The Accreditation Link to Organizational Quality Improvements

1. The Accreditation Link to Organizational Quality Improvements AACOM 2nd Annual Meeting June 25, 2005 Richard Winn, EdD Assistant Director, Western Association of Schools and Colleges, Accrediting Commission for Senior Colleges and Universities (WASC/ACSCU)

5. Ideally, Accreditation should serve two functions: • QA: Quality Assurance – Turning to several publics (students, parents, government, employers, the professions, and other schools) and verifying minimum compliance • CQI: Continuous Quality Improvement – Providing wisdom and incentives to embed processes for improvement into the culture of the institution • Most agencies are expanding toward more CQI

6. Why does quality matter in Medical Education? “’ . . . The burden of harm conveyed by the collective impact of all of our health care quality problems is staggering’ (Chassin et all, 1998) Errors lead to tens of thousands of Americans dying each year, and hundreds of thousands suffering or becoming sick as a result of nonfatal injuries. Other studies have documented pervasive overuse, misuse, or underuse of services.’” –2003 National Academy of Sciences, Executive Summary for “Health Professions Education: A Bridge to Quality.”

7. “It’s supposed to ward off frivolous lawsuits.”

8. A New Vision for Health Professions Education “All health professionals should be educated to deliver patient-centered care as members of an inter-disciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.”—Bridge to Quality (emphasis supplied)

9. Is there, in fact, a link between accreditation and academic quality?

10. It depends . . . • The link between accreditation and quality improvement is neither automatic nor assured • It depends! • It depends on the mindset, mandate, and political courage of the accrediting agency • It depends on the institution’s commitment to leverage accreditation to transformation

11. The Accrediting Agency: How is “quality” defined: Resources, Processes, Outcomes? Do they hold institutions accountable? How do they measure effectiveness? For whose sake do they function? The Institution: Does insightful edu-cational leadership prevail? Does accreditation lead to transformation or validation? Does Continuous Quality Improvement pervade the culture? It depends:

12. INPUTS PROCESSES Resources Structures Policies Course Approval Program Review Faculty Development Assessment RESULTS/ OUTCOMES Learning Results Licensing Results Test Results Portfolio Results Dimensions of Quality

13. In order for accreditation to drive quality (not just affirm minimum compliance), it must: • Represent a profession-wide commitment • Transcend institutional ownership interests and hold them accountable for educational effectiveness • Require and reward embedded processes that lead to assessment, reflection, and improvement (“institutional learning”) • Embrace cutting-edge national trends in “accreditation-as-transformation”

14. In order for accreditation to drive quality (not just affirm minimum compliance), it must: • Engage with institutions, both expecting and assisting in a paradigm shift • Collaborate with all agencies of the profession in changing the national culture (through site team development, national training events, research and publication) • Resist professional solipsism and engage mutually in the national health professions education conversation

15. “It’s about the outcomes” • From the federal Department of Education • From CHEA (Council for Higher Education Accreditation) • From regional and specialty accrediting agencies • From major, surging trends in national education (AAHE, AAC&U, etc.) . . . .Higher education is being transformed by a focus on learning outcomes

16. I taught Spike how to whistle! But I don’t hear him whistling. I said I taught him. I didn’t say he learned how!

17. Three big questions: • What do we want students to know (to value, to be able to do) at the conclusion of the course (the lab, the project, the class session) • How do we know if they know it? • How do we use assessment to improve learning? (“Educative assessment” –Grant Wiggins)

18. Teaching & Learning: A Comparison

19. “What does he know and how long will he know it?”

20. Reframing the Mental Models for Accreditation • From regulatory to capacity-building • From police officer to partner • From standards to context-based • From compliance to inquiry and engagement • From “We know how to do it!” to creation of a learning community where we learn together • From silos to a whole systems approach

21. Common Themes of National Accreditation Reform • The shift from an episodic add-on to a value-adding engagement • The shift in definition of quality from resources and processes to educational outcomes • The redefinition of “accreditation” from a conservator of traditional values to an agent for purposeful change

22. The Institute of Medicine’s “Health Professions Education: A Bridge to Quality” “Recommendation 3: Building upon previous efforts, accreditation bodies should move forward expeditiously to revise their standards so that programs are required to demonstrate—through process and outcome measures—that they educate students in both academic and continuing education programs in how to deliver patient care using a core set of competencies. In so doing, these bodies should coordinate their efforts.”

23. The IOM’s “Core Competencies” • Provide patient-centered care • Work in interdisciplinary teams • Employ evidence-based practice • Apply quality improvement • Utilize informatics

24. “Apply Quality Improvement” —a thought-starter Compare the mental images associated with each of these concepts: • Assessment of learning • Assessment for learning • Assessment as learning

25. Please note: • A key quality principle is that each individual is responsible for evaluating his or her own work and for improving it • An accrediting agency will not design or impose an assessment model on an institution • An accrediting agency should be alarmed if a sustained conversation about assessment isn’t happening on campus

27. Accreditation & Educational QualityIt also depends on the institution • Does insightful educational leadership prevail? • Does accreditation lead to transformation or validation? • Does Continuous Quality Improvement pervade the culture?

28. What is your mental model of accreditation?

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37. Does Osteopathic Accreditation Drive Quality Improvement? It depends on the AOA: • The AOA COCA Standards • The AOA COCA visit process • Team training • Team mandate • The AOA COCA options for action • Decisions about sanctions • Political realities

38. Does Osteopathic Accreditation Drive Quality Improvement? It depends on the COM: • The COM’s dominant mental model of accreditation • The COM’s expectations from the review • The insight, mandate, and credibility of key academic leadership • The COM’s commitment of resources— sustained over time—to a vision of quality