Accreditation

It has been a stressful week at work. Why? Accreditation. The only people in the world who do not hate accreditation is probably the auditors. I have heard that auditors too, do not necessarily enjoy their work.

I have worked in a government organisation when I first encountered an experience with being evaluated for Quality Assurance. The funny thing was, always in retrospect, that my boss at that time, and most of my working colleagues, were completely clueless as to the process. The leaders themselves were in the dark because the previous leaders had left without fully explaining the situation. So we just waited for the arrival of the internal auditors and 'prepared to be slaughtered'.

Thinking back I am reminded of what the whole process is about. In one word, it is about documentation. Everything that we do must be documented so that it can be evaluated by someone from the outside.

Yes, documentation is very important in medicine. Everything that happens to a patient during the course of a hospital stay or interaction as an patient in the community must be written or entered in a computerised electronic health care system. Why? For the records, so that when another doctor or health care professional attends to the same patient, they have accessed to the whole story, not just from the patients perspective but also from the doctors perspective. And, I guess more importantly, should anything go wrong, God forbid, there are records of what had happened so that such mistakes (if proven to be) could be avoided in future, or the records could prove that despite everything was carried out in the normal expected way, the patients deterioration was outside the control of the treating physician.

That worked well in the practice of medicine. I've written countless of entries into countless of medical charts, both electronic and hand-written, both in hospital and in the community. It seemed logical and the right thing to do. But in academia? Why? Who would want to read it anyway? It turns out that yes, every single organisation needs to document their operations and the academia industry is no exception.

At the department level, department meetings, and other standard operating procedures must be detailed in the relevant files. The funny thing is (ok, maybe its not that funny), is whatever you decide to write in the SOPs, must be followed through. So if you can't, then dont write it down. So the documents are not goals but rather reflects what is done in reality. And if it does not concur with reality then it is something that must be changed (either the documents or the reality).

For the academia world, curriculum is everything. Ok its not everything but it is very important. One of the first things the auditors will look at. From my experience in a previous institution, a person was hired to prepared the entire syllabus and who showed this to the auditors who were not even interested to flip through the hundreds of pages of medical school curriculum. Instead, I am told, they are looking for very specific things.

It seems the curriculum, timetable and lecture samples are the highlights from an individual level. From the customer perspective they look at contact hours, time spent on wards, ratio of lecturers to students, then of course there is the assessment. They also look at the logistics, are there enough lecture halls and facilities for students, the library, the anatomy lab, the pathology specimens, the hospital and wards available, and human resources, they scrutinize the staff hired, are they suitably qualified to what they are meant to do, are they being paid enough to prevent high staff turnover and so on.

My second experience with accreditation was a good one, they identified areas which require improvement, which I think regardless of how good an institution is, no one or thing is perfect expect God, so there will always be room for improvement. Then, they gave the green light that the institution was given accreditation for a number of years before they will return again for a routine review.

The scariest thing that can happen is if an institution does not get accreditation. That means there are severe deficiencies that make it not up to mark of standards that is acceptable for the organisation benchmark. The organisation is then left to make repairs and then subject itself to another round of accreditation.