Accreditation

for institutions
UNIT NO 14
PRESENTED BY: GROUP “E”
Group members:

 Meerab kafeel
 Bushra
 Hira Karim
 Rimsha shahbaz
 Shazia Khan
 Inam ur rehman
 Ahtisham ul haq
 Hamad khan
 Shehzad
 Jahidullah
Objectives;
At the end of this unit the learner will be able to :

 Describe the historical background of accreditation Of institution

 Define Accreditation
 Purpose of Accreditation
 Discuss the importance of accreditation in Growth of the
institution
 Differentiate between ISO and 9000 And JCIA
 Discuss its implementation of these standards in hospital/
organization
Historical background of
accreditation
 Early 1900s (USA):
 Accreditation began in the United States to ensure quality education, mainly
in higher education.
 1910s–1920s:
 Regional accrediting bodies were formed to evaluate schools and colleges
based on set standards
 1990s–2000s:
 International interest in accreditation grew; many countries began developing
their own systems.
 Today:
 Accreditation is a global practice used to maintain quality in education, ensure
public trust, and help institutions improve continuously.
Accreditation
Accreditation is a third-party/independent body certification process
in which an organization or institution is evaluated against
established standards by an independent body. The goal is to ensure
that the quality of entity meet the performance standards,
Healthcare Accreditation
In the healthcare sector, accreditation is the process by which
healthcare organizations such as hospitals, clinics, and laboratories
are evaluated and certified by an external body to ensure they meet
standards related to quality of care, patient safety, and operational
performance Joint Commission International (JCI)
Purpose of Accreditation
 Ensures quality education and promotes continuous improvement
 Protects students' rights and academic investment
 Enables access to financial aid and government funding
 Supports credit transfer between institutions
 Enhances graduate employability
 Ensures eligibility for professional licensure encourages
transparency and accountability
Importance of accreditation in
Growth of institutions
Accreditation is important because:
 It improve public trust that the organization is concerned for patient safety and quality of
care.
 It provide a safe and efficient work environment that contributes to worker satisfaction.
 Listen to patient and their families, respect their rights, and involving them in the care
process as partners
 Create a culture that is open to learning from the timely reporting of adverse events and
safety concerned.
 Established collaborative leadership that sets priorities for and continues leadership for
quality and patient safety levels.
 Identify systemic break-down and close gaps or loopholes.• Provide ways to detect and
correct error and problems.
 Ensure conformance to and effectiveness of documented processes.• Focus on patient and
provider needs and expectation.• Streamline workflow and maximize resource utilization.•
Maximize customer satisfaction
Differentiate between ISO 9000
and JCIA
 ISO 9000
A set of international standards on quality management and assurance,
helping companies document quality system elements needed for an
efficient quality system. Application to organizations of any size and
industry.
 History
First published in March 1987, it has become the most successful standard
in the history of the International Organization for Standardization.
 Joint Commission International (JCI):
Works to improve patient safety and healthcare quality internationally by
offering education, advisory services, and accreditation. Partners with
various healthcare entities to promote rigorous standards of care.
 ASPECT ISO 9000 JCIA

(Abbreviation) International Organization for Joint Commission

Standardization – ISO 9000 International Accreditation
series

(Purpose) To establish a quality To improve quality and safety

management system (QMS) of patient care in healthcare
applicable to all industries organizations

(Industry focus) Applicable across all Specifically for healthcare

industries and sectors organizations
Specifically for healthcare
(Focus area) Customer satisfaction, Patient safety, care quality,
continual improvement, infection control, medical
process management ethics

(Validity period) Typically, 3 years, with Usually valid for 3 to 5 years,

surveillance audits with follow-up evaluations

(Certification Body) Various accredited bodies Joint Commission International

worldwide (JCI)

(Focus area) Customer satisfaction, Patient safety, care quality,

continual improvement, infection control, medical
process management ethics
Implementation of these
standards organization
Implementing accreditation standards like ISO 9000 or JCIA in hospitals or
organizations involves several steps:
 Gap Analysis:
Conducting an initial assessment to identify areas that need improvement
to meet the accreditation standards.
 Policy Development:
Developing and updating policies and procedures to align with the
accreditation standards.
 Training and Awareness:
Providing training to staff on the new policies, procedures, and the
importance of accreditation.
 Implementation:
Putting the new policies and procedures into practice.
 Continue…
 Continuous Monitoring and Improvement:
Regularly monitoring compliance with the standards and making
improvements as needed.

 Accreditation Survey:
Undergoing a survey by the accrediting body to assess compliance
with the standards.
Implementation of these
standards in hospital setting
Self-Assessment:
 Hospitals begin by evaluating their current practices against established
accreditation standards.
 This process involves identifying areas of strength and areas for
improvement.
Application:
 The hospital officially applies for accreditation, providing documentation
and information about its self-assessment.
Assessment:
 A designated accreditation body assesses the hospital's compliance with
the required standards.
 This assessment can involve site visits, document reviews, and
interviews with staff.
 Continue…
Approval and Certification:
 If the hospital meets the accreditation standards, it is awarded
accreditation.
 This typically involves the issuance of a certificate or recognition.
 Approval and Certification:
 If the hospital meets the accreditation standards, it is awarded
accreditation.
 This typically involves the issuance of a certificate or recognition.
Summary
Accreditation is a process used to evaluate and recognize educational
institutions or specific programs for meeting established standards of
quality and effectiveness. It is carried out by official accrediting bodies
and serves as a form of quality assurance in education confirms that
institutions and programs provide reliable, high-quality education,
benefiting students, educators, employers, and society.
MCQ’s
1.Which organization is responsible for hospital accreditation in many
countries?
A. WHO
B. UNESCO
C. Joint Commission (JCI)
D. ILO

2-what is the main purpose of institutional accreditation?

A. Increase tuition fees

B. Improve public image
C. Ensure quality and continuous improvement
D. Reduce student intake
3. Accreditation is usually granted for a period of?
A. 3 to 5 years
B. 1 year
C. 6 months
D. 10 years

4. Which of the following is not a benefit of accreditation?

A. Improved patient care
B. Guaranteed government funding
C. Enhance institutional reputation
D. Standardized procedures
5- What is the primary focus of educational institutional
accreditation?
A. Campus size
B. Curriculum standards and quality
C. Number of students
D. Library aesthetics

6- Which of the following best describes the correct sequence

of steps in the accreditation preparation process?
A. Training → Implementation → Gap Analysis → Policy Development
B. Gap Analysis → Policy Development → Training → Implementation
C. Implementation → Training → Gap Analysis → Policy Development
D. Policy Development → Gap Analysis → Training → Implementation
7.Which of the following best summarizes the relationship
between ISO 9000 and JCIA in healthcare institutions?
A. Both are clinical standards with the same guidelines
B. ISO 9000 supports process quality, JCIA ensures healthcare delivery
quality
C. JCIA certifies equipment, ISO certifies hospitals
D. ISO focuses on healthcare laws, JCIA focuses on manufacturing laws

8-How does accreditation help improve internal hospital systems?

A. It prevents government audits
B. It identifies systemic breakdowns and corrects errors
C. It removes all administrative roles
D. It limits training and education
9- What is the main purpose of conducting a gap analysis during
accreditation preparation?
A. To finalize staff roles and responsibilities
B. To identify the strengths of the hospital only
C. To determine areas that need improvement to meet accreditation
standards
D. To train staff on hospital safety protocols

10- Which leadership quality is promoted through accreditation?

A. Top-down decision-making without feedback
B. Collaborative leadership with a focus on patient safety
C. Ignoring front-line staff input
D. Delegation of all safety roles to administration only
Answers key:
1- “C”
2- “C”
3- “A”
4- “B”
5- “D”
6-“D”
7- “B”
8- “B”
9- “C”
10-”B”
Reference:

https//www.researchgate.net/publication/288161974_The_Role_of_A
ccreditation_of_Higher_Education_Institutions