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Accrediting Graduate Programs in Healthcare Quality and Safety

Oglesby, Willie H. PhD, MBA, MSPH, FACHE1; Hall, Allyson G. PhD2,3; Valenta, Annette L. DrPH, FACMI4; Harwood, Kenneth J. PT, PhD, FAPTA5; McCaughey, Deidre PhD, MBA6; Feldman, Sue RN, MEd, PhD7,8,9; Stanowski, Anthony C. DHA, FACHE10; Chrapah, Sandra MHA11; Chenot, Teri Ed.D., MS, M.Ed., MSN, RN, CCE(ACBE), FNAP, FAAN12; Brichto, Eric Esq.10; Nash, David B. MD, MBA1

Author Information
doi: 10.1097/JMQ.0000000000000021
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Abstract

Introduction

Quality health care is safe, effective, patient-centered, timely, efficient, and equitable.1 Safety is the foundation upon which the processes of quality of care are built.1,2 Several influential publications in the United States and Canada highlighted the significant quality problems associated with current healthcare delivery,1–3 and provided a roadmap for improving performance.2 Since the publication of these reports, health systems and the related organizations have increased improvement efforts resulting in signs that some aspects of healthcare delivery are indeed safer.4 However, there continue to be areas in need of sustained improvement and attention to prevent adverse events, poor patient outcomes, and poor quality of care.4

Building a quality healthcare system while reducing and mitigating unsafe acts requires organizations to adopt a culture where quality and safety are valued.3–5 Such organizations must have leaders and personnel committed to high quality care who have the requisite knowledge and skills necessary to lead quality improvement processes and transform the organization at the micro/unit and macro/organizational levels. In this quest for excellence, healthcare organizations are increasingly embracing quality improvement methods developed in industry (eg, Lean, Six Sigma, Plan-Do-Study-Act, and change management) to systematically address performance. These methods rely on the collection and interpretation of data to drive performance and improve quality.6 Leaders in quality and safety must be able to interpret data and make it actionable and understandable across all levels of the organization.

Healthcare quality and safety (HQS) as a profession have emerged as the need for leadership and innovation in this space has expanded. In the past, preparation for a career in HQS might include a graduate degree in nursing, business, health informatics, health administration, or public health. However, there is an increasing realization that for professionals working in these disciplines, these degrees are not sufficiently focused on domains needed to develop knowledge and skills specific to HQS. Healthcare organizations now recognize that academic graduate degrees in the content area of HQS, with or without complementary healthcare degrees, offer a robust supplement to organizational training and will aid in developing expertise and trust to lead quality improvement and patient safety departments.

In response to an increased demand for training in this specialized field, universities in North America are now offering graduate degree programs in HQS. As an example, in 2017, the authors identified 15 programs in the United States and Canada that offered graduate education in HQS. Since 2017, it is estimated that the number of graduate programs in HQS has at least doubled. The difficulty in getting an exact count is that programs are sometimes bundled into concentrations in nursing, healthcare management, informatics, or other disciplines. The delivery format of these programs varies from fully online to fully in-person, and programs exist in a variety of settings including schools of nursing, medicine, public health, and health professions. These programs contain a common set of distinctive content areas that reflect the unique knowledge and skills required of healthcare quality and safety professionals.7 Although the universities offering these programs are accredited by regional bodies, given the nascent nature of HQS programs, opportunities for accreditation at the program-level accreditation have not existed.

The Council for Higher Education Accreditation defines accreditation as “a process of external quality review created and used by higher education to scrutinize colleges, universities and programs for quality assurance and quality improvement.”8 It uses a process that typically involves faculty, administrators, staff, and a team of subject matter peers selected by the accrediting association to evaluate programs by using a set of standards centered around quality and integrity.8 For students, employers, and the general public, academic accreditation provides assurance that educational programs voluntarily agree to engage in continuous program improvement and to adhere to a set of standards or criteria that ensure the education provided is of a high quality.

Timeline to Develop HQS Accreditation Standards

In September 2016, the Commission on Accreditation of Healthcare Management Education (CAHME) along with academic leaders at Thomas Jefferson University and the University of Alabama at Birmingham initiated discussions on creating an accreditation process for graduate programs in HQS. These initial discussions lead to an in-person meeting in September 2017 at Thomas Jefferson University of 14 programs across North America and Canada to discuss issues and approaches to HQS accreditation. During that meeting, the programs agreed to a set of organizing principles to support an approach to accrediting graduate programs in HQS. Twelve programs subsequently committed to become “Founding Members” of the accreditation development process and to fund the initiative with CAHME (Table 1). Three programs that initially provided funding eventually decided not to pursue accreditation at that time, reducing the number of Founding Members to nine. The National Association of Healthcare Quality later joined the initiative to provide logistical support and to facilitate engagement with the broader community of HQS professionals.

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Table 1:
Founding Members.

In a subsequent meeting in November 2017, 6 committees comprised primarily from the 12 programs were formed (see Table 2). The HQS Accreditation Standards Committee developed the overall criteria for accreditation and the Competency Development Committee identified specific domains that would serve as the foundation of the curricular requirements. These 2 committees, under the direction of an Executive Committee and General Committee, embarked on an ambitious timeline to develop the core standards for HQS program accreditation. The strength of this approach allowed for the quick and ongoing sharing of ideas, which allowed this process to be completed more than a year ahead of schedule. By early 2019, the Competency Development and the Accreditation Standards Committees completed their work. In May 2019, the CAHME Board of Directors adopted the proposed HQS accreditation standards (see Table 2). In April 2020, after the work was complete, the entire HQS accreditation development committee structure was terminated.

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Table 2:
Timeline.

Accreditation Standards and the Accreditation Process

Since 1968, CAHME has accredited graduate programs in healthcare management. The current process for healthcare management programs seeking accreditation is to first make an official request to CAHME and complete an eligibility statement declaring that the program has met 11 eligibility requirements, including attesting that the university has achieved regional accreditation; the program has graduated at least one class; and that there will be no discrimination on the basis of gender, age, creed, race, ethnicity, disability, or sexual orientation.9 Programs then move into Candidacy Status following approval of the candidacy application by a committee of representatives from peer programs. The Candidacy program establishes communication, assistance, and continuity between programs and CAHME. Programs then complete a “year of record” during which program characteristics and achievements are documented using 4 sets of criteria outlined in Table 3.

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Table 3:
CAHME Healthcare Management and Healthcare Quality and Safety Accreditation Criteria.

At the end of the year of record and following submission of a self-study document, programs are visited by an accrediting team comprised faculty from other institutions and employers. The site visit report is then read by other experts on the Accreditation Council. Accreditation is then voted on by the Board of Directors based on the recommendations of the Accreditation Council. Existing programs are generally accredited for 7 years and new programs for 3 years.

HQS Accreditation Standards

The HQS Accreditation Standards Committee reviewed the existing CAHME healthcare management standards document outlining the requirements for meeting the 4 criteria and revised it to meet the specific needs of HQS programs. Substantive changes involved identifying the specific domains and competencies to be included in HQS curricula as described below.

HQS Content Domains

Before developing the content domains and competencies that would drive the curricula, and thus the standards around accreditation, the Competency Development Committee agreed that foundational definitions of the HQS discipline were needed to guide the process. There have been many published definitions of the disciplines of HQS. The Competency Development Committee’s initial deliberations used the literature to standardize a definition. Drawing from the work of the Institute of Medicine,2 Shojania et al (2001),10 and World Health Organization,11–13 the Competency Development committee established its own definitions for quality and safety.

Quality in health care is defined as the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes. It encompasses the concepts of effectiveness, efficiency, timeliness, equitable care, patient-centered care, and is informed by best practice evidence.

Patient safety is the prevention of errors and adverse effects associated with the delivery of health care that may result in temporary or permanent injury to patients, families, and caregivers.

The committee recognized that healthcare quality and patient safety are separate fields, yet inextricably linked. They may share theoretical frameworks, concepts, models, and tools; however, context has a significant influence on the activity. The development of the content domains was guided by these underlying assumptions: each field has its own body of the literature, each field is equally important in the delivery of health care, and professionals in HQS collaborate to attain optimal outcomes.

Years of scholarship and scholarly debate surround the concepts of competence, competency development, and the acquisition and assessment of competence. The Competency Development Committee deliberated these issues and adopted the following definition to guide content domains and sample competencies development.

A competency is “an observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes. Since competencies are observable, they can be measured and assessed to ensure their acquisition.”14,15

Competence is the ability to effectively engage in an activity.

A competency statement reflects the related knowledge, skills, and attitudes someone must demonstrate for competence, measured at a point in time. Competencies acquired lead to competence.

There has been little national or international agreement over what knowledge, skills, and attitudes (competencies) a graduate from an HQS program should exhibit. The Competency Development committee used the work of Moran et al16 as the starting point for developing the content domains expected of accredited curricula in HQS. The authors conducted a literature review of position papers published by professional associations, expert panels, consortia, centers and institutes, and convened committees. Among the 22 position papers meeting the inclusion criteria, they identified a series of themes at the skill acquisition levels of competent and expert, based on the definitions developed by Dreyfus and Dreyfus.17 The competency development committee examined the themes and agreed they should become the content domains for the discipline. Additionally, they defined each content domain and created a set of exemplar competencies for each domain.

The Competency Development Committee settled on 13 domains (see Table 4). Four of the domains are foundational for HQS education: safety and error science, improvement science and quality principles, evidence-based practice, and measurement and process improvement. The committee added communication, health informatics, human factors, professionalism, leadership, systems thinking, legal and regulatory, interprofessional collaborative work, and patient- and family-centered engagement domains as essential competencies for HQS practice.

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Table 4:
Accreditation Domains, Descriptions, Sample Competencies, and Sample Knowledge (K), Skills (S), and Attitudes (A).

While all the domains must be included in the curricula, programs are encouraged to individualize their curricula based on mission, student needs, and other factors. As an example, a program could develop its curricula to emphasize safety and error science, evidence-based practice, health informatics, and human factors, and minimally address legal and regulatory issues and patient- and family-centered engagement. Thus, while programs must have breadth across the domains, the level of depth is up to the individual program.

Discussion

There are significant benefits associated with academic accreditation. Programs that conduct continuous quality improvement and have their efforts validated through the accreditation process realize benefits such as increased enrollment, reputation, and competent graduates. Accreditation also provides a framework for teaching and training excellence that supports culture change for healthcare systems. Prospective employers will trust the education and competence of their prospective employees who received their education from an accredited degree program.18

Programs view accreditation as a way to strengthen education processes and quality efforts in an ongoing commitment to continuous improvement. Program-level accreditation is an achievement of a broadly recognized minimum standard of excellence. These criteria, content domains, sample competencies, and sample knowledge, skills, and attitudes, developed by peer programs and documented here, provided a critical first step toward establishing standards for accrediting HQS programs in North America, and defined the field of HQS. These steps reflect those taken by others in health care to establish a recognized profession, in this case, a profession in HQS. The nature of program accreditation tracks the evolution of a profession. Since the HQS field is rapidly evolving and as employment and professional engagement matures, the content domains and other elements of program accreditation will change to reflect current professional practice.

Conflicts of Interest

The authors have no conflicts of interest to disclose.

References

1. Kohn LT, Corrigan JM, Donaldson MS, eds. Institute of Medicine (US) Committee on Quality of Health Care in America. In To Err is Human: Building a Safer Health System. 2000, Washington, DCNational Academies Press
2. Committee on Quality of Healthcare in America. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001, The National Academies Press
3. Agency for Healthcare Research and Quality. National Healthcare Quality and Disparities Report. Chartbook on Patient Safety. 2021. Accessed March 22, 2021. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/patientsafety/2019qdr-patient-safety-chartbook.pdf
4. Chassin MR, Loeb JM. The ongoing quality improvement journey: next stop, high reliability. Health Aff (Millwood). 201130559–568
5. Feldman SS, Buchalter S, Zink D, et al. Training leaders for a culture of quality and safety. Leadersh Health Serv (Bradf Engl). 201932251–263
6. Modi S, Ozaydin B, Zengul F, et al. The emerging literature for the triad of health informatics, healthcare quality and safety, and healthcare simulation. Health Syst (Basingstoke). 20198215–227
7. Tekian A, Infante AF, Valenta AL. Master’s programs in patient safety and Health Care Quality Worldwide. J Patient Saf. 20211763–67
8. Eaton JS. An Overview of U.S. Accreditation 2015. Accessed April 7, 2021. https://www.chea.org/overview-us-accreditation
9. Commission on Accreditation of Healthcare Management Education. Accreditation Standards and Self-Study Handbook. 2021. Accessed April 1, 2021. https://drive.google.com/file/d/11J-nk-OuLMjJbVUZbkzMo77pACXeIBkY/view
10. Shojania KG, Duncan BW, McDonald KM, et al. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ). 200143i-x–1-668
11. World Health Organization. Multi-professional patient safety curriculum guide, Topic 2: What is human factors and is it important for patient safety. Accessed April 7, 2021. http://www.who.int/patientsafety/education/curriculum/who_mc_topic-2.pdf
12. World Health Organization. Patient safety. Accessed April 7, 2021. http://www.euro.who.int/en/health-topics/Health-systems/patient-safety/patient-safety
13. World Health Organization. Framework for action on interprofessional education & collaborative practice. 2010. Accessed April 7, 2021. http://apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pdf;jsessionid=3EC3B2471B4DCB1FE5542A92992910E7?sequence=1
14. Frank JR, Mungroo R, Ahmad Y, et al. Toward a definition of competency-based education in medicine: a systematic review of published definitions. Med Teach. 201032631–637
15. Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach. 201032638–645
16. Moran KM, Harris IB, Valenta AL. Competencies for patient safety and quality improvement: a synthesis of recommendations in influential position papers. Jt Comm J Qual Patient Saf. 201642162–169
17. Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in directed skill acquisition. 1980. Accessed April 7, 2021. https://apps.dtic.mil/sti/citations/ADA084551
18. Brittingham B, Harris MF, Vlasses P, et al. The value of accreditation. Council for Higher Education Accreditation. Accessed April 4, 2021. https://www.acpe-accredit.org//pdf/ValueofAccreditation.pdf
Keywords:

healthcare quality; patient safety; education; accreditation

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.