Healthcare Accreditation Programmes: Which one is the best?

At a recent workshop on Clinical Governance, the classic question came up again in the group of participants.

The debate revolved around the various models — North American, European, Asian, Australian, Indian, South American — that over the last 65 years have influenced the processes for the improvement and safety of health care in more than one hundred countries.

The changes that have been made in the methodology of accreditation to become established as a product on the market and be a mechanism of visibility of clinical and non-clinical risks for health organisations were also discussed. The class approached the subject in a way that allowed us to analyse the outcomes of adopting the methodology within the scope of the Clinical Governance.

Generally, there was no disagreement about the fact that all the existing national and international accreditation programmes add significant value to the healthcare services and the people relational environment of those services. There is no doubt about the cultural and behavioural changes that occur in the core business of the organisations that have incorporated and continue to include in the management of their practices the standards developed by the various accreditation schemes around the world. Evidence can be noted, in the majority of those institutions, through comparative studies of their periodic cycles of external evaluation for accreditation, regardless of the programme adopted.

The consensus, however, was that the purpose for the use of accreditation incorporated new objectives over time.

The effectiveness of the application of standards became requisites that are secondary to the process of choice based on the market prestige of the accreditation brand. The primary interest of some institutions for fast and satisfactory results are many times imputed to the accrediting agency’s renown and its national or international market shares. The brand of the programme, and whether it is known worldwide, or not, has become important and influential in making the choice. Some institutions look for seals that can generate more visibility and increase their competitiveness immediately after the accreditation award. In other words, sometimes the objectives for joining one of these worldwide programmes transcend the principles of progressive self-improvement to look for the benefits that standards conformities may represent to the image.

But, what, among all, is the best accreditation programme?

Someone insisted on asking that question.

Considering the evolution of the fundamental concepts of accreditation, based on historical series and accumulated experience, the “best” model or programme should no more be a relevant question.

Despite the differences in semantics, editorial aspects and classification existing between the manuals published, the context and the principles of the good practice standards do not, in their majority, offer significant differences in their purposes.

On that point, I answered, almost instinctively, that, for me, there is no best programme.

It is supposed that the health systems that aim for accreditation or certification, and that regulate their practices, seek to meet the requirement, recommendations and principles of the models of care quality they have adopted, for the primary purpose of achieving the highest reliability for the services they provide.

For me, therefore, the best programme will always be the one that is best understood and best used by the organisation.

The accreditation of health systems and services, in a vast majority of classic schemes, is the same methodology applied to progressive and continuing improvement based on achievable standards. And, as all progressive methodology, accreditation suggests the path to take and does not address the endpoint. As a pedagogical tool, if it is poorly applied, it will not achieve the goals of the desired learning, and the internal culture of the organisation will not be changed at all if it is not well understood by the people involved in the processes. In the end, the institutional success depends on the proper and conscientious way of applying the chosen methodology. And the question to ask is whether the organisation can measure and monitor the impact on the individual experience of those who promote and use these services, to ratify the prestige acquired after obtaining the accreditation status.

I believe that an excellent programme is one that is well understood, well applied and very well prepared internally.

It is important to point out that the patients, the professionals, the relational problems and the work processes, good or bad, are autochthonous to health services. The preparation for the changes stimulated by the standard-based methodologies is eminently local and particular. The optimal results depend on the capacity of the organisation to accept the challenge to read, learn, find, create and share its solutions.

As a rule, the manuals of standards are reference tools for the processes of self-evaluation, self-reflection and self-development. The accrediting agencies are there to assess, confirm and attest to the self-effort put forth to achieve the improvement that will always be progressive if the institution so perceives and evolves.

The central issue is therefore not the simple choice of an extraordinary programme that relieves the organisation of its problems with quality and safety of its services. On the contrary, that decision should be aligned with the institutional mission and should opt for a programme that stimulates self-inspiration, self-motivation and self-enthusiasm for the needed changes.

Above all, it should be a programme based on standards that inspire high reliability and the sustainability of the organisation.

And if at each cycle of accreditation, using this programme the patients and professionals’ experiences are satisfactory and remain so, then, yes, there will be evidence that the “best programme of all” has been used.

In this way, the achievement of the best practices will have taken place, essentially, by the institutional self-determination although encouraged by an accreditation program, which can be considered somehow or other the best ever, most famous, best-known or ideal.

©CARLOS HIRAN GOES DE SOUZA
London, September 2017