Accreditation—a help or a hindrance to the development of patient care?
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1 Practice Development in Health Care, 2(1) 1–3, 2003 © Whurr Publishers Ltd Editorial Accreditation—a help or a hindrance to the development of patient care? In a recent conversation about practice development issues, a colleague from another organization highlighted the negative impact of a high profile, national accreditation scheme on practice at her unit. She described how the team had managed to free itself of many of its ritualistic practices over the previous couple of years and had successfully introduced a number of innovative practices, which pushed the boundaries of care in her specialty. Unfortunately, the external assessors did not feel that some of the innovations introduced were consistent with their defined standards and were therefore recommending that practice in the unit should revert to the standards. This was naturally a severe blow to the morale of the team, who felt that their practice was perhaps ahead of the generally accepted standards. In view of the importance of the external assessment, however, the team’s practice was changed. Internationally, health services are the subject of an increasing range of accred- itation schemes and external assessments, relating to all aspects of practice. This includes organization-wide and specialty-specific service standards, such as cancer standards or risk management standards. Individual professional practice has also adopted occupational standards, such as those described in the paper by Nancarrow and Clark, about Australian allied health professions later in this issue. Naturally, an important aspect of accreditation is the assurance that a service or practitioner is meeting defined standards. However, there is also a major emphasis on the need to modernize health services, to be flexible, to innovate and to look for new ways of working in response to changing patient or client need. Although accreditation schemes may help to move practice incrementally towards their defined standards, it is also important to consider the extent to which they help or hinder the more radical processes of innovation which underpins the modernization of health services. Figure 1 suggests some questions to ask yourself about accreditation or external assessment schemes that you may be involved with. Does the scheme support or inhibit innovation and creativity? Does it recognize and encourage innovative practice or, like the example quoted in the opening paragraph, does it emphasize the need for conformity to the generally accepted norm? Does the programme excite or turn-off clinical teams? Some processes are aimed at the level of the organization as a whole. Others are meant to be relevant to practitioners working directly with patients and clients, but are written in a language
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Transcript of Accreditation—a help or a hindrance to the development of patient care?
1Practice Development in Health Care, 2(1) 1–3, 2003 © Whurr Publishers Ltd
Editorial
Accreditation—a help or a hindrance to thedevelopment of patient care?
In a recent conversation about practice development issues, a colleague from anotherorganization highlighted the negative impact of a high profile, national accreditationscheme on practice at her unit. She described how the team had managed to free itselfof many of its ritualistic practices over the previous couple of years and had successfullyintroduced a number of innovative practices, which pushed the boundaries of care inher specialty. Unfortunately, the external assessors did not feel that some of theinnovations introduced were consistent with their defined standards and weretherefore recommending that practice in the unit should revert to the standards. Thiswas naturally a severe blow to the morale of the team, who felt that their practice wasperhaps ahead of the generally accepted standards. In view of the importance of theexternal assessment, however, the team’s practice was changed.
Internationally, health services are the subject of an increasing range of accred-itation schemes and external assessments, relating to all aspects of practice. Thisincludes organization-wide and specialty-specific service standards, such as cancerstandards or risk management standards. Individual professional practice has alsoadopted occupational standards, such as those described in the paper by Nancarrowand Clark, about Australian allied health professions later in this issue. Naturally, animportant aspect of accreditation is the assurance that a service or practitioner ismeeting defined standards. However, there is also a major emphasis on the need tomodernize health services, to be flexible, to innovate and to look for new ways ofworking in response to changing patient or client need. Although accreditationschemes may help to move practice incrementally towards their defined standards, it isalso important to consider the extent to which they help or hinder the more radicalprocesses of innovation which underpins the modernization of health services.
Figure 1 suggests some questions to ask yourself about accreditation or externalassessment schemes that you may be involved with. Does the scheme support or inhibitinnovation and creativity? Does it recognize and encourage innovative practice or, likethe example quoted in the opening paragraph, does it emphasize the need forconformity to the generally accepted norm?
Does the programme excite or turn-off clinical teams? Some processes areaimed at the level of the organization as a whole. Others are meant to be relevant topractitioners working directly with patients and clients, but are written in a language
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that totally fails to engage the audience. Is the focus on patients or clients or on theprofessional? There is often very little involvement of service-users in the process. Howthen may we be sure that the processes are likely to lead to improvements focused onpatient needs and expectations? Does the process help or hinder collaborative working?Uni-professional accreditation processes may be useful in highlighting certain practicestandards, but do they also help to reinforce professional ‘silos’? Lastly, is the processlikely to have a high or low impact on the behaviour and working patterns of thepatient care team? If the process inhibits innovation and creativity, turns off the team,does not challenge professional assumptions and does little or nothing to promotecollaborative working, its effect is likely to be minimal. Without a change in the waywe think and behave as individuals and teams, there is unlikely to be the change inbehaviours we are seeking.
Clearly, this editorial does not seek to suggest that all accreditation or externalassessment is bad, but to emphasize the importance of considered decision-makingbefore accreditation schemes are accepted.
Most organizations or teams will reap some positive benefit from even the mostmediocre processes, if they have a desire to develop their practice along the way. Someprogrammes, such as the University of Leeds’ practice development unit accreditation,actively support innovation and development through the flexible application ofcriteria that enables teams to adapt criteria to their own care setting, rather than a‘one-size-fits-all’ approach. It is all too easy to get caught up in the idea that checkingoff lists of evidence against volumes of standards represents progress. Whether we arebeing assessed/accredited, or are on the other side of the table and working as assessors,it is important to remember the limitations as well as the benefits of such schemes andto ensure that whatever the process, there is still room for a little creativity andinnovation in the workplace!
Steven Page and Susan HamerEditors
Editorial
Figure 1. Healthcare accreditation programmes—some issues to consider.
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