ACEHSA Accreditation Safeguards the Public Interest

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The Accrediting Commission on Education for Health Services Administration

by Steven M. Sundre, Ph.D.

You can accomplish anything in life, provided that you do not mind who gets the credit.

-Harry S. Truman

The public has a crucial stake in the caliber and quality of professional program accreditation. Indeed, promoting the safety, the health, and well-being of the citizenry through rigorous preparation programs is among the principal objectives of programmatic accreditation in the health services professions. In todayís competitive environment, the organization, management and evaluation of health services is central to preserving, repairing or promoting personal health status. The professions of health services administration are accountable to the public in return for the trust the public places in health services organizations.

Accreditation is the principal mechanism whereby academic preparation programs in health services management renew, extend and enhance that knowledge and those techniques deemed critical to professional practice and to the public good. Yet, the concept of program accreditation in health services remains elusive in the public eye. Perhaps the most that can be said of public perception is that to be accredited is "good," to be dis-accredited is "bad" and to be unaccredited is problematic.

No professional field remains static. Health administration is no exception. New knowledge is created, tested, synthesized, applied, evaluated and adopted daily. Fields of professional health management practice are amoeba-like creatures, expanding and contracting in response to public perception, environmental change, regulatory pressure and economic condition as new knowledge applications emerge. Nowhere is rigorous attention to effective professional preparation more critical than in the management of the nationís health resources and the overseeing of institutions designed to distribute those resources.

Noted accrediting expert Kenneth E. Young and his associates, in their 1983 Understanding Accreditation, present a compendium of essays on aspects of institutional and specialized accreditation. Although written two decades ago, the five basic themes articulated in this widely heralded work, highlighted in bold-print here, remain important guideposts today. As public interest in the caliber and quality of health services increases, accreditation emerges as a principal mechanism for ensuring highly trained health professionals. Attention to these five themes promote the public interest:

One:

Accreditation is a valuable - perhaps even essential - social tool whose usefulness and effectiveness have not been fully appreciated and whose full potential has yet to be realized.

A dynamic and ever-evolving society requires parallel forces governing its health institutions. Self-regulated, professional program accreditation performs that function by focusing on the frontier of new knowledge to be explored, mastered and extended to all preparation programs wishing to be called "accredited" By so doing, the interests of the public in safe, accessible and affordable health services are extended.

Recently emerging interest in professional competency assessment and its application to graduate preparation programs holds promise in raising the bar for additional accountability to the public. In the evolution of programmatic accreditation over the past twenty years, heightened attention to the competency of individuals graduating from accredited health management programs has emerged. Such attention has been possible due to strides made in educational assessment technology and identification of competency components as the health management education field has matured.

Programmatic accreditation, properly applied, is indeed a social "tool" As a tool, its components are modified over time as the job it is expected to do also evolves. Just as it is unlikely that a simple screwdriver and wrench can fix a modern car engine, so too must the diagnostics, repair and treatment protocols for todayís modern health organization change to address its increasing complexities.

As a social tool, therefore, the ACEHSA program of accreditation has increased in usefulness and effectiveness as heightened attention has been paid to the appropriateness of accrediting criteria, standards measurement and the emerging application of reasonable outcomes assessment to individual competency. The publicís confidence in its investment in graduate health management preparation programs is enhanced as the bar for professional practice is raised through profiling the competencies by which the profession is defined.

Two:

Accreditation began as a voluntary, non-government process and should remain so if its inherent values are to be preserved and enhanced.

Self-regulation in any profession normally leads to higher standards than other forms of regulation. Advancement of a profession by its members raises both the ceiling on the knowledge base and the level of competence by which membership in the profession is maintained. Ever more rigorous standards of performance translated into preparation program excellence serves the public well.

Conversely, external regulation often results in a lessening of commitment to excellence, since only thresholds of program quality ("lowest common denominators") are enforceable across wide groups of programs and individuals. Accountability enforced by non-experts can have the effect of depressing personal ownership in the professional decision-making process. Performance is then measured by rules followed rather than attention to ever-expanding dimensions of professional excellence. Programs become stagnant, repetitive and predictable.

Three:

Accreditation is a process that, at its heart, consists of guided self-evaluation and self-improvement and serves as a centerpiece to the little-understood, informal, but elaborate [commitment to] self-regulation in post-secondary education.

The primary value of accreditation is to be found in the process itself, not in the formal results of the process - - that is, the announced decision on whether a Ö program is accredited.

Members of the public should be encouraged to know that guided self-evaluation and self-improvement has been the mission of ACEHSA since its inception. ACEHSA Criteria and Program of Accreditation materials periodically undergo rigorous examination, review, dissemination, adjustment and testing. The widest possible faculty and practitioner audience is solicited for input.

Self-regulation in post-secondary education is among the most potent forces to ensure reasonable applications of standards across wide groups of collegiate preparation programs. The accrediting process offers channels of communication between geographically dispersed faculties, presents common core content concepts to be adapted to individual university circumstance, and creates opportunities for knowledge-sharing beyond institutional boundaries. It is by this process of self-improvement, challenge and adaptation supplied by ACEHSA affiliation that graduate preparation programs assure the vigor and productiveness of their educational offerings.

The vibrancy of any profession is driven by the caliber of individuals seeking to practice it. Professional standards increase when the members of the profession aspire to higher levels of competence.

Accreditation also serves the public interest by providing students with a "litmus test" that signifies the education they are receiving meets or exceeds the standards of what the profession has judged appropriate academic preparation. Therefore, students, as consumers, can be assured their investment in advanced education is likely to pay the dividends they anticipate. Accredited programs attract better students as a result. Better students have greater potential to improve professional practice. Improved professional practice serves the public interest.

Four:

Accreditation should be judged by its effectiveness in encouraging and assisting the [program] to evaluate and improve its educational offerings. All other outcomes and uses of accreditation are secondary to this objective and should not undermine it. To be effective, accreditation must focus primarily on the Ö program, just as education must focus on the student.

In recent months there has been considerable debate in professional circles about the future impact of health management education and health administration graduate programs on health organizations. Heightened attention to individual student/graduate competency forms the basis of the discussion. Health management education leadership is indeed challenged by increasingly troublesome organizational complexities brought on by consolidation, regulation, diffusion, differentiation, expansion, unionization and any number of "--I-O-N-S" that have become commonplace in this first decade of the 21st century. Leadership positions require an ever-increasing level of individual professional sophistication in order to creatively and competently deal with the issues.

Competitive graduates capable of achieving distinction in wrestling with the myriad of countervailing forces affecting health care delivery should be the goal of every health management preparation program. The unique authority of ACEHSA lies in assuring the public that the preparation programs it endorses possess

in order to justify the public trust.

Prudent accrediting organizations approach competency assessment and "testing to the standard" with care. Many point to the national experience of the leadership in elementary and secondary education during the past decade. Proficiency assessment in our nationís public and private, elementary and secondary schools has consumed public policy, not always to the good. Testing and assessment of our school children occur at every turn, prompting the emergence of a not-flattering but accurate comparison:

"You donít fatten cattle by weighing them."

Accreditation must focus on the program, just as the program focuses on the education of the student.

Five:

Accreditation is highly vulnerable to misuse and abuse by those who wish to turn it to other purposes. But there are enough countervailing forces Ö to offset perversions of the process or power plays.

A review of voluntary accreditation reveals examples when the process has been used for various purposes beyond programmatic review, professional preparation assessment and accountability. Many can point to instances of perceived abuse of the process as various forces seek to use the "hammer of accreditation" to further political and/or exclusivity agendas.

However, the field of health services administration can be extremely proud of the way in which the structure of the ACEHSA has been organized, extended and enhanced to minimize instances of misuse and abuse. While the vast majority of programmatic accrediting organizations are solely or very substantially collectively governed only by the academic programs, schools or colleges, ACEHSA is broadly representative of the various fields and modalities of health management practice. This is an extremely important point. By balancing those representing academic content and its advancement with those responsible for actually running health care organizations and improving their management daily, the result is accrediting Criteria that contain strong elements of management theory, practical application and ethical dimension. This structure allows for better articulation between theory and practice, improved accountability mechanisms, and better communication between preparation programs and practice organizations.

This Criteria then becomes self-improving and self-adapting as the leadership from the full spectrum of health management education and practice bring their best minds to the table to determine what academic programs should be doing now and in the future to meet established and projected needs.

These national health management membership organizations have banded together to establish and support an interdisciplinary, practice-focused accrediting organization capable of convening and supporting the type of visionary leadership necessary to keep graduate health management education programs vibrant and focused on fulfilling the public trust:

American College of Healthcare Executives (ACHE)

American College of Medical Practice Executives (ACMPE)

American Hospital Association (AHA)

Association of University Programs in Health Administration (AUPHA)

Blue Cross Blue Shield Association (BCBS)

Canadian College of Health Services Executives (CCHSE)

Federation of American Hospitals (FAH)

Healthcare Financial Management Association (HFMA)

Healthcare Information and Management Systems Society (HIMSS)

The public is indeed well served by the checks and balances and diversity of viewpoint these national ACEHSA sponsors bring to the organization and delivery of health services through their participation in health management educational program accreditation.

Summary

Daily, we are reminded that the publicís investment in attaining quality health and medical care is among the most important priorities of our nationís citizens. Central to realizing that attainment is the level of professional competence of those charged with managing the nationís health resources. The not-for-profit Accrediting Commission on Education for Health Services Administration is the sole national organization governing the standards by which future health managers, administrators and executives are educated and trained in accredited graduate programs. The impact of the ACEHSA is growing as health and medical leaders, government and regulatory policy-makers, insurance executives, special interest groups and, of course, members of the public increasingly realize that top-flight health care delivery requires excellence in the management of health resources.

Steven M. Sundre, Ph.D. serves as a Public Commissioner for the Accrediting Commission on Education for Health Services Administration. He is Distinguished Research Professor at The University of Dayton and Executive Vice President, SchoolMatch® by Public Priority Systems, Inc., a Columbus (OH) based national educational services, consulting and research firm.

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