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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH
validity of accreditation. The accreditation industry is faced with pressure to focus its standards on the relevant issues, collaborate with similar organizations, and consolidate the multitude of accreditation standards to reduce overlap and redundancy.
The accreditation process entails generating standards and then comparing the actual delivery of care with the standards. There are at least seven distinct steps:
Measures of performance, also known as parameters, are identified and recommended as standards.
A process of review leads to acceptance of the standards.
The standard is generally tested internally (“alpha” tested) and then tested on a external site (“beta” tested).
After testing, the standards are incorporated into a review process.
Organizations desiring to be accredited apply to be surveyed.
A site review is performed by peer surveyors who examine the inner workings of the organizations against the standards.
Finally, a process of scoring is developed to determine the organization 's degree of compliance with each standard and whether the aggregated results reached the threshold for granting accreditation.
These steps are described in the following section.
A standard, according to Donabedian (1982), is a professionally developed expression of the range of acceptable variation from the norm. A standard has also been defined as the desirable and achievable (rather than the observed) performance or value with regard to a given parameter (Slee, 1974).
A parameter is an objective, definable, and measurable characteristic of the process or the outcome of care (e.g., access to behavioral health care within 5 days of a request in a nonurgent situation). Each parameter has a scale of possible values. For example, a geographic access parameter might require outpatient mental health services to be available within 30 minutes of a consumer's home or workplace. Variables would include, for example, traffic patterns in a busy urban setting where traveling 5 miles could take 1 hour during rush hour. Another variation might be in a rural setting, where there is a scarcity of consumers and services and travel time may be longer because of distance.
The development of the current accreditation standards is based on professional consensus. The extent and diversity of opinions into the consensus process vary from agency to agency, as well as from standard to standard. Some agencies use a wide range of experts and elicit public participation, whereas others may use a closed panel of experts and a board review-editing procedure to develop a standard. The scope and relevancy of the standards by this process are dependent on