Factors Affecting Implementation Of Accreditation . - Semantic Scholar
RAERVIEWT I C L EGloria KB NgGilberto KK LeungJanice M JohnstonBenjamin J Cowling吳幗寶梁嘉傑莊臻寧高本恩Factors affecting implementation of accreditationprogrammes and the impact of the accreditationprocess on quality improvement in hospitals: aSWOT analysisObjectivesThe objectives of this review were to identify factors thatinfluence implementation of hospital accreditation programmesand to assess the impact of the accreditation process on qualityimprovement in public hospitals.Data sourcesTwo electronic databases, Medline (OvidSP) and PubMed, weresystematically searched.Study selection“Public hospital”, “hospital accreditation”, and “qualityimprovement” were used as the search terms. A total of 348citations were initially identified. After critical appraisal andstudy selection, 26 articles were included in the review.Data extractionThe data were extracted and analysed using a SWOT (strengths,weaknesses, opportunities, threats) analysis.Data synthesisIncreased staff engagement and communication, multidisciplinaryteam building, positive changes in organisational culture, andenhanced leadership and staff awareness of continuous qualityimprovement were identified as strengths. Weaknesses includedorganisational resistance to change, increased staff workload,lack of awareness about continuous quality improvement,insufficient staff training and support for continuous qualityimprovement, lack of applicable accreditation standards for localuse, and lack of performance outcome measures. Opportunitiesincluded identification of improvement areas, enhanced patientsafety, additional funding, public recognition, and marketadvantage. Threats included opportunistic behaviours, fundingcuts, lack of incentives for participation, and a regulatoryapproach to mandatory participation.ConclusionsBy relating the findings to the operational issues of accreditation,this review discussed the implications for successful implementation and how accreditation may drive quality improvement.These findings have implications for various stakeholders (government, the public, patients and health care providers), when itcomes to embarking on accreditation exercises.Key wordsAccreditation; Hospitals, public; QualityimprovementHong Kong Med J 2013;19:434-46DOI: 10.12809/hkmj134063Department of Surgery, The Universityof Hong Kong, Queen Mary Hospital,Pokfulam, Hong KongGKB Ng, BSc, MPHGKK Leung, MB, BS, FHKAM (Surgery)School of Public Health, The Universityof Hong Kong, Pokfulam, Hong KongJM Johnston, PhD, FFPH(RCP)(UK)BJ Cowling, BSc (Warwick), PhD (Warwick)Correspondence to: Ms Gloria KB NgEmail: gloriakbng@gmail.com434IntroductionAccreditation, defined as “a public recognition by a national healthcare accreditationbody of the achievement of accreditation standards by a healthcare organization,demonstrated through an independent external peer assessment of that organization’slevel of performance in relation to the standards”,1 is an important strategy for qualityassessment and improvement in health care.2 Accreditation can be conducted by statutoryor voluntary bodies that offer organisational development through external assessmentof health services by means of published standards. External assessment determineswhether a health care organisation complies with international standards and can providequality assurance.3 Accreditation is usually performed by a multidisciplinary team of healthprofessionals and the assessments often include self-appraisal, on-site surveys, peerreview interviews, review of documentation, checking of equipment, and the appraisal ofkey clinical and organisational data.4Hong Kong Med J Vol 19 No 5 # October 2013 # www.hkmj.org
# Implementation of accreditation programmes #Concerns have been raised on whetheraccreditation may only result in organisationalchanges in standardisation and decision-makingprocesses for care, rather than actual improvedquality of care.5 There is at present a lack ofevidence on the efficiency and effectiveness ofthese programmes and the factors which may affectsuccessful implementation.3,6-10 A recent review byHinchcliff et al11 concluded that there is a lack ofstrong evidence to support the effectiveness of healthservice accreditation and highlighted knowledgegaps from empirical research. Another review thataimed to analyse research into accreditation reportedthat consistent findings were only recorded forpromoting change and professional development.12Alkhenizan and Shaw13 reviewed both general andsubspecialty accreditation programmes and reportedthat accreditation improved the process of care andclinical outcomes. It has been highlighted that therewas a paucity of high-quality controlled evaluationsabout the effectiveness of external inspection oncompliance with standards in improving health careorganisational behaviour, health care professionalbehaviour, and patient outcomes.14 This reviewsupplements previous findings by employing a SWOT(strengths, weaknesses, opportunities, threats)analysis to provide a comprehensive view of thefactors affecting the implementation of accreditationprogrammes and facilitates understanding of theirpotential �究篩選以「公立醫院」（public hospital）、「醫院認證」（hospital 計劃的相關問題。The SWOT analysis is described as “a list of anorganization’s strengths and weaknesses as indicatedby an analysis of its resources and capabilities, plus alist of the threats and opportunities that an analysisof its environment identifies”.15 It consists of aconfrontation between internal capabilities (strengthsand weaknesses) and external developments#2: Hospitals/ OR *Accreditation/ or hospital(opportunities or threats), and aids in identifyingaccreditation.mp. OR *“Joint Commission on16strategic options. This review was conducted in theAccreditation of Healthcare Organizations”/ ORcontext of an accreditation scheme introduced in*Quality Assurance, Health Care/Hong Kong. The Hospital Authority Pilot Scheme of#3: *“Outcome and Process Assessment (HealthHospital Accreditation in Hong Kong was started inCare)”/ OR *“Quality of Health Care”/ OR2009. We aimed to identify what factors could affect*Quality Assurance, Health Care/ OR *Totalthe successful implementation of an accreditationQuality Management/ or quality improvement.programme, and investigate the potential impact ofmp.the accreditation exercise on quality improvement in#4: #1 AND #2 AND #3public hospitals.The literature search was conducted on 12February 2011. The reference lists of the selectedMethodsarticles were also reviewed to identify further studiesTwo electronic databases, Medline (OvidSP) of interest, and to ensure that potentially relevantand PubMed, were systematically searched from articles were reviewed. Articles published up toinception to January 2011, using the following search January 2011 were included. Published non-Englishterms: “public hospital”, “hospital accreditation”, and citations and citations without an abstract were“quality improvement”. Medical Subject Headings excluded. Articles relevant to the objectives of this(MeSH) were used in order to create a focused search review were included using the following inclusioncriteria:strategy. The search strategy was as follows:#1: Public hospital.mp. OR Hospitals, Public/(1)Population was hospitals;Hong Kong Med J Vol 19 No 5 # October 2013 # www.hkmj.org435
# Ng et al #(2)(3)(4)(5)Intervention was implementation of hospitalaccreditation entstrategies,before-and-aftercomparison, or no intervention;Outcomes included the impacts of accreditationon quality improvement, or identification offactors or barriers that affect the successfulimplementation of accreditation programmes;Study design included observational studies (egtime series, cohort, cross-sectional, controlledand uncontrolled before-and-after comparison)or qualitative studies (eg discussion articles,case studies, and commentaries).Potentially relevantpapers identified andscreened for retrieval(n 348)Abstracts retrievedand assessed foreligibility (n 126)Papers excluded afterreviewing titles andcancelling duplicatecitations (n 222)Papers excluded afterreviewing abstracts(n 96)Full text retrieved forin-depth evaluation(n 30)Additional citationsSince it is difficult to evaluate qualityidentified from theimprovement programmes based on experimentalreference list of the 30methodologies,6 in order to provide a comprehensiveselected papers (n 13)assessment on the impact of accreditation on qualityimprovements in hospitals, this review includedqualitative studies. Observational studies of anyPapers excluded afterassessment of full textdesign and qualitative studies were included if they(n 17)were relevant to the objectives. Articles irrelevant tothe research questions or articles on single-specialtyaccreditation programmes and accreditation ofPapers included in the review (n 26)training were excluded. Reviews, periodicals,and conference reports were also excluded. Allrelevant data of the selected papers were extracted FIG. Selection process from databases of Medline Ovid andand summarised. Factors which may affect the PubMedimplementation of accreditation were identified andanalysed, using a SWOT analysis to illustrate theirpotential implications.ResultsInitially, 348 citations were identified from theelectronic database search; 126 citations remainedafter the first round of exclusions based on scanningof the titles and cancellation of duplicate citations.After reviewing the abstracts, 30 citations remainedand full texts of these were retrieved for furtherassessment. The reference lists of these 30 articleswere also reviewed and 13 additional citationsidentified. The selection process is illustrated inthe Figure. After critical appraisal and selection ofthe studies based on the defined inclusion criteria,26 articles were utilised in the final review. Theseincluded 9 cross-sectional studies, 12 discussionarticles, and 5 commentaries.Data in the selected articles were summarisedwith respect to details regarding study design,setting and participants, outcome measures, andkey findings (Table 14,6-8,17-38). As presented hereafter,factors affecting the implementation of hospitalaccreditation programmes and the impact ofaccreditation exercises were identified. These wereanalysed and classified using a SWOT analysis (Table2).436Hong Kong Med J Vol 19 No 5 # October 2013 # www.hkmj.orgFactors affecting the implementation of hospitalaccreditation programmesLinking to funding mechanismsHospital participation in accreditation programmesmay be associated with direct financial incentives,such as core funding or reimbursement. It hasbeen suggested that the strongest drive for hospitalaccreditation could be the prospect of additionalfunding.17 Hospitals may have to demonstrate qualitycare in order to satisfy funding and reimbursementsagencies’ requirements for acceptable qualityassurance systems.18In the United States, accreditation has asubstantial impact on a hospital’s accountability forquality of care, because participation in accreditationallows the hospital to participate in Medicare,which may act as a major source of funding.19Many hospitals in the United States rely on theJoint Commission on Accreditation of HealthcareOrganizations (JCAHO) accreditation programmefor continued participation in the Medicare andMedicaid programmes. Such participation providesan enormous share of reimbursements for mosthealth care institutions, by fulfilling the requirementsof hospital bond indentures, and for participation
# Implementation of accreditation programmes #TABLE 1. Summary of studies included for systematic reviewACHS denotes Australian Council on Healthcare Standards, AHRQ Agency for Healthcare Research and Quality, ANAES Agence Nationale d'Accréditationet d'Evaluation en Santé (National Agency in Accreditation and Evaluation in Health Care), CBA Consortium for Brazilian Accreditation, COHSASA Councilfor Health Service Accreditation of Southern Africa, CQI continuous quality improvement, FOES final overall evaluation score, HSP Hospital StandardizationProgrammes, IQIs/PSIs Inpatient Quality Indicators and Patient Safety Indicators, JCAHO Joint Commission on Accreditation of Healthcare Organizations, andQI quality improvementStudyStudydesignSetting and participantsOutcome measuresKey findingsEl-Jardali,7 2007 DiscussionarticleDiscussion of hospitalaccreditation policy inLebanon from year 2001 to2005Not applicable Hospitals might adopt opportunistic behaviours with the aim ofgaining the accreditation if the hospital funding mechanisms arelinked to the accreditation Setting up an independent body dedicated to qualityimprovements in hospitals can minimise the political interferenceto the hospital accreditation policy Barriers for effective implementation of hospital accreditationpolicy included organisational culture of resistance to changeShaw,17 2004Discussion of the use ofexternal assessment ofhealth servicesNot applicable The strongest drive for hospital accreditation was the prospect ofaccess to additional funding Organisational development was one of the major motives ofhospital management to implement accreditation programmeLinking to funding mechanismsCommentaryMandatory versus voluntary nature of accreditationDiscussionarticleDiscussion of Frenchaccreditation system andits impacts on hospitalbudgetary allocation andaccreditation policiesNot applicable Accreditation may be regarded as an inspection rather than aCQI process if it is mandatory Hospitals may adopt strategic behaviours aimed at merelyattaining accreditation if the accreditation results are used forresource allocation The use of accreditation results should be clear and using it forfinancial sanction is not recommendedde Noronha and DiscussionarticlePereira,24 1998Discussion of the qualityimprovement initiatives,the Five-Track QualityImprovement Strategy, inBrazilNot applicable Accreditation was proposed to be voluntary, distinct from regularlegal licensing procedures and to be conducted by independent,non-governmental accreditation agencies The accreditation result was not linked to funding mechanismsand the report was not publicly disclosedShaw,8 2001CommentaryDiscussion of characteristicsand deficiencies of externalassessment of health carein BritainNot applicable Different voluntary and statutory external assessmentprogrammes needed to be integrated to ensure valid standards,consistent assessment, transparency, and public accountability Accreditation programmes should be patient-centred, clinicallyfocused, complementary to internal quality improvement andresults should be publicly available Absence of government lead and lack of national coordinationwere the causes for various accreditation programmesdeveloped with little integration, consistency, and reciprocityShin,37 1995CommentaryDiscussion of historyand characteristics ofinternational accreditationprogrammes and the Koreaaccreditation programmeNot applicable The accreditation programme in Korea started since the KoreanHospital Association introduced the HSP in 1981 The accreditation programme in Korea was voluntary and theaccreditation status and evaluation process were not open to thepublic Participation in the HSP influenced the designation of interresident training hospitals and the number of trainees allocatedDiscussion of the overviewof accreditation programmein South AfricaNot applicable The pilot accreditation programme in South Africa incorporatedan integrated, multidisciplinary, and CQI approach withemphasis on capacity building of hospital staff Accreditation standards were reviewed, adapted to localconditions and constantly updated Recommendation for accreditation was by an independent andnon-profitable accreditation body, the COHSASACrosssectionalstudyIndependent blindedassessment of organisationalperformance data in arandom, stratified sample of19 acute care hospitals inAustralia from 2001-2006Correlations of accreditationperformance withorganisational culture,organisational climate,consumer involvement,leadership and clinicalperformance Accreditation performance was positively correlated withorganisational culture and leadership, and a positive trend wasobserved between accreditation and clinical performance Accreditation was unrelated to organisational climate andconsumer involvementEl-Jardali et al,23 Cross2008sectionalstudyQuestionnaire survey of 1048nurses from 59 accreditedhospitals in LebanonCustomer satisfaction,quality of services providedby the administration, qualityof care, quality of servicesprovided by clinical supportdepartments and overallquality of health services Leadership, commitment and support, use of data, qualitymanagement, staff involvement and hospital size were predictorsof quality improvement during and after accreditation process How senior hospital management managed the accreditationprocess and the capability of the hospital to use data to improvequality had direct effects on quality improvement Quality management had the greatest impact on medium-sizedhospitals and staff involvement in accreditation had the greatestimpact on small-sized hospitalsPomey et al,252005Staff engagement and communicationWhittaker et al,33 Discussion2000articleLeadership and staff trainingBraithwaite etal,4 2010Hong Kong Med J Vol 19 No 5 # October 2013 # www.hkmj.org437
# Ng et al #TABLE 1. (cont'd)StudyStudydesignMaguerez et al,27 Discussion2001articleSetting and participantsOutcome measuresKey findingsReview of 64 CQI projectson patient safety and patientmanagement in Francethrough meeting with projectleaders and on-site visitsNot applicable Hospital management provided continued support, offeredtraining, created a CQI unit, and allocated a budget to supportCQI projects CQI projects had positive impact on staff attitudes by fosteringacceptance of changeIncreased staff workloadDaucourt andMichel,30 2003DiscussionarticleReview of the Frenchfirst 100 summaries ofaccreditation reportsavailable from the ANAESNot applicable Information given to patients and its traceability on patientrecords, and signing of prescriptions for medication weremostly frequently identified as high-priority areas that neededimprovement No significant difference in accreditation results betweenhospitals of different sizes and statusMeadows,292003CommentaryDiscussion of the useof information systemson enhancing regulatorycompliance and improvingpatient safetyNot applicable Regulatory requirements from accreditation agency couldgenerate extensive workload on administrative tasks and the useof information system could streamline complianceQuestionnaire survey of 728health care professionalsin 39 hospitals and 41nationally registeredsurveyors in ThailandHealth care professionals’and surveyors’ opinionstowards 24 selecteditems in national hospitalaccreditation standards ‘Integration and utilisation of information’ was considered themajor obstacle by both health care professionals and surveyors ‘Adequacy of staff’ ranked the highest as a major obstacle byhealth care professionals ‘Discharge and referral process’ and ‘medical recording process’were the major obstacles as considered by surveyorsPhase I: Questionnairesurvey of 389 acutehospitals in 8 EuropeanUnion countries;Phase II: On-site audits in 89participating hospitalsClinical outputs; safety;patient-centredness;cross-border patientcentredness Implementation of both internal and external qualityimprovement strategies in hospitals had beneficial effects on thehospital outputs in terms of clinical, safety, patient-centredness,and cross-border patient-centredness Internal quality improvement strategies were inter-related at thesame organisational level Different developmental levels in quality improvement wasobserved within a hospitalDiscussion of the progressof accreditation in Brazil in1994-1998Not applicable A non-governmental accreditation agency, the CBA, wasestablished in Brazil in 1994 CBA was responsible for the development of national standardsand procedures for the accreditation of health services byadapting the 1996 hospital standards from JCAHO Cultural acceptance, relevance to the Brazilian health caresystem, compatibility with Brazilian laws and regulationsand adaptability to both public and private hospitals wereconsidered when adapting the accreditation standards fromJCAHOOvretveit,36 2001 DiscussionarticleDiscussion of the criteria andconsiderations for selectingquality evaluation scheme toassess quality in health careorganisationsNot applicable How a quality evaluation scheme was introduced andimplemented could be more important than which particularscheme was chosen Balance between simplicity and low cost with scientific validityand credibility was important for the success for qualityevaluation schemeCollopy,38 1995Discussion of the revisionof the ACHS surveyprogramme and standardsto address the process ofcare by introducing clinicalperformance measures intothe accreditation process inAustraliaNot applicable The ACHS developed 150 clinical performance measures toaddress the process of care, including the process of access,assessment, treatment, discharge, follow-up, and communitylinkagesHospitals’ patient safetyinitiatives, level ofimplementation of JCAHOrelated patient safetyinitiatives, facilitators andbarriers of hospitals’ safetyimprovement A quasi-regulatory organisation (the JCAHO) was the mosteffective to reduce medical errors and to drive patient safetyinitiatives than professionalism and market forces Meeting JCAHO requirements was the primary driver of patientsafety initiatives in hospitals, especially in areas of reporting andpreventing sentinel events, meeting patient safety standards andJCAHO patient safety goals Medicare was found to be a major facilitator for patient safetyimprovement as hospitals must be accredited by JCAHO toparticipate in Medicare Absence of strong local market incentives and lack of resourcesand IT infrastructure were found to be major barriers for patientsafety improvementIntegration and utilisation of informationPongpirul et al,26 Cross2006sectionalstudySunol et al,312009CrosssectionalstudyAdoption of accreditation standardsde Noronha etal,32 1999DiscussionarticleDiscussionarticlePatient safety/reducing medical errorsDevers et al,212004438Crosssectionalstudy87 Interviews with hospitalchief executive officers anddirectors for patient safetyinitiatives, 226 interviewswith employers andinsurance brokers, and 32questionnaire surveys to keystaff responsible for patientsafety in hospitals in the USin 2002-2003Hong Kong Med J Vol 19 No 5 # October 2013 # www.hkmj.org
# Implementation of accreditation programmes #TABLE 1. (cont'd)StudyStudydesignSetting and participantsOutcome measuresKey findingsHosford,34 2008CrosssectionalstudyQuestionnaire survey ofhospital administrators from145 hospitals in 45 states inthe US in 2006Reduction or prevention ofmedical errors JCAHO accreditation was an effective intervention to reducemedical errors while medical error reporting and increased publicawareness were not effective Progress of implementing patient safety standards and medicalerror management system was more substantial in JCAHOaccredited hospitals than non-accredited hospitals 74% Hospitals provided training to the key personnel whowere responsible for implementation of quality improvementstrategies, and 96% hospitals provided staff training related toquality improvementMiller et al,202005CrosssectionalstudyAnalysis of JCAHOaccreditation scores andthe AHRQ’s IQIs/PSIs in2116 hospitals in the US in1997-1999IQIs, PSIs, JCAHO scores,JCAHO FOES, andaccreditation decisions No significant relationship between accreditation scores andIQIs/PSIs and between JCAHO categorical accreditationdecisions and IQI/PSI performance Worse performance on the PSI factor was associated with worseperformance on JCAHO scores Most hospitals scored high FOES despite broad variation in scussion of the legal andoperational issues relatedto JCAHO unanticipatedoutcomes disclosurestandard in the USNot applicable Courts may refer to the JCAHO standards as the hospitalstandard of care and potential liability may be resulted ifhospitals fail to observe these standards and cause harm topatients The JCAHO developed the unanticipated outcomes disclosurestandard and an elaborate system of requirements for identifyingand analysing sentinel events to respond to concerns on patientsafety Existing concerns on disclosure of privileged documents to anoutside agency like the JACHO could constitute a waiver of theprivilegeOvretveit andGustafson,62002DiscussionarticleDiscussion of the challengesand methods of how toevaluate and improve theeffectiveness of qualityimprovement programmesNot applicable Methodological challenges of measuring the outcomes andattributing causality to complex and long-term accreditationprogramme were reasons for the lack of evaluation research Evaluation of quality improvement could be improved bymeasuring the level of implementation, using wider outcomeassessment and developing an explanatory theoryLaschober etal,28 2007CrosssectionalstudyTelephone survey of 650senior hospital executivesand 664 directors of hospitalQI departments from 800acute-care hospitals in 50states and the District ofColumbia in the US in 2005No. of QI initiatives in 4clinical areas: heart attack,congestive heart failure,pneumonia, and surgicalinfection prevention;frequency of internal sharingand requests of hospitalperformance data Public reporting of hospital quality measures helped to focushospital leadership attention to QI, increase investment in QIprojects, raise staff attention to best practice guidelines andimprove internal sharing of QI results Large ( 300 beds), JCAHO-accredited hospitals responded topublic reporting efforts more consistently than small, non-JCAHOaccredited hospitals Public reaction to hospital performance reporting was moderate,while internal sharing and use of public reporting were moreprevalent within hospitalsWeil,35 2001CommentaryDiscussion of the impact ofpublic disclosure on qualityimprovement and costreductionNot applicable Whether public disclosure of quality of care and financialinformation could result in quality improvement or cost reductiondepended on the indicators chosen and amount of informationdisclosed to the public It could be difficult for patients to compare the quality of careand cost of different health care providers if the accreditationresults disclosed to the public limited to whether theorganisation was accredited or notPawlson andO’Kane,19 2002DiscussionarticleDiscussion of the impact ofprofessionalism, regulation,accreditation, and marketforces on accountability forquality of careNot applicable Accreditation results disclosed to the public limiting to theorganisation accredited or not may not be sufficient for patientsto compare the quality among different hospitals Accreditation had a substantial impact on hospital accountabilityfor quality of care in the US as participation in accreditation wasrequired for the hospitals to participate in Medicare, a majorsource of funding for hospitals Proliferation of new services and products in health care was animportant challenge to accreditation as accreditation processfocused largely on in-patient standardsPublic disclosureIncreased investment and resources dedicated to quality improvementHadley andMcGurrin,181988CrosssectionalstudySurvey conducted bythe National Institute ofMental Health of 216 statepsychiatric hospitals in theUS in 1983Average cost per patient,per diem bed cost, total staffhours per patient, clinicalstaff hours per patient, %of staff hours provided bymedical staff, bed turnoverand % of beds occupied JCAHO-accredited hospitals had higher values of average costper patient, per diem bed cost, clinical staff hours per patient, %of staff hours provided by medical staff, bed turnover and % ofbeds occupied than hospitals without accreditation Higher values on the 7 hospital characteristics (outcomemeasures) may reflect conditions necessary for better quality ofcareHong Kong Med J Vol 19 No 5 # October 2013 # www.hkmj.org439
# Ng et al #TABLE 2. SWOT analysis of hospital accreditation**InternalExternalPositiveStrengths Staff engagement & communication Multidisciplinary team building & collaboration Change in organisational culture Enhanced leadership & staff training Integration & utilisation of information Increased resources dedicated to CQIOpportunities CQI Identification & prioritisation of improvement areas Enhanced patient safety & reduction of medical errors Additional funding Public recognition Advantage in market competition Development of suitable accreditation standards for local useNegativeWeaknesses Organisational culture of resistance to change Increased staff workload Lack of awareness on CQI Insufficient staff training & support for CQI Lack of applicable accreditation standards for local use Lack of performance outcome measuresThreats Hawthorne effects & opportunistic behaviours Resource & funding cuts Lack of incentives for participation A regulatory approach for mandatory participation High costs for sustaining the programmesCQI denotes continuous quality im
tation and how accreditation may drive quality improvement. These findings have implications for various stakeholders (govern-ment, the public, patients and health care providers), when it comes to embarking on accreditation exercises. Factors affecting implementation of accreditation programmes and the impact of the accreditation
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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
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
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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
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The API Standard 2000 5th Edition takes into account Tank Volume, Liquid Flow, and Temperature Change. It was written as a basis for the pressure control of hydrocarbons, and considered industrial tanks as well. It is this 5th Edition that is probably in widest use today. In 2009, this was updated to the API Standard 2000 6th Edition.
