Accreditation vs Regulation:
It’s that difference that makes a difference!
First Dubai Health Regulation Conference
for the MENA region
22-23 October , 2014
Today, regulation is an encompassing term for three different
potential regulatory activities...
Licensing
Regulation—any
standard that is
mandated by a
governmental
agency or
authoritative body
• Licensing implies meeting minimal standards
Certification
• Certification: Procedure by which a third
party gives written assurance that a
product, process or service conforms to
specific requirements
• Credentialing means that an individual has
demonstrated the capabilities necessary for
successful participation in that profession
•
Accreditation
Accreditation implies performing at a higher
level and are meeting additional standards
beyond the licensing standards
2
Definitions have been unified to a certain extent…
 usually a voluntary program,
Licensing
Accreditation
 sponsored by a non-governmental agency
 trained external peer reviewers evaluate a health care organization's compliance with pre-established
performance standards
 addresses organizational rather than individual practitioner capability or performance
 is an internationally recognized evaluation process
 used to assess and improve the quality, efficiency and effectiveness of health care organisations.
ISQua definition of accreditation: “Act of granting credit or recognition by an external evaluation
organization of the achievement of accreditation standards, demonstrated through an independent
external peer assessment of that organisation’s level of performance in relation to the standards.”
Licensure: “Licensure: process by which a government authority grants permission to an individual
practitioner or health care organisation to operate or to engage in an occupation or profession.”
ISQua Accreditation Council 2002
*Unlike licensure, accreditation focuses on continuous improvement strategies and achievement of optimal
quality standards rather than adherence to minimal standards intended to assure public safety.“ - Simply put,
accreditation is based on the premise that adherence to evidence-based standards will produce higher quality
health care services in an increasingly safe environment. It is also a way to publicly recognize that a health
care organization has met national quality standards”. (Pomey, 2005)
3
… And the USA-based Quality Assurance Program and Joint
Commission Resources have proposed a table of definitions
Process
Accreditation
(voluntary or
mandatory)
Licensure
(mandatory)
Object of
Evaluation
Requirements
Uses recognised
tools, often
an NGO but
may be part of
government or
funded by
government
Organization e.g.
hospital, clinic,
community service,
network of health
services and
facilities
Compliance with or achievement of
published standards, on-site
evaluation, compliance usually not
required by law and/or regulations
but a developing trend of becoming
required by governments
Governmental
authority
Individual
Organization
Individual
Certification
(voluntary or
mandatory)
Components/
Issuing
Organization
Authorized body,
either
government or
NGO
Organization or
component
Standards
Regulations to ensure minimum
standards, exam, or proof of
education/competence
Regulations to ensure minimum
standards, on-site inspection
Evaluation of predetermined
requirements, additional
education/training, demonstrated
competence in specialty area
Set at a maximum achievable level to
stimulate improvement over time,
often with different levels of
achievement for different levels of
accreditation
Set at a minimum level to ensure an
environment with minimum risk to
health and safety
Set by national professional or
specialty boards
Industry standards (e.g. ISO 9000
Compliance with set standards, on- standards) evaluate conformance to
site evaluation
design specifications,
or specific health standards
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But there is a crucial need to differentiate health service
accreditation from both certification and licensing, especially
when we are looking at institutional competence.
Do we need
accreditation?
Accreditation
Licensure
Which
standards
should we
use?
Certification
How does
that differ
from
regulation?
5
Regulation seems to be more stringent on accountability
6
While accreditation seems to focus on growth !
Benefits (Nicklin2011)
 A framework systems and processes to improve operations
and health outcomes
 Decreases variances in practice among healthcare providers
and decision –makers
 Improves communication and collaboration
 Stimulates continuous raising of the bar
 Strengthen interdisciplinary team effectiveness
 Leads to the improvement of internal practices
 Demonstrates credibility and a commitment to quality and
accountability
 Increases health care organisations’ compliance with quality
and safety standards
 Decreases liability costs:
 Improves patients’ health outcomes
 Mitigates the risk of adverse events
 Provides a team-building opportunity for staff and improves
their understanding of their co-workers’ functions
 Sustains quality and organisational performance
 Enables on-going self-analysis
 Ensures an acceptable level of quality among healthcare
providers
 Enhances the understanding of continuum of care
 Improves the organisation’s reputation among end-users and
enhances their awareness & perceptions
 Promotes capacity-building, professional development and
organisational learning
 Codifies policies and procedures
 Promotes an understanding of how each person’s job
contributes to the healthcare organisation mission & services
 Contributes to increased job satisfaction among physicians,
nurses and other providers
 Engenders a spill-over effect, whereby the accreditation of
one service helps to improve the performance of other service
 Highlights practices that are working well
 Promotes the sharing of policies, procedures and best
practices among health care organisations.
7
Can this diagram summarize it? Or is it too easy?
8
Accreditation, unlike regulation, seems to have the essence of self
assessment and self growth
Continued
reporting
Mystery client
Un-announced
midpoint
assessment
Contiguous
engagement
New standards
every other
year
9
Many approaches look at accreditation as a developmental
approach where as licensing as a regulatory one
Developmental
Regulatory
Purpose
Dynamic, organisational improvement
Static, control
Terminology
Accreditation, certification
Licensing, regulation
Governance
Non-governmental organisation, stakeholders
National, regional government agency
Primary Customers
Healthcare providers
Government
Secondary customers
Patients, professions, health care insurers
Population, politicians, public finance
Incentives for healthcare
organisations to
participate
Ethical, commercial
Legal, mandatory
Uptake
Voluntary self-selection to available programs
All institutions in all sectors
Standards
Defined by non-governmental organisation,
optimal achievable
Defined by regulation, minimal acceptable
Funding
Cross-border mobility
Self-financing
Limited by language, culture
State
Limited by political borders
10
In simple terms, accreditation is to educate and elevate while
regulation/licensing is to investigate and enforce
Licensure
•
Building safety
•
Physical space
•
provider-to-beneficiary ratios
•
Staff qualifications
•
Transportation
•
Compliance to regulation
•
Accreditation
•
Access ,Assessment and continuity of care
•
Patient Right and Education .
•
Care of Patients .
•
Management of Medication .
•
Hospital Infection Control .
•
Continuous Quality Improvement
•
Responsibility of Management .
•
Facility Management and Safety .
•
Human Resource Management
•
Information Management System .
Action
Sanctions, fines
Patient decision, pay for performance
Implementation
Inspectors, Auditors
Assessors, Surveyors
Areas of Focus
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Accreditation also seems to be more in depth!
infection
Policies
&
procedur
es
hazardous
material
resuscita
tion
maintena
nce
medical
equipme
nt
privacy
continuit
y
of care
basic
hygiene
fire
safety
radiation
safety
triage
Plans and
guidelines
sterilizati
on
waste
manageme
nt
laws and
regulatio
ns
human
rights
emergency
care
Medicati
on
referral
system
lack of
privacy
Chemical
exposure
Qualified
staff
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In summary, we may be able to simplify it with that licensure can
be a starting point while certification and accreditation can be the
continuous way forward
Heath
Institution
Heath
Institution
Heath
Institution
Accreditation
Certification
Licensure
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To end with another layer of questions:
What is after accreditation?
Excellence?
Continuous
readiness?
Heath
Institution
Heath
Institution
Heath
Institution
Accreditation
Certification
Licensure
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Questions and Comments
15
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Thank You