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PubMed1990

The College of American Pathologists Laboratory Accreditation Programme.

The Laboratory Accreditation Programme (LAP) offered by the College of American Pathologists (CAP) was begun in 1961. It is a voluntary peer review programme with the goal of laboratory improvement to excellence. It presently accredits more than 4300 laboratories throughout the world, although the majority are in the United States and Canada. Accreditation is contingent upon continuing successful performance in the CAP proficiency testing programmes, as well as passing biennial on-site laboratory inspections. These on-site inspections are done by practising laboratorians who use checklists appropriate for the various laboratory disciplines. Several governmental regulatory agencies (e.g. the Health Care Financing Agency) as well as private agencies (e.g. the Joint Commission on Accreditation of Healthcare Organizations) accept the LAP in place of their own programmes for laboratory accreditation.

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PubMed1983

Rights and responsibilities in the accreditation process.

This article is the text of a presentation for the plenary session of the October 1981 meeting of the Committee on Allied Health Education and Accreditation (CAHEA) and its panel of consultants and special advisors. The legal, philosophical, and practical aspects of rights and responsibilities in the accreditation process are examined from the institutions' perspective. Excerpts from the various CAHEA review committee's Essentials and Guidelines are cited as examples of how accrediting agencies unwittingly infringe on institutional prerogatives. The article suggests the need for institutions, allied health professions, and accrediting agencies to collaborate and to establish more realistic accreditation standards.

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PubMed1980

Educator perceptions of accreditation.

A 25-item survey was developed to collect data for a paper delineating educators' concerns for accreditation. Distributed randomly in the instrument were statements relating to the constructive aspects of accreditation, the constraints on the effectiveness of accreditation, and the logistical short-comings of the accreditation process. Responses were separated into four categories of institutions and were subjected to computer analysis. Results clearly demonstrated different perceptions of relative importance among the various institutional categories. Of possibly greater significance was the demonstration that the great majority of respondents expressed far more concern over the processes of accreditation than they did over the principles.

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PubMed1997

Patient safety in accredited office surgical facilities.

The medical profession is besieged by concerns about cost containment. This in turn has focused attention on the use of ambulatory surgical facilities. However, the costs of hospital outpatient surgery programs usually prevent them from being competitive when compared with the costs of using office surgical facilities. To address the question of patient safety in office surgical facilities, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) sent a questionnaire to its accredited facilities. Two-hundred and forty-one (57.7 percent) of the 418 accredited facilities returned the anonymous questionnaires, a very high response rate. Or interest are the following findings: 400,675 operative procedures were reported during a 5-year period. Significant complications (hematoma, hypertensive episode, wound infection, sepsis, hypotension) were infrequent, occurring in 1 in every 213 cases. Return to the operating room within 24 hours and preventive hospitalization were less frequent. A death occurred in 1 in 57,000 cases (0.0017 percent). The overall risk is comparable in an accredited office (plastic surgical facility) and in a free-standing or hospital ambulatory surgical facility. This study documents an excellent safety record for plastic surgery done in accredited office surgical facilities by board-certified plastic surgeons.

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PubMed1998

[Report on the activity of the blood bank accreditation program (1987-1995)].

PURPOSE: To show the incidence of the deficiencies detected in the Blood Banks for the accreditation by the Transfusion Accreditation Committee (CAT), previously named PABAS. MATERIALS AND METHODS: Analysis of the reports of the accreditation of 85 Blood Banks made by the PABAS during the period 1987-1995. RESULTS: Eighty-five (20.8%) of the 407 Community Blood Centers, Hospital-Based Blood Banks and Transfusional Services of Spain had been surveyed. There were 244 deficiencies, of which 31 (12.7%) were of the equipment, 114 (46.7%) of the procedures used, and 99 (40.6%) of the documentation. The activities with more incidence of faults were: Control of the temperatures of the storage of units 53 (21.7%), label of the components 38 (15.5%), quality system of the institution surveyed 32 (13.1%), transfusional procedures 30 (12.3%), and on the procedure of the selection of donors 29 (11.9%). By contrary, the areas of work with fewer incidences of faults were those related with the collection of the blood and components 10 (4.1%) and the laboratory 14 (5.7%). CONCLUSIONS: Low percentage of the Community Blood Centers, Hospital-Based Blood Banks and Transfusional Services, which ask to be accredited by the Transfusion Accreditation Committee. The 83.7% of the errors detected are of the procedures and documentation, which could be easily corrected by the training and continuous improving of the quality, and without need of new inversions in equipment.

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PubMed1998

[Accreditation professional degrees and teaching institutions: the case of Chile].

Accreditation has acquired special relevance for the habilitation of professional practice, considering the proliferation of teaching institutions, the variety of training programs and the increasing amount of professionals requiring accreditation or revalidation of their titles. The internationalization of professional activities requires global and uniform accreditation procedures to avoid inequalities in evaluation of different professionals coming from abroad or from Chile. In the scope of medical practice, these concepts acquire special relevance, considering the appearance of new medical schools in the last decade and the increasing number of foreign physicians that need to revalidate their titles. In the period between January 1996 and September 1997, 192 foreign physicians applied to revalidate their titles and only 55 were approved. Therefore, the establishment of and effective evaluation system will correct deficiencies in the accreditation process and will promote the revision of training programs and the progress of teaching institutions. The organisms that will require to be accredited must be confident that this action will improve the quality of Chilean professional training.

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PubMed1998

Accreditation manual for nephrology.

The IRS did not develop a new theory of accreditation but drew up a methodology for assessing public policies, which internalised accreditation philosophy and was based on a theory of the decision-making process. Two questions underlie this theory: 1) whether health is a professional organisation, a company or a public policy, 2) whether accreditation in the internationally accepted meaning of the term is the most effective system of continuous improvement for this sector as it is organised in Italy. According to the IRS, health is all three of these things and accreditation responds adequately to the complexity of the sector. In fact: a) internalises professional knowledge (and is therefore ideal for a professional organisation); b) it triggers a process of continuous improvement of the product/service supplied (and that is ideal for a company that must maintain the competitiveness of its product/service as high as possible); c) it uses a methodology which highlights the mechanisms of interaction between the actors (a methodology underlying decision making theory where there are actors who decide, knowing that they have to find a consensus and who exchange resources in a virtuous circle. The principal qualitative element identified by the IRS methodology was the internalisation by the health system of patients' expectations and patients' satisfaction in the welfare process. The main feature of the accreditation methodology designed by the IRS is that the assessment focuses neither on structures (which would have been useful to measure the degree of reliability) nor on the compilation of behaviour guidelines, but is centred on the assessment of a function, on the quality of the provision of a specialist health service. The decision to assess a specialist function (e.g. nephrology) and not a structure (e.g. a nephrology department or a hospital) gives maximum importance to the figure of the professional.

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PubMed1993

Aphis and the accredited veterinarian. A partnership in regulatory medicine.

APHIS has a long history of partnership with the private practitioner in the veterinary accreditation program. The accreditation program is truly the backbone of the nation's regulatory programs for the prevention, control, and eradication of domestic livestock diseases. The United States' animal export program also relies heavily on the expertise, diligence, and integrity of the accredited practitioner. Accredited veterinarians provide assurance to regulatory officials, and clients, both within the United States and internationally that newly acquired animals will not introduce disease into the livestock population. With the approach of the twenty-first century and the continuing trend toward a global agricultural economy, it becomes even more imperative that APHIS and the accredited veterinarian work together to develop and maintain an active and sound partnership to enhance American agriculture.

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PubMedDate not supplied

International trends in accreditation.

Accreditation of hospitals began in the early part of the twentieth century in the USA as a mechanism to ensure an appropriate environment in which clinicians could practise effectively. It was adopted in Canada and Australia, where it conformed to the early design of standards to control the hospital environment. In the past decade, these accreditation systems have been forced to change in response to the decline in the role of the hospital in health care delivery; the demands of governments and the public for greater information about quality of health care. They have also responded to pressure for greater knowledge of clinical effectiveness by introducing indicators of clinical performance. Within the past 5 years, accreditation has been adopted in a number of other countries where governments have extended their role into assuring the quality of health care. Accreditation, originally perceived as a vehicle to enable organizational development, is increasingly an agent of government regulation.

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PubMed1995

Accreditation: what can we learn from the Anglophone model?

There is growing interest in the development and application of standards for the health care to both promote quality assurance but also to improve the processes by which health services are held accountable to the public. This paper maps the development of organisational accreditation systems in the USA, Canada, Australia and the United Kingdom. In the USA, accreditation, which began as a means of ensuring the correct environment for clinical practice has developed into a form of public regulation. In the United Kingdom, many different approaches to the setting of standards and their assessment has created a variety of accreditation systems. The case studies demonstrate that as the concept of accreditation diffuses into the health care systems of different countries, it is being adapted to meet the wider policy needs of different national circumstances.

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PubMed2005

Strategic opportunities in the oversight of the U.S. hospital accreditation system.

Hospital accreditation and state certification are the means that the Centers for Medicare & Medicaid Services (CMS) employs to meet quality of care requirements for medical care reimbursement. Hospitals can choose to use either a national accrediting agency or a state certification inspection in order to receive Medicare payments. Approximately, 80% of hospitals choose the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The purpose of this paper is to analyze and discuss improvements on the structure of the accreditation process in a Principal-Agent-Supervisor framework with a special emphasis on the oversight by the principal (CMS) of the supervisor (JCAHO).

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PubMed1996

Accreditation programs for hospitals: funding and operation.

Accreditation is a formal process by which an authorized body assesses and recognizes an individual, an organization (like a hospital), a program, or a group as complying with requirements such as standards or criteria. This article analyses and compares the activity and funding of six health care accrediting bodies which operate in five different countries, and which in 1994, accredited over 5000 health centres. The data included in this article could be useful for other institutions who wish to commence accreditation programmes for health care organizations.

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PubMed1993

The cost of accreditation: one hospital's experience.

OBJECTIVE: The 1989 survey conducted by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) at the UCLA Neuropsychiatric Hospital was the hospital's first using standards outlined in the 1989 edition of JCAHO's Accreditation Manual for Hospitals. The authors' goal was to calculate the cost of preparing for and undergoing the 1989 survey. METHODS: Costs associated with planning for the survey and conducting a mock survey and the actual survey were based on records of staff time spent on those activities, fees for consultant services, and fees for the actual survey. Costs associated with follow-up of the mock survey, preparation for the actual survey, and additional staff time spent in record keeping and treatment planning to meet accreditation standards were based on staff estimates of time spent in these activities. RESULTS: Documented and estimated costs for the survey process totaled $326,784, which represented about 1 percent of the hospital's operating budget for 1989. CONCLUSIONS: Although the hospital had a successful survey outcome and received accreditation with few contingencies, the authors question whether quality of care was improved by the survey process and whether the high cost of the survey constitutes an appropriate use of resources.

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PubMed1997

JCAHO mental health care network accreditation as a performance improvement project.

In June 1995 the Southeastern Area of the Massachusetts Department of Mental Health became the third health care network, and first mental health care network, to be accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) under its new network standards. This paper provides a brief overview of how the Southeastern Area network prepared for and went through the JCAHO survey. The author shows how the effort undergoing the accreditation procedure helped improve the performance of the network. To help other organizations considering JCAHO network accreditation, specific aspects of the survey process are presented, including preparing documents, understanding key concepts emphasized by JCAHO, and preparing staff for participation in the survey interviews.

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PubMedDate not supplied

Relationship between performance measurement and accreditation: implications for quality of care and patient safety.

This study examined the association between the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation scores and the Agency for Healthcare Research and Quality's Inpatient Quality Indicators and Patient Safety Indicators (IQIs/PSIs). JCAHO accreditation data from 1997 to 1999 were matched with institutional IQI/PSI performance from 24 states in the Healthcare Cost and Utilization Project. Most institutions scored high on JCAHO measures despite IQI/PSI performance variation with no significant relationship between them. Principal component analysis found 1 factor each of the IQIs/PSIs that explained the majority of variance on the IQIs/PSIs. Worse performance on the PSI factor was associated with worse performance on JCAHO scores (P=.02). No significant relationships existed between JCAHO categorical accreditation decisions and IQI/PSI performance. Few relationships exist between JCAHO scores and IQI/PSI performance. There is a need to continuously reevaluate all measurement tools to ensure they are providing the public with reliable, consistent information about health care quality and safety.

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PubMed1993

Medicare and Medicaid programs; recognition of the Joint Commission on Accreditation of Healthcare Organizations standards for home care organizations--HCFA. Final notice.

This final notice recognizes accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for home health agencies (HHAs) that wish to participate in the Medicare or Medicaid programs. As a result of this recognition, HHAs accredited by JCAHO are deemed to meet the Medicare conditions of participation for HHAs to the extent described in this notice. This final notice sets forth certain specific requirements with which JCAHO must comply to maintain Medicare and Medicaid recognition of its HHA accreditation program.

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PubMedDate not supplied

Results of a JCAHO accreditation survey in a university student health center.

This article describes the results of our initial accreditation survey by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Strengths, as well as supplemental recommendations in our clinic and laboratory programs, were identified during the accreditation survey. Mechanisms for addressing the supplemental recommendations are described in this report. Direct and indirect costs of the accreditation process also are discussed.

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PubMed2000

[Accreditation of hospitals in the USA according to the standards of the Joint Commission of Healthcare Organizations (JCAHO)--reflections on the transferability of these procedures to Germany].

The Accreditation-Process of the Joint Commission on Accreditations of Healthcare Organisations (JCAHO), specially the new international arm of the Joint Commission International Accreditation (JCIA) is also in Germany already in use. Some decades of experiences with the accreditation of healthcare institutions in the USA, generally recognized standards as well as a transparent process of survey are best conditions for an international transfer. The current legal requirements will be fulfilled by the system. Finally the JC-Process defeats the philosophy of a continuous quality improvement.

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