by Hassan Aziz, PhD, FACSs, MLS(ASCP)^cm , Dean and Professor, College of Nursing and Health Sciences, Texas A&M University – Corpus Christi

Accreditation standards play a crucial role in maintaining the quality and integrity of educational institutions. These standards ensure that institutions meet specific criteria, fostering consistency, reliability, and trust in their services. While accreditation standards for health professions programs share similarities in their overarching goals, each discipline has unique accrediting bodies, standards, processes, and outcome expectations. Some accreditors prescribe more standardized curricula due to the nature of licensure and certification exams, while others allow for some flexibility, especially in integrating clinical experiences and advanced practice concepts. Understanding these differences is crucial for educators, students, and institutions as they navigate the accreditation landscape in these fields.

Throughout my career, I have gained extensive experience in institutional and various health program accreditations. I have developed a comprehensive understanding of the standards and procedures of different accrediting bodies. My expertise spans several aspects of accreditation, including preparation, evaluation, and continuous improvement. This article outlines several accreditation standards for health programs and compares their impact on quality assurance, innovation, and organizational effectiveness.

The National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) is the primary accrediting body for clinical laboratory science programs. NAACLS standards emphasize the importance of preparing students for certification exams and ensuring that they have the technical skills and knowledge required for laboratory practice. NAACLS focuses on the integration of clinical practice experiences, ensuring that students gain hands-on experience in a laboratory setting. The outcome-driven standards require programs to track certification exam pass rates, employment rates, and placement rates.

Nursing educational programs are accredited by several organizations, depending on the level of the program. The primary accrediting bodies include the Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE), and the National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Each accredits different types of programs, such as associate degree, baccalaureate, and graduate-level nursing programs. Nursing accreditation standards focus on areas such as program mission and governance, faculty qualifications, curriculum, student support services, clinical practice experiences, and program outcomes (including licensure pass rates and employment). These standards emphasize the integration of evidence-based practice, the development of clinical competencies, and the preparation of students for licensure exams.

The Commission on Accreditation in Physical Therapy Education (CAPTE) is the sole accrediting body for physical therapy education programs. CAPTE accredits Doctor of Physical Therapy (DPT) programs, which is the required degree for entry into the profession. Like nursing, CAPTE’s standards are comprehensive and cover aspects such as the institution’s mission, program governance, curriculum, faculty qualifications, resources, and program outcomes. CAPTE places a strong emphasis on clinical education, requiring extensive hands-on training in a variety of settings. Additionally, CAPTE standards ensure that graduates are prepared to meet the licensure requirements in all states. While CAPTE allows some flexibility in how programs structure their curriculum, there are stringent requirements for clinical education and outcomes. Programs must ensure that students gain the competencies needed for licensure, leaving little room for deviation in clinical education components.

Radiologic technology education programs are mainly accredited by the Joint Review Committee on Education in Radiologic Technology (JRCERT). JRCERT standards emphasize curriculum design, clinical competency, faculty qualifications, and program outcomes. The standards ensure that programs provide students with the necessary skills to perform diagnostic imaging and radiation therapy procedures safely and effectively. Clinical education is a critical component, focusing on hands-on training in various imaging modalities. JRCERT places a strong emphasis on ensuring that students are clinically competent and prepared for certification exams such as the American Registry of Radiologic Technologists (ARRT) exams.

Another example is respiratory therapy programs that are accredited by the Commission on Accreditation for Respiratory Care (CoARC). CoARC accreditation focuses on the preparation of students for entry into the profession and ensuring they meet licensure and certification standards. CoARC standards focus on curriculum content, faculty qualifications, clinical practice experiences, and program outcomes. These standards ensure that students are adequately prepared to pass national certification exams, such as the Registered Respiratory Therapist (RRT) exam and enter the workforce as competent respiratory therapists. The standards also emphasize the importance of integrating clinical experiences with didactic learning.

There is ongoing debate about whether accreditation standards should be descriptive, offering detailed and prescriptive guidelines (e.g., length of program, number and qualifications of faculty, student enrollment, instructor-to-student ratio, clinical hours, and financial and physical resources), or flexible, allowing academic programs the autonomy to adapt standards to their specific contexts.

Descriptive standards provide clear, specific criteria that academic programs must meet to achieve accreditation. This clarity ensures that all institutions are evaluated against the same benchmarks, promoting consistency across the board. For example, the standards can specify exact protocols for student enrollment and number of instructional staff minimizing variations in practice and ensuring a uniform level of quality across different programs. Academic programs benefit from the straightforward nature of descriptive standards, as they provide detailed instructions on how to comply. This reduces the ambiguity and guesswork involved in meeting accreditation requirements, making the process more straightforward and less prone to errors. Institutions with limited resources or expertise may find descriptive standards particularly advantageous, as they can follow a clear roadmap to achieve accreditation. Descriptive standards offer a high degree of accountability, as organizations are judged based on well-defined criteria. This transparency is crucial for stakeholders, including students, administrators, and the public, who rely on accreditation as a marker of quality. Regulatory bodies and accrediting agencies can also enforce compliance more effectively when standards are explicitly outlined.

However, the primary drawback of descriptive standards is their rigidity. By focusing on specific criteria, these standards may not account for the unique needs and contexts of different programs. This lack of flexibility can stifle innovation and creativity, as institutions are required to adhere strictly to prescribed guidelines, even when alternative approaches might be more effective. Descriptive standards often fail to consider the diversity of institutions and programs seeking accreditation. What works for one institution may not work for another, especially when considering factors such as size, location, and population served. This one-size-fits-all approach can lead to inefficiencies and may not always result in the best outcomes for all organizations. The emphasis on meeting specific criteria can sometimes lead programs to prioritize compliance over genuine quality improvement. Institutions might focus on ticking boxes rather than striving for excellence, resulting in a culture of minimal compliance rather than continuous improvement.

On the other hand, flexible standards allow organizations to tailor accreditation criteria to their specific contexts, recognizing that different institutions have different needs, resources, and challenges. This adaptability encourages innovation, as programs can experiment with new approaches and solutions that better fit their unique circumstances. Flexible standards often emphasize outcomes over processes, encouraging programs and institutions to focus on achieving high-quality results rather than simply adhering to prescribed methods. This focus on outcomes fosters a culture of continuous improvement, as programs are motivated to find the most effective ways to meet their goals. By allowing programs to adapt standards to their needs, flexible accreditation standards promote innovation. Institutions can develop and implement creative solutions to meet accreditation requirements, leading to improvements in program delivery, educational practices, and overall quality. This flexibility can be particularly beneficial in rapidly changing fields, where new technologies and methodologies are constantly emerging.

The primary concern with flexible standards is the potential for inconsistency. Without clear, dogmatic guidelines, different programs might interpret standards differently, leading to varying levels of quality and performance. This inconsistency can undermine trust in the accreditation process, as stakeholders may find it difficult to compare the quality of services across different institutions. Flexible standards can be more challenging to implement and assess, as they require programs to develop their own criteria and justifications for meeting accreditation requirements. This added complexity can be a burden for programs, especially those with limited resources or expertise.

The COVID-19 pandemic had a profound impact on the accreditation of health programs, leading to significant adaptations and changes to established processes. As the pandemic disrupted education, program officials were faced with the sudden closure of campuses and a lack of clinical teaching environments. With no immediate alternatives and healthcare facilities shutting their doors, program administrators turned to accrediting agencies for guidance and flexibility in meeting accreditation standards amidst restricted clinical environments. Accrediting bodies responded with a range of measures, from issuing advisory opinions to providing broader statements, and some were compelled to grant temporary waivers for standards that programs could no longer meet.

For many disciplines, transitioning to virtual teaching required programs to seek permissions and file substantive change requests with their national accreditors. Accrediting agencies were often forced to allow programs to adjust their curriculum sequences, moving didactic content online while deferring fieldwork and clinical rotations. This ensured that students could continue their education despite not being able to complete clinical placements. Both ACEN and CCNE, for example, temporarily allowed nursing programs to reduce the number of required direct patient care hours. In certain cases, telehealth, case studies, and virtual simulations were permitted to meet clinical education requirements. Programs were also allowed to shift clinical instruction to later in the curriculum as access to clinical sites improved.

CAPTE, while emphasizing its commitment to maintaining standards, allowed physical therapy programs to adjust competency evaluations to accommodate remote learning. Students could demonstrate competencies through virtual patient interactions or case simulations. CAPTE encouraged programs to ensure that students developed the necessary skills, even if traditional hands-on assessments weren’t feasible, but mandated that clinical experiences still encompass the management of patients across the lifespan in diverse care settings.

Similarly, JRCERT allowed radiology programs to use simulations in place of certain clinical experiences for a limited time, with the expectation that students would complete in-person clinical requirements later. CoARC offered temporary flexibility by permitting the use of adjunct or part-time faculty who did not meet standard qualifications, alleviating the strain caused by faculty shortages when clinical educators were needed in frontline healthcare roles.

The Liaison Committee on Medical Education (LCME), responsible for accrediting medical schools, granted extensions for programs unable to meet clinical clerkship requirements, allowing more time for students to complete essential clinical experiences without jeopardizing accreditation. Likewise, the Accreditation Council for Pharmacy Education (ACPE) approved virtual and simulation-based experiences for specific Advanced Pharmacy Practice Experiences (APPEs), enabling pharmacy students to progress despite the lack of direct patient care opportunities in hospitals and pharmacies.

The flexibility of NAACLS accreditation standards in areas of teaching modalities, clinical training, and number of faculty allowed program officials to be creative and innovative in delivering robust teaching methods to continue delivering education and to maintain regular operations without the need to secure special approvals or risking suspension of accreditation standards. This adaptability was crucial in maintaining a steady pipeline of new graduates into the laboratory workforce. With a pre-existing national shortage of laboratory professionals, the flexibility of NAACLS standards became even more vital as the pandemic significantly worsened the workforce crisis.

The debate between descriptive and flexible accreditation standards reflects a broader tension between consistency and adaptability. Descriptive standards offer clarity, consistency, and accountability, making them easier to implement and enforce. However, they can be rigid, stifling innovation and potentially leading to a compliance-focused culture. On the other hand, flexible standards encourage innovation, adaptability, and continuous improvement, but carry the risk of inconsistency and increased complexity.