Licensure, Certification and Accreditation Hospitals Must Meet

Licensure, Certification and Accreditation hospitals must meet various requirements in order to legally function as hospitals. Three avenues/requirements are: state licensure, based on minimum state requirements for a hospital; DHHS certification based on requirements for participating in Medicare and Medicaid; and JCAHO accreditation, based on meeting standards set by the Joint Commission. Though JCAHO accreditation is an indication of at least better-than-State standards for performance and quality of care, the accreditation process has some inherent weaknesses.

The Role of Accreditation In order to understand the role of "Accreditation" in health care, particularly for hospitals, it is best to also review the nature and roles of "Licensure" and "Certification." All three terms apply to many types of health care providers; however, this work focuses on hospitals. As we learned in our course, hospital "Licensure" is overseen by State governments and is usually administered by each State's department of health.

Essentially, a license is a privilege to operate as a hospital, based on meeting minimum standards for sufficient facilities, safety, space, equipment and personnel. For example, the New York State Department of Health governs licensure for medical facilities within New York State, oversees hospital performance, may suspend or revoke a hospital's license and imposes fines for violations (New York State Department of Health, 2001). Consequently, the role of licensure is to establish, maintain and monitor minimum State standards for the privilege of operating as a hospital.

We also learned that hospital "Certification" is governed by the Department of Health and Human Services and allows hospitals to participate in Medicare and Medicaid programs, provided the hospitals meet "conditions of participation" (Centers for Medicare & Medicaid Services, 2012). Consequently, the role of certification is to establish, maintain and monitor minimum standards for participation in Medicaid and Medicare. In contrast to Licensure but similar to Certification, Hospital "Accreditation" is voluntary. Accreditation is governed by the Joint Commission on Accreditation of Hospitals (JCAHO).

Founded in 1951, JCAHO began as united effort of the American College of Surgeons, the American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association (Joint Commission, 2012).

With a mission statement "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value" (Joint Commission, 2012) and a vision statement of "All people always experience the safest, highest quality, best-value health care across all settings" (Joint Commission, 2012), this nonprofit organization is dedicated to voluntarily accrediting health care organization that meet a higher-than-State standard of performance.

Consequently, the role of accreditation is to establish, maintain and monitor exceptionally high standards of performance and care (Levine, 2007). If a hospital has JCAHO accreditation, it is automatically nationally known to have voluntarily met the Joint Commission's high standards (Joint Commission, 2012). In addition, JCAHO has taken on a new role of helping health care providers find "solutions to health care problems" (Gebhart, 2011); consequently, accreditation also means that the hospital is associated with a powerful amalgam of highly skilled health care providers who are consciously finding health care solutions.

Weaknesses Inherent in the Health Care Accreditation Process Some inherent weaknesses of the accreditation process have been detected. David Greenfield and Jeffrey Braithwaite amassed and examined the results of 66 studies on various accreditation programs, including but not limited to JCAHO. While accredited organizations claim there are positive benefits of the process and indicate that the process gives staff the opportunity to reflect and communicate about standards (Greenfield & Braithwaite, 2008), other staff had considerable complaints. A number of staff complained about the excessive bureaucracy involved (Greenfield & Braithwaite, 2008).

Accreditation is a long process involving considerable paperwork and inspections of facilities, staff and documentation. Some respondents also complained about the higher workloads and stress on staff in order to meet requirements for accreditation (Greenfield & Braithwaite, 2008). The JCAHO accreditation process requires a concerted effort on the part of staff that is already heavily burdened with their primary function -- providing quality health care. Still other respondents complained that the JCAHO accreditation process necessarily consumes "considerable resources" (Greenfield & Braithwaite, 2008).

Consequently, while JCAHO accreditation is a nationwide symbol of a higher level of care than that required by State licensing, the accreditation process has inherent weaknesses. Conclusion In contrast to state licensure, which is concerned with minimum requirements, and certification, which is concerned with participation in Medicare and Medicaid, JCAHO licensure is ideally concerned with the highest possible standards of performance and care.

Established in 1951 by the united efforts of the American College of Surgeons, the American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association, JCAHO's ultimate vision is that "All people always experience the safest, highest quality, best-value health care across all settings." As a result of JCAHO's standards and efforts, a JCAHO accreditation means that a health care facility has met standards aimed toward the highest quality of care.

While it is true that JCAHO accreditation is meaningful, the accreditation process has inherent drawbacks. Some staff involved in the accreditation process complains of excessive bureaucracy, higher workloads and stress on staff, and the consumption of "considerable resources" as a hospital wends its way through the accreditation process. Nevertheless,.