuity and population-based quality care. As a fledgling industry, MBHOs are subject to unique market demands and trial and error. These forces have alienated many practitioners who provide services to MBHO members; however, practitioners must be able to tease out those aspects of managed care that facilitate quality care for their patients. Fundamental to this is the need for practitioners to understand and contribute meaningfully to QI initiatives directed at meeting NCQA standards. Despite their impositions, the new demands they place on practitioners, and the conflicted relationship in which they take place, QI efforts reflect an effort on the part of accrediting organizations and MBHOs to define, through empirical assessment and improvement efforts, quality care at a systemic level. Such care directly relates to effective behavioral health care by ensuring that a population of members receives care over a continuum of time and setting. Accreditation standards ultimately translate into quality of care and service, which patients and practitioners as well as the other stakeholders in the health care marketplace, agree is important.

Accreditation↗
PubMed2000

FAHCT accreditation: common deficiencies during on-site inspections.

BACKGROUND: The Foundation for the Accreditation of Hematopoietic Cell Therapy (FAHCT) was established in 1996 to develop and implement the inspection and accreditation program of the parent organizations, the International Society for Hematotherapy and Graft Engineering (ISHAGE) and the American Society of Blood and Marrow Transplant (ASBMT). Training of inspectors began in September 1996 and the first on-site inspections were conducted in September 1997. METHODS: The process of attaining FAHCT Accreditation includes the assessment of written application materials against uniform accreditation criteria and an on-site inspection of each of the sites in the applicant hematopoietic progenitor cell (HPC) transplantation program. Observations at each inspection are recorded by the inspector on a checklist, reviewed by the FAHCT Accreditation Chairman and/or Technical staff, and presented to the FAHCT Board of Directors for review. Each observation is determined to be in compliance with Standards, a deficiency, or a variance. The deficiencies observed in these inspections were tallied following Board review and entered into an electronic database. Those deficiencies occurring in > 25% of the transplant programs reviewed are described below. RESULTS: Significant deficiencies in the clinical programs included inadequate data management; incomplete or inadequate Quality Management Plan; and incomplete or absent standard operating policies and procedures. In the collection facilities, the most common significant deficiencies were incomplete or absent standard operating procedures; inadequate management of the results of donor evaluation findings and test results; lack of documentation of adverse reactions to collection; and deficiencies in the label applied to the HPC at the end of collection. Deficiencies in HPC laboratory services included validation procedures and/or records missing; ABO/Rh testing of the HPC component and/or the comparison of the results with prior test results not done or documented; labels in use did not meet Standards; incomplete quality control documentation; HPC infusion documents not available, or in use; HPC storage policies and procedures incomplete; adverse reactions to HPC infusion not documented, or tracked; and engraftment not tracked by the laboratory. DISCUSSION: Although all programs had a few to many deficiencies noted initially at the on-site inspection, 23 have successfully completed full accreditation. A few specific standards give problems to many programs. Participants, in general, believe the changes made in preparation for FAHCT accreditation have improved their HPC transplantation programs.

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PubMed2001

Accreditation of a personal dosimetry service in Switzerland: practical experience and transition from EN 45004 to ISO 17025.

In compliance with the Swiss legislation on radiological protection, the Paul Scherrer Institute (PSI) operates a dosimetry service that is approved by the Swiss Federal Nuclear Safety Inspectorate. In 1997, the dosimetry service was also accredited by the Swiss Federal Office of Metrology and Accreditation as an inspection body for legal personal and environmental dosimetry, according to EN 45004. The accreditation covers determination of personal dose equivalent for photon, neutron and beta radiation, and ambient dose equivalent for photon and neutron radiation, by means of thermoluminescence and solid state track detection techniques. Within this formal accreditation it was confirmed that the relevant requirements of ISO 9002 are also fulfilled. The first re-accreditation will take place in 2001 and work is going on to achieve the transition from EN 45004 to ISO 17025. Accreditation is a feasible, practicable and acceptable way to achieve harmonisation in the field of dosimetry. However, before starting on the path to formal accreditation, a careful analysis should be made, taking into consideration not only cost-benefit aspects but also national legal requirements.

Accreditation↗
PubMed2002

Determining the predictors of internal medicine residency accreditation: what they do (not what they say).

PURPOSE: The Accreditation Council for Graduate Medical Education and the Residency Review Committee for Internal Medicine (RRC-IM) evaluate internal medicine residency programs using a list of 301 program requirements. The authors investigated which requirements, program demographics, and site-visitor characteristics were the strongest predictors of accreditation. METHOD: The authors surveyed the program directors of all 405 accredited internal medicine residency programs in February 1998, obtaining data on the duration of the accreditation process, site visitors, and number and quality of citations. They also requested a copy of the notification letter containing citations and length of time until the next accreditation site visit (cycle length). RESULTS: A total of 217 responses (54%) was received. The mean cycle length was 3.0 years, and the accreditation process averaged 14.5 months. Smaller programs had a shorter average cycle length. Site visitors were reported to be prepared and professional overall. However, site visitors with the lowest evaluations by program directors were associated with shorter cycle lengths. Four program characteristics and program citations accounted for 60% of the variation in cycle length: total number of citations in the notification letter, percentage of graduates passing the American Board of Internal Medicine Certifying Examination, inadequate demonstration of resident scholarship, and inadequate ambulatory care experience. CONCLUSION: The authors devised an independent mechanism for determining the duration of the RRC-IM review process, influence of program demographics on the process, influence of site visitors on the accreditation action, and program requirements having the greatest effect on cycle length.

Accreditation↗
PubMed1986

Accreditation of graduate medical education in radiology. Historic perspectives.

Initially, accreditation represented a somewhat informal and voluntary relationship between the AMA Council on Medical Education and Hospitals and representatives of the specialty board organizations to jointly survey hospitals where training programs were conducted. In recent years, changes in public policy and the law, and the greater involvement of governmental agencies have institutionalized accrediting decisions as a consideration in noneducational actions such as funding. The accreditation process today has an indirect but important influence upon regulatory activities carried out by governmental agencies; accreditation has thus been transformed, by governmental action, into a public service performed by quasipublic agencies. In order to reconcile educational and professional objectives with present-day societal needs, certain standards must be followed. Accreditation must have autonomy to function independent of political or economic influence and must be impartial and free to act without actual or apparent conflicts of interest. Those involved in the review process must be highly knowledgeable and respected in their own discipline and should be trained in the work of the accrediting agency. The decision-making process must be formal, uniform, and consistent with public standards and procedures that are available to all interested parties. All parties directly affected by the accreditation decision must have the opportunity to present their views under due process. In a separate but related issue, the United States Congress, third-party carriers, and perceptive leaders of the medical education establishment are presently reviewing critically the funding of graduate medical education.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed2006

Global standards and accreditation in medical education: a view from the WFME.

Globalization of medicine is increasing, as manifested by the growing number of migrating doctors and cross-border education providers. In addition, new medical schools of dubious quality are proliferating. This situation accentuates the need to define standards and introduce effective and transparent accreditation systems. With this background, and reflecting the important interface between medical education and health care delivery, a World Health Organization (WHO)/World Federation for Medical Education (WFME) Strategic Partnership to improve medical education was formed in 2004. In addition to working on reform processes, capacity building, and evaluation of medical education at the regional and national levels, the partnership in 2005 published guidelines for accreditation of basic medical education. Only a minority of countries have quality assurance systems based on external evaluation, and most of these use only general criteria for higher education. The WHO/WFME Guidelines recommend establishing accreditation that is effective, independent, transparent, and based on criteria specific to medical education. An important prerequisite for this development was the WFME Global Standards program, initiated in 1997 and widely endorsed. The standards are now being used in all regions as a basis for improving medical education throughout its continuum and as a template for national and regional accreditation standards. Promotion of national accreditation systems will pivotally influence future international appraisal of medical education. Information about accreditation status--agencies involved and criteria and procedures used--will be essential to future databases of medical schools and will be a foundation for international "meta-recognition" of institutions and programs ("accrediting the accreditors").

Accreditation↗
PubMed1998

Attitude of laboratory personnel towards accreditation.

A multiple choice questionnaire was submitted to medical technologists in three medical laboratories, at varying times after obtaining an EN 45001 accreditation. A large majority (85-90 per cent) considered that their workload was increased by the accreditation process. In two laboratories, the technologists did not think that the accreditation process had improved the quality of the results. The major advantages were the fact that everything was traceable, that the technologists felt more sure about the procedures to follow, received more responsibilities and had a better knowledge of the tests they performed. The major disadvantages were the increased paperwork, discrepancies between the procedures and the reality, the fact that more attention is paid to the formalities than to the quality of the results and that the accreditation process decreased the adaptability. The number of advantages mentioned seemed to increase with the interval since the accreditation. A small majority of the technologists preferred working in an accredited laboratory than in a non accredited one.

Accreditation↗
PubMed2006

European guidelines for the accreditation of Sleep Medicine Centres.

This document describes guidelines for accreditation of Sleep Medicine Centres in Europe. These guidelines are the result of a consensus procedure, in which representatives of the European Sleep Research Society (ESRS) and representatives of different European National Sleep Societies (ENSS) were involved. The information obtained during different rounds of consultation was gathered and processed by the members of the Steering Committee of the ESRS. The scope of the guidelines is to define the characteristics of multidisciplinary Sleep Medicine Centres (SMCs), in terms of requirements regarding staff, operational procedures and logistic facilities. Accreditation of SMCs is proposed to be the responsibility of the individual ENSS. The Accreditation Guidelines may thus be considered an instrument for the national societies to develop new or standardize existing accreditation questionnaires, as well as procedures for visiting the site, drafting the accreditation report, and finally, granting the accreditation. The Accreditation Guidelines are meant to be a line of action, that ideally should be followed as close as possible, but that may be subject to certain exceptions, depending on local customs or regulations.

Academic Medical Centers↗
PubMed2001

State HMO accreditation and external quality review requirements: implications for HMOs serving rural areas.

The purpose of this article is to analyze state regulations regarding health maintenance organization (HMO) accreditation and external quality review; to briefly describe states' experiences implementing these regulations; and to discuss the implications of these regulations for HMOs serving rural areas. The incorporation of HMO accreditation and external quality review requirements into state HMO licensure processes and state employee contracting raises many policy issues, including several that are especially relevant to HMOs serving rural populations. A key issue is whether the linkage of accreditation and external quality review requirements to HMO licensure will be an additional deterrent to the development of new HMOs or the expansion of existing HMOs into rural areas. Other issues relate to the costs and benefits of accreditation for HMOs serving rural populations, and the potential impact of HMO accreditation requirements on efforts to expand managed care enrollment of rural Medicaid and Medicare beneficiaries and rural state employees. Nine states were identified that have regulations requiring HMOs to seek accreditation or to undergo an external quality review as a condition of licensure. Four states were identified as implementing requirements that an HMO be accredited in order to serve state employees. Many of these requirements are still in the early stages of implementation. Several states with the requirements have significant rural populations and will provide opportunities to evaluate their impact on HMOs serving rural areas, rural providers and rural consumers.

Accreditation↗
PubMed2000

FESCC survey on accreditation and post-graduate training in clinical chemistry in European countries. Federation of European Societies of Clinical Chemistry.

Promotion of the professional growth and development of specialists in the field of clinical chemistry in European countries, and harmonisation of quality assessment and accreditation procedures are listed among the main goals and activities of Federation of European Societies of Clinical Chemistry (FESCC), according to its 1999-2000 strategic plan. The European countries that are members of the European Union are in the process of establishing the "European Register for Clinical Chemists", based on minimum standards of education, training and experience as defined by the European Communities Confederation of Clinical Chemists (EC4). Many other European countries would like to adapt their system of professional education to this model. Data on post-graduate training in EC4 FESCC members have already been gathered in 1998. However, at the present time, there is no detailed knowledge of pre- and post-graduate professional education of specialists in clinical chemistry in the non-EC4 European countries. FESCC launched a survey in July 1998 in order to gather this information with the hope to start a database about existing systems. All FESCC members received the same questionnaire on accreditation (seven questions) and non-EC4 FESCC members received an additional questionnaire with 11 questions related to post-graduate training in clinical chemistry. The response rate of the 35 FESCC member countries was 93% from the 15 EC4 members (14 responses/15 countries) and 80% from the 20-non-EC4 (16 responses/20 countries). The heterogeneity of the data on post-graduate training in clinical chemistry indicates that a great effort will be needed before harmonisation is reached. These results, however, will provide an interesting basis for further discussion and promotion of post-graduate training in clinical chemistry. The data provided on accreditation show that the total number of accredited laboratories was relatively low in EC4 countries and even lower in non-EC4 members. It was not surprising to see that the number of accredited laboratories was the highest in the two countries which started accreditation the earliest (i.e. Sweden and UK, 1992). This situation, however, is changing at a fast rate in most countries and the number of the accredited sites is expected to increase rapidly in the next few years.

Accreditation↗
PubMed2002

Accreditation of clinical laboratories in the Philippines.

In order to assure the reliability of the results of laboratory services, clinical laboratories are regulated in the Philippines. This started with the passage of the Clinical Laboratory Law in 1965, which required the Licensing of clinical laboratories by the Bureau of Research and Laboratories, Department of Health (BRL, DOH) before they can operate. Standards were set for the various types of laboratory services. In 1988, the minimum standards of laboratory services were formulated for three categories, ie, primary, secondary and tertiary categories. Subsequently, to permit clinical laboratories to offer 'special service', accreditation of clinical laboratories was instituted. In 1968, the Philippine Society of Pathologists (PSP) decided to accredit clinical laboratories for Residency Training Program in Anatomic and Clinical Pathology. The following year after the passage of the Medical Technology Law, the BRL, DOH began accrediting clinical laboratories that trained Medical Technology Interns. A few years later, the BRL, DOH started to accredit clinical laboratories who did Water Analysis. In 1989, after realizing the serious implications of HIV Testing, the DOH mandated the BRL, DOH to set standards for clinical laboratories performing HIV testing. In 1997, upon request of the Philippine Health Insurance Corporation (PhilHealth), the PSP formulated and submitted standards for the accreditation of clinical laboratories, both hospital and free-standing, for reimbursement of fees for laboratory services rendered to patients enrolled in the PhilHealth social insurance program. In 2000, the Philippine Council for Accreditation of Healthcare Organizations (PCAHO) approved the Standards for the accreditation of Hospitals for the provision of quality medical services. Included were the standards for the Department of Pathology.

Accreditation↗
PubMed2004

[Accreditation of clinical laboratories based on ISO standards].

International Organization for Standardization (ISO) have published two international standards (IS) to be used for accreditation of clinical laboratories; ISO/IEC 17025:1999 and ISO 15189:2003. Any laboratory accreditation body must satisfy the requirements stated in ISO/IEC Guide 58. In order to maintain the quality of the laboratory accreditation bodies worldwide, the International Laboratory Accreditation Cooperation (ILAC) has established the mutual recognition arrangement (MRA). In Japan, the International Accreditation Japan (IAJapan) and the Japan Accreditation Board for Conformity Assessment (JAB) are the members of the ILAC/MRA group. In 2003, the Japanese Committee for Clinical Laboratory Standards (JCCLS) and the JAB have established the Development Committee of Clinical Laboratory Accreditation Program (CLAP), in order to establish the CLAP, probably starting in 2005.

Accreditation↗
PubMed2005

Accreditation of medical training in Australia and New Zealand.

The Australian Medical Council (AMC) accredits both Australian and New Zealand (NZ) medical courses and also college specialist training programmes. The common accreditation process allows mutual recognition of basic medical training and vocational training between Australia and New Zealand. The ultimate purpose of accreditation assure stakeholders including medical registration boards, health departments, students/trainees and the general community of the quality of the programs and the competence of those completing such training. AMC revised its own accreditation guidelines using the WFME standards as the model around which the new AMC standards were developed. The College Accreditation Process is similar to and builds on AMC experience in the medical school accreditation process. In conclusion, AMC accreditation has been successful in improving medical education in Australia and New Zealand and has been able to do so without the imposition of any exclusive educational model or philosophy.

Accreditation↗
PubMed1983

Accreditation: dispelling the myths.

Accreditation is a major issue in allied health education. This article explores the purposes of accreditation and eight myths about nongovernmental programmatic accreditation. These myths focus on professional society control versus accountability to the general public and student consumer, the method of national standard setting versus statewide accrediting, credibility of the process, the conduct of the process by volunteers, costs of accreditation, and the role of paid accreditation staff. Appropriate US Department of Education criteria and Council on Postsecondary Accreditation provisions that affect these areas are included.

Accreditation↗