Research ArticleDoes Accreditation Stimulate Change? A Study Of The .
Pomey et al. Implementation Science 2010, /1/31ImplementationScienceOpen AccessRESEARCH ARTICLEDoes accreditation stimulate change? A study ofthe impact of the accreditation process onCanadian healthcare organizationsResearch articleMarie-Pascale Pomey*1, Louise Lemieux-Charles†2, François Champagne†1, Doug Angus†3, Abdo Shabah†4 andAndré-Pierre Contandriopoulos†1AbstractBackground: One way to improve quality and safety in healthcare organizations (HCOs) is through accreditation.Accreditation is a rigorous external evaluation process that comprises self-assessment against a given set of standards,an on-site survey followed by a report with or without recommendations, and the award or refusal of accreditationstatus. This study evaluates how the accreditation process helps introduce organizational changes that enhance thequality and safety of care.Methods: We used an embedded multiple case study design to explore organizational characteristics and identifychanges linked to the accreditation process. We employed a theoretical framework to analyze various elements and foreach case, we interviewed top managers, conducted focus groups with staff directly involved in the accreditationprocess, and analyzed self-assessment reports, accreditation reports and other case-related documents.Results: The context in which accreditation took place, including the organizational context, influenced the type ofchange dynamics that occurred in HCOs. Furthermore, while accreditation itself was not necessarily the element thatinitiated change, the accreditation process was a highly effective tool for (i) accelerating integration and stimulating aspirit of cooperation in newly merged HCOs; (ii) helping to introduce continuous quality improvement programs tonewly accredited or not-yet-accredited organizations; (iii) creating new leadership for quality improvement initiatives;(iv) increasing social capital by giving staff the opportunity to develop relationships; and (v) fostering links betweenHCOs and other stakeholders. The study also found that HCOs' motivation to introduce accreditation-related changesdwindled over time.Conclusions: We conclude that the accreditation process is an effective leitmotiv for the introduction of change but isnonetheless subject to a learning cycle and a learning curve. Institutions invest greatly to conform to the firstaccreditation visit and reap the greatest benefits in the next three accreditation cycles (3 to 10 years after initialaccreditation). After 10 years, however, institutions begin to find accreditation less challenging. To maximize thebenefits of the accreditation process, HCOs and accrediting bodies must seek ways to take full advantage of each stageof the accreditation process over time.IntroductionToday's healthcare organizations (HCOs) struggle withparadoxes of all kinds. They must reconcile multiplegoals, such as teaching students and caring for patients,with different modi operandi (managerial, professional,* Correspondence: marie-pascale.pomey@umontreal.ca1Department of Health Administration, GRIS, Faculty of Medicine, University ofMontreal, CP 6128, Succ. Centre Ville, Montreal, Québec, Canada H3C 3J7† Contributed equallyFull list of author information is available at the end of the articletechnocratic, and others) [1,2]. They must give doctorsthe freedom to exercise their clinical judgment while promoting the standardization of practices [3]. They mustact autonomously, yet in coordination with communityplayers, and they must both meet expectations and innovate. In addition, they are under increasing pressure toimprove performance, as a number of recent publicationshave reported serious shortcomings in the quality andsafety of services and care [4-8]. 2010 Pomey et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsBioMed Central Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.
Pomey et al. Implementation Science 2010, /1/31One of the ways in which countries around the worldhave sought to improve performance is through accreditation [9-12]. A literature review of the impacts of accreditation on HCOs suggests that more research is necessaryto determine whether accreditation truly improveshealthcare services delivery and health outcomes [13].This is certainly the case in Canada, where even thoughaccreditation through the United States' Joint Commission of Healthcare Organizations dates from the beginning of the twentieth century, little is known about thereal impacts of the accreditation process on CanadianHCOs [14-19]. Still, recent government-commissionedreports that recommend making accreditation obligatoryfor all HCOs demonstrate the prevalence of Canadians'assumption that accreditation is a guarantee of a highlevel of quality and safety of care [6,7].Given this background, our study aimed to clarify theimpacts of accreditation in Canada by asking the following question: what kind of organizational changes doesthe accreditation process introduce within HCOs?To answer this question, we analyzed changes thatoccurred during a recent accreditation cycle in five Canadian HCOs. The lack of result indicators during theperiod of study prevented us from assessing the impact ofaccreditation on patient outcomes. Rather, we identifiedthe principal organizational changes that occurred duringthe accreditation cycle.Overview of accreditation in CanadaIn Canada, questions of the quality of care fall mainly tothe provinces, where they have principally been treated asa professional concern, with the provincial college of eachmedical specialty regularly monitoring its members. Inaddition, Accreditation Canada (formerly the CanadianCouncil on Health Services Accreditation--CCHSA)helps guarantee uniformity throughout the Canadian system. A member of the International Society for Quality inHealth Care [20], Accreditation Canada is a national,non-profit, independent organization that was created in1958 to help guarantee that healthcare organizationsacross Canada furnish services of acceptable quality.Accreditation Canada follows international accreditationrules regarding HCOs' self-assessment against a given setof standards, an on-site survey followed by a report withor without recommendations, and the award or refusal ofaccreditation status. The standards are determined byprofessional consensus.The understanding between the accrediting body andthe HCO is that the information in the accreditation visitreport remain strictly confidential. However, a list ofaccredited establishments is published on the Accreditation Canada website. In Canada, accreditation surveyorsmust adhere to their role as evaluators and quality advisors, not whistle-blowers, although those who notice sig-Page 2 of 14nificant problems tend to notify the authorities. Finally,even though accreditation in Canada is voluntary (exceptfor First Nations' facilities, university-affiliated hospitals,and since 2005, institutions in the province of Quebec[21]), 99% of Canada's short-term stay institutions, 85% ofits mental health establishments and 80% of its long-termcare institutions participate in accreditation [22].Theoretical frameworkTo study the changes that took place in five CanadianHCOs as a result of the accreditation process, weemployed a theoretical framework that had previouslybeen used to analyze organizational changes in a FrenchHCO during the self-assessment phase of accreditation[23,24]. Based on the literature on the theory of change,this framework inventories changes that take place as aresult of the accreditation process and explores theimpact of internal and external conditions (Figure 1). Thefeatures of the changes are studied in terms of their characteristics (conceptual approach and action strategies)and their issues (strategic transformation, organizationaltransformation and transformation of the relationship).Insofar as internal and external conditions are concerned,four factors are seen to promote change: (1) an environment that exercises external pressure and allows a projectto go forward; (2) the existence of certain basic factors;(3) a realistic conceptual approach and specific implementation strategies; and (4) appropriate skills and leadership.While our study is exhaustive in its listing of thechanges that took place in the institutions studied, thenumber of case studies and the number of changesobliged us to limit our discussion to the most significantways in which organizational changes related to contextual conditions.Study design and methodsBetween 2003 and 2005, we conducted an in-depth retrospective case study [25] of five HCOs with differentaccreditation statuses. Rather than aim for the best possible internal and external validity [26,27], we chose toassess a small number of cases in detail [28,29], conducting a multi-case study with multiple levels of analysis[26,29].Case selectionThe literature suggests that context often has an important influence on organizational change [30]. For that reason, we selected cases that represented a variety ofaccreditation situations in Canada but still followed thesame accreditation program: Achieving Improved Measurement [31]. This meant that all cases possessed thesame comprehensive accreditation report. We used threeselection criteria simultaneously. The criteria were chosen by the research team for their particular importance
Pomey et al. Implementation Science 2010, /1/31Page 3 of 14Conditions favouriing the emerggence and proopagation of change General environmentEnvironment exxerting strongg pressure in foreseeable wways Organiizational Fundamenntals xxxxxSuurplus capacitties of leegitimate actoors Discretionary aautonomy Inntellectual and relational skkills of actors Shharing of infoormation An open and eexplicitly deescribed project Accredditation cyclexxxConcepptions Deductive: top/down Inductive: bbottom/up Straategic transfoormation Accquisition of quality baased manageement Conceptions and strrategies xxxxxAcquuisition of neww models Iteraative understaanding Disseemination/propagation Learnning Buy in Leaddership and ccompetencyxxxxxVisible enngagement of actors with strong leadership potential Identificaation of resouurce people Project innitiators and implementerrs with recognizeed legitimacyy Ongoing valorization oof projects Competeencies in quality managemment Characteristtics of changees AAction Strateggiesx Internal: coopperative/disruuptive x External: manEnipulative/autthoritative x Alongside: incAcentive/influeence/authoritty/engagement Isssues Organizzational transsformation Transsformation off the relationnship x Symbbolic/physical//organizationnx Betwween the orgaanization and its al struucture envirronment x Proceess/actor x Trajecctory/performmance Figure 1 Conditions and characteristics of change [24].to the Canadian context. The first criterion was geographical location. We wished cases to represent Canada's four general cultural zones: the Western and prairieprovinces (British Columbia, Alberta, Saskatchewan andManitoba), Ontario (Canada's most populous province),Quebec (Canada's only French-speaking province), andthe Atlantic provinces (Nova Scotia, New Brunswick,Newfoundland and Labrador, and Prince Edward Island).The second criterion related to HCOs' organizationalstructure. Substantial structural reforms have taken placein Canada over the past 20 years, giving rise to threekinds of establishments, largely organized by geographical region: 1) regional health authorities (RHAs) in theWestern and Atlantic provinces, 2) merged academicHCOs in Ontario, and 3) hospitals in Ontario and Quebec. The third and last criterion regarded accreditation
Pomey et al. Implementation Science 2010, /1/31status, namely, the length of time the HCO had beenengaged in accreditation. A Canadian study [17] showedthat changes within HCOs differed according to the number of years the HCOs had spent participating in accreditation. In other words, changes varied according towhether an HCO was in its first accreditation cycle, hadalready experienced several cycles, or had participated inaccreditation for over 10 years. To reconcile these criteria, we asked Accreditation Canada for a list of HCOsthat participated in accreditation with the HCOs' location, their type of organization, and the number of yearsthey had been involved in the accreditation process. Withthis information, we chose five establishments that represented the diversity of Canada's HCOs at the time ofselection. This allowed us to follow Creswell's recommendations for qualitative research and study severalcases in depth in order to maximize lessons learned.The five cases retained were as follows: a RHA inAlberta that had participated in accreditation for the firsttime (Case 1); an urban hospital in Ontario that had participated in accreditation for many years (Case 2); an academic center in Ontario that had recently merged into anewly accredited HCO, the constituent institutions ofwhich had all been previously accredited (Case 3); a semirural hospital in Quebec that had been accredited formany years (Case 4); and a RHA in New Brunswick thatwas newly accredited, the pre-merger institutions ofwhich had all been accredited in the past (Case 5). Table 1summarizes the characteristics of each case.Data collection methodsThe use of multiple data sources is helpful in generatingcomplex theories and strengthening empirical grounding[32]. Our use of multiple sources allowed us to address awide range of issues and obtain a nuanced understandingof the context of events that affect the relationshipbetween accreditation and changes in quality. Accordingly, we collected retrospective data via document analysis, 25 interviews and 10 focus groups. Insofar asdocuments were concerned, we accessed both the HCOs'self-assessment reports and their accreditation reports.For interviews, we talked to chief executive officers(CEOs), quality directors/vice-presidents, humanresources directors/vice-presidents, medical directors/vice-presidents and nurse directors/vice-presidents witha view to discerning top management's perception of theimpact of the accreditation process. We conductedbetween five and seven interviews at each site and foreach interview, we used a semi-structured questionnairecomposed of four sections adapted from the study inFrance and previously tested in two Canadian HCOs (oneFrench-speaking and one English-speaking). Our focusgroups were designed to obtain the perceptions of staff.Accordingly we conducted two focus groups at each site,one with a sample of employees who had been involved inPage 4 of 14the clinical self-assessment team (between 8 and 10employees per site) and another with a sample of employees who had been involved in the support self-assessmentteam (i.e., employees from the Leadership and Partnership Team, the Environment Team, the Information Management Team and the Human Resources Team; betweenfive and eight employees per site). In the focus groups, weagain used a semi-structured questionnaire with the samefour sections, also tested in English and French. Eachinterview or focus group lasted one to two hours. Allwere taped and transcribed for analysis with N-Vivo. Thecomposition of each focus group was determined by thesite's quality director in concert with the primary authorand was made up of representatives from departmentsacross the HCO. In total, 67 participants were involved inthis study: 25 in interviews and 42 in focus groups.Data analysisFor each case, the interviews and the focus groups weretranscribed and processed using N-Vivo software (QSRInternational). The documents were also analyzed usingN-Vivo. All data were examined in light of our theoreticalframework. To cross-compare cases, we used techniquesfor data reduction and presentation similar to those suggested by Miles and Huberman [33,34]. Research teammembers collectively analyzed and interpreted the resultsusing deductive methods related to our theoreticalframework. Our research team was staffed by professionals from a variety of backgrounds, namely, economics,public health, sociology, management, medicine, andnursing. In order to validate our analysis, we forwarded apreliminary research report to each quality director forcomment [35-39]. Our interpretation of the entire set ofdata integrates these directors' feedback and their validation of our results.ResultsIn this section, we present the conditions of change andthe organizational changes that occurred during theaccreditation cycle studied, for each case. A summary ofthe conditions favoring organizational change are presented in Table 2.Case 1A newly created RHA made up of the merger of severalHCOs, none of which had previous experience with theaccreditation process.Conditions for the implementation of changeAlberta in the early 1990s was experiencing serious financial problems that caused cuts to healthcare services.These cuts mandated a more integrated healthcare system with lower spending and more stable funding. In1994, Alberta's Regional Health Authorities Act established 17 autonomous health regions. In 1998, Alberta's
Page 5 of 14Pomey et al. Implementation Science 2010, /1/31Table 1: Profiles of the casesGeneral characteristicsCase 1: Rural regional healthauthorityCase 2: University healthcarecenterCase 3: General hospitalCase 4: Local hospitalCase 5: Urban regionalhealth authorityProvinceAlbertaOntarioOntarioQuebecNew lation served300,0001,500,000400,000135,00086,000Number of employees8,000 staff and 350 physicians10,600 staff and 1125 physicians2,400 staff and 400 physicians1037 staff and 102 physicians2,600 staff and 340 physiciansNumber of sites and beds35 sites and 1300 beds3 sites and 1099 beds2 sites and 500 beds1 site and 303 beds8 sites and 425 beds in 2hospitalsDate of accreditation visitstudied; accreditationstatus awarded2002; accreditation with report(3 key recommendations and 3recommendations)2004; accreditation (9recommendations and 9 goodpractices)2003; accreditation with report(20 key recommendations, 18recommendations and 1 goodpractice)2003; accreditation withreport (9 keyrecommendations and 3recommendations)2002; accreditation withreport (3 keyrecommendations and 2good practices)Length of participation inthe accreditation processSince 2002Since 2000 for the new entitySince 1951Since the 1980sSince 1998 for the new entityNumber of accreditationteams15 clinical teams4 support teams17 clinical teams4 support teams8 clinical teams4 support teams8 clinical teams4 support teams8 clinical teams4 support teamsResearch site visit datesNovember 1 and 2, 2004June 16 and 17, 2004December 5 and 6, 2004June 21 and 22, 2004June 1 and 2, 2004Type of accreditationNon compulsoryCompulsoryCompulsoryNon compulsoryNon compulsory
Page 6 of 14Pomey et al. Implementation Science 2010, /1/31Table 2: Conditions favouring organisational changesDeterminantsCase 1Case 2Case 3Case 4Case 5General environmentSerious financial problems andmajor financial cuts.New provincial accountabilityagreement.Presence of the Foundation ofLeadership and its Thousandand One Leaders Program.Financial pressure.Absence of a faculty ofmedicineFew opportunities for externalrecognition.FundamentalsMerger into a single region.Quality of care and clientcentering recognized asimportant values.Teamwork and creativityencouragedMerger of three hospitals.Increase in cognitive capacitiesby hiring new staff with higherqualifications and experience.Autonomy encouraged.Placement under theguardianship of a supervisor in2001 and again in 2002.New board committeestructure and a new set ofboard policies.A new CEO appointed in 2003.High turnover of personnel.Increasing services offered tomeet to the needs of the localpopulationRecruitment campaign to hire50 physicians.Good relationships with theministry of health.Merger into a RHAAppointment of a new board.Focus on patient care.StrategiesCreation of forums whereleadership seeks staff input;numerous newsletters; onlinechats; investigative teamsfrequently created to inform quickdecisions.Surveys, regular visits fromvice-presidents, regularmeetings of professional teams.Communication plan for theentire hospital for everydecisions taken by the board ofdirectorsManagers meet monthly withclinical and support assistants;multidisciplinary unit councilsmake decisions for majorinitiativesProfessionals are consulted onall mattersHorizontal exchanges of ideasand horizontal learning anddissemination of information.Training courses, includingincident reporting system;audits; patient surveys;benchmarking.Leadership andCompetenciesStrong leadership by experiencedmanagement at all levelsCEO'sinvolvement in QI.Creation of a quality departmentand quality teams for theaccreditation process.High level of leadershipdissemination.CEO's personally involved in QIMember of the Foundation ofLeadership and its Thousandand One Leaders Program.Strong legitimacy of the qualitydirectorStrong leadership by the CEO.Focus on outcomes and notprocesses -Leadership for QI encouragedat all levelsDirector of QI and Risk Managerseen as leaders.Conceptualization/PhilosophyDeveloped a confident andaccountable method of decisionmaking.Seemed to have the ability tocritique itself.Seemed keen to accept newmodel of thinking.Felt the duty to meet publicexpectations.Presented a certain lack of selfworth
Pomey et al. Implementation Science 2010, /1/31per capita health spending dropped to the lowest in Canada. In 2003, the 17 health regions were reduced to nine.The consensus from study participants was that leadership was strong and concerned not only the CEO butmanagement at all levels. Both medical and informalleadership were recognized. Changes were sometimeunexpected and were sometimes economically or politically driven, but even as the organization expanded, itsworkers and their knowledge of history remained, givingstaff stability and a sense of continuity. Because of frequent changes and stable leadership, this RHA had developed a confident and accountable decision-makingapproach.Changes during the accreditation cycleIt was clear the changes during the self-assessment phasewere substantial; indeed, the most important changesimplemented during the accreditation cycle had beenidentified during self-assessment. Preparations foraccreditation were mostly conducted by the new qualitycontrol entity, and nurse managers were mainly in chargeof organizing the process. The RHA mainly used accreditation to integrate the pre-existing entities into the newentity. It instituted a Quality Department and QualityImprovement Teams specifically for the accreditationprocess, and the self-assessment phase created theopportunity for individuals from different sites to meet,begin to overcome their differences and start seeingthemselves as part of one new organization. The RHAwas a large organization composed of a number of facilities spread over a wide geographical area. The accreditation process also proved to be a means for the RHA toinvolve community members in decision-making anddetermination of the organization's orientation. Beforethe accreditation visit and the report, the RHA hadalready worked to remedy some of its problems:"There were major issues that my team identified.Some of them sort of overlapped into each other aswell, and one of them was related to fire drills acrossthe region. There were no documented standardsaccording to which [the drills] should occur, and therewas no documentation to identify what to do in caseof fire. So actually once it was identified, there hadbeen, before the surveyors even came, there was somework being done on trying to correct that problem."(Case 1 - Clinical Focus Group)Respondents considered that accreditation's highlighting of problem areas helped the institution set prioritiesand accelerate procedures to implement change becauseof the pre-determined structure of the accreditation process, which required participants to answer to the accrediting body regarding matters where change was expected.In addition, the Quality Steering Committee asked eachself-assessment team to name its top three priorities andidentify eight to ten regional priority areas for the entirePage 7 of 14organization to start working on before the surveyorsarrived and/or the final report was issued.Many of the resulting changes took place at the publichealth level (the interconnection of immunization registries and community mapping) and at the clinical level(new space and equipment in the nursery unit, new evidence-based practices in maternal child and palliativecare, and new ambulatory and emergency services planning)."So for the continuing care team, following theaccreditation report, on one hand the best practicesteam took all the suggestions. to improve anddevelop practices, and on the other hand, it set priorities and incorporated them into our operational planwherever they needed to be" (Case 1 - Support FocusGroup).Several improvements also occurred at the management level: a new information management strategy wascreated, a new performance appraisal process was implemented, and the positions of director of human resourcesand education officer were merged. At the regional level,a security and incidents committee, a research committeeand an ethics committee were set up.Case 2An academic healthcare facility in Ontario that hadrecently merged into a new HCO and was experiencingits first accreditation cycle. All three pre-merger institutions had been accredited in the past.Conditions for the implementation of changeThe greatest environmental pressure exerted on this hospital was the 1998 merger that created it subsequent to adecision by the Ontario Health Services RestructuringCommission. A provincially legislated accountabilityagreement was also increasing financial pressure: in thewords of one interviewee, the hospital had already beenunder an 8-year "fiscal siege". Regarding organizationalconditions, the hospital encouraged a high degree ofautonomy, which facilitated the implementation ofchange. In addition, Board of Directors meetings wereopen to all staff members, who were welcome to participate in Board decisions. The CEO also held regular openforums where employees had the opportunity to learnabout management decisions and could express theirconcerns. Professional development was encouraged viaprofessional teams that met regularly and the hospitalhad a high level of leadership diffusion, meaning that alllevels of staff, from nurses to senior management, wereinvolved with and responsible for creating quality initiatives. The hospital tried to hire physicians with leadershipand administration skills, and these personnel, along withthe leadership of key senior managers, was helping theinstitution become recognized as a leader in some areas,especially quality and patient safety, both within the com-
Pomey et al. Implementation Science 2010, /1/31munity and nationally. Finally, stakeholders were encouraged to participate in the institution's functioning.Changes during the accreditation cycleWhile this was the new, integrated HCO's first accreditation process, all three pre-merger institutions had beenaccredited for over 5 years. The accreditation processtook place just a few months after the merger and wasconducted by nurse managers who were also in charge ofquality improvement. Doctors' participation varied byself-assessment group, but overall, doctors did not muchparticipate. Despite a history of competition, the threesites were obliged to work together during the accreditation process. At the beginning of the self-assessmentphase, staff seated around the table had divided into threegroups, each of which spoke to the moderator but not tothe other groups. By the end of the self-assessment phase,staff from different sites sat in mixed groups around thetable. They also exchanged protocols, discussed means ofimplementing common working procedures, and collaborated on better integrating the patient pathway withinthe organization. In this way, even though accreditationwas not linked to the merger per se, the CEO felt that itserved to accelerate the merging process."In the process of merging, accreditation showed noimpact on the merger decision itself: this was a strongexternal process solely directed by outside forces. Butit showed great impact as a framework to speed andshare a totally new culture." (Case 2 - CEO's Interview)No changes took place during the site visit. After thevisit, most changes resulted from the accreditationreport. Three changes affected group practices: socialwork hours in the intensive care unit were increased,medical quality improvement and risk indicators andactivities were incorporated into the institution's qualityprogram, and a pain management tool was developed andimplemented. Additional changes involving the entireorganization concerned new, improved reporting mechanisms on safety, quality, and risk, including adverseevents; the resolution of space and equipment issues inambulatory care; and the implementation of an ethicscommittee. The accreditation report had mentioned theneed to centralize rehabilitation services and to collectinformation on population health determinants such asobesity, smoking, and poverty. As a result, the HCO solicited the help of the provincial government in securingcapital for new
whether an HCO was in its first accreditation cycle, had already experienced several cycles, or had participated in accreditation for over 10 years. To reconcile these crite-ria, we asked Accreditation Canada for a list of HCOs that participated in accreditation with the HCOs' loca-tion, their type of organization, and the number of years
Practice Accreditation Program Web based program launched in January 2011 Application, interview and data collection forms, surveyor report and summary are all captured electronically No more paper ACR-ASTRO accreditation outcomes 3 Categories: Accreditation Defer Denial of Accreditation ACR-ASTRO Accreditation Accreditation Cycle is 3 years
o Accreditation Visit by the Commission on Public Schools o Accreditation Decision Substantive Change Policy Glossary . 3 NEASC CPS - Accreditation Handbook (Revised Fall 2021) Overview of the Redesigned Accreditation Process The NEASC Accreditation process is a 10-year cycle intended to serve as a guide for schools to meet .
The Accreditation Criteria are divided into three levels. To achieve Provisional Accreditation, a two year term, providers must comply with Criteria 1, 2, 3, and 7–12. Providers seeking full Accreditation or reaccreditation for a four-year term must comply with Criteria 1–15. To achieve Accreditation with
This will result in one accreditation determination that will apply to all the facilities in the group. Length of Accreditation Cycle. APEx accreditation is granted for up to four years. In order to avoid a lapse in accreditation, the ROP must complete the next facility visit no later than 90 days after the expiration of its current accreditation.
Accreditation Application Review Process The accreditation application review is the first step in the accreditation process. Once submitted, the SSH Accreditation staff will review the application. If the application is complete and all eligibility criteria met, an on-site review will be scheduled. Accreditation On-Site Survey Process
Accreditation Issue date Expiration date Not applicable The Joint Commission Accreditation CARF accreditation AOA accreditation COA accreditation Please list other accreditation(s) held by your organization Licensure/certification Entity issuing license or certification Type of license or certificate License number Expiration date 1. 2. 3. 4.
CONTINUING PROFESSIONAL DEVELOPMENT (CPD) ACCREDITATION . Application for Accreditation – Program (for Professionalism Content only) Application Instructions . Review the detailed instructions for applications for accreditation on the . CPD Accreditation Process . page and .
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