The Accreditation Link to Organizational Quality

Improvements

AACOM 2nd Annual Meeting

June 25, 2005Richard Winn, EdD

Assistant Director, Western Association of Schools and Colleges, Accrediting Commission for Senior Colleges

and Universities (WASC/ACSCU)

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

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.”

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

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)

Is there, in fact, a link between accreditation and

academic quality?

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

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:

Dimensions of Quality

INPUTS PROCESSES

RESULTS/ OUTCOMES

Resources Structures Policies

Course Approval Program Review Faculty Development Assessment

Learning Results Licensing Results Test Results Portfolio Results

In order for accreditation to drive quality (not

just affirm minimum compliance), it must:

1. Represent a profession-wide commitment

2. Transcend institutional ownership interests and hold them accountable for educational effectiveness

3. Require and reward embedded processes that lead to assessment, reflection, and improvement (“institutional learning”)

4. Embrace cutting-edge national trends in “accreditation-as-transformation”

In order for accreditation to drive quality (not just affirm minimum compliance), it must:

5. Engage with institutions, both expecting and assisting in a paradigm shift

6. Collaborate with all agencies of the profession in changing the national culture (through site team development, national training events, research and publication)

7. Resist professional solipsism and engage mutually in the national health professions education conversation

“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

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!

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)

Teaching & Learning: A Comparison Teaching Paradigm

Learning Paradigm

The Nature of Knowledge:

Information transferred from

teachers to students

Understanding jointly constructed by

students with faculty

The Students’ Role:

Listen and remember as faculty impart

knowledge

Active constructor, discoverer, and

transformer of ideas

Primary Role of Assessment:

Audit learning; classify and sort students

[Summative]

Guide development of students’ skills

[Formative]

Students’ Primary Focus

The PRODUCT (getting the right

answers)

The PROCESS (learning to ask right

questions)

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

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

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

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.”

The IOM’s “Core Competencies”

• Provide patient-centered care

• Work in interdisciplinary teams

• Employ evidence-based practice

• Apply quality improvement

• Utilize informatics

“Apply Quality Improvement” —a thought-starter

Compare the mental images associated with each of these concepts:

1. Assessment of learning

2. Assessment for learning

3. Assessment as learning

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

Assessment . . . of learning

. . . for learning

. . . as learning

Purpose: Audit/sort students (assign a grade)

Give feed-back to improve learning

Enhance students’ skill to assess own learning

Who is accountable?

Faculty (as summative judge)

Faculty (as formative coach)

Student (as guided by faculty rubric)

Enhance future skills for self-reflection?

Seldom even considered

Leads to better understanding of criteria

Builds sense of personal responsibility to assess, improve

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?

What is your mental model of accreditation?

Burden—Onerous tasks imposed on an institution by external authorities for the sake of the regulatory agency

Mostly ← Uncertain → Mostly Opportunity—A well-designed process for the sake of making improvements to my institution.

Your mental model

Assert & Affirm—A lengthy report, filled with glowing claims, to persuade reviewers that everything’s just fine.

Mostly ← Uncertain → Mostly Evidence-Based Analysis—A thoughtful selection of evidences to inform campus decisions about improvement.

Your mental model

Validation—A process intended to confirm what an institution is already doing.

Mostly ← Uncertain → Mostly Transformation—A process leading to profound shifts in an institution’s values and vision.

Your mental model

Episodic—An on-again, off-again process that starts over from zero each time.

Mostly ← Uncertain → Mostly Continuous—An ongoing and embedded process that is a recognized part of the culture.

Your mental model

Hierarchy—A top-down, mostly solitary process, driven from some remote office.

Mostly ← Uncertain → Mostly Inclusion—A widely embraced plan that engages the entire campus community.

Your mental model

Compliance—A “checklist” kind of relationship with the accrediting agency—a mostly mechanical conformity to its requirements.

Mostly ← Uncertain → Mostly Engagement—A mutual and collaborative relationship with the accreditation agency—an exciting commitment to a shared vision.

Your mental model

Resource Focus—A catalog of institutional resources, based on the belief that quality is defined by the institution’s acquisition of things.

Mostly ← Uncertain → Mostly Outcomes Focus—A depiction of evidences of student learning, based on the belief that learning-centeredness defines quality.

Your mental model

“Mission Accomplished”—The sense that the accreditation task is over when the site team leaves the campus.

Mostly ← Uncertain → Mostly “Mission Begun”—The sense that the accreditation task has framed on-going processes that will continue to renew the campus for years to come.

Your mental model

Spin—An impressive array of data and essays designed to persuade others to think well of the institution.

Mostly ← Uncertain → Mostly Reflection—A process designed to enhance an institution’s capacity to think honestly about itself.

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

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