Accreditation and accountability.

The program that provided the training and cleared the path by which you currently hold your position in laboratory medicine was probably accredited by one of four accrediting agencies (see sidebar). For many, that recognition assured you access to federal/state financial aid. As a graduate of an accredited program, you were deemed eligible to take your certification exam fresh out of school.

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Accreditation, the process by which an institution or program assures quality, protects the student and public. After existing for 100+ years, accreditation took a front seat after June 22, 1944, when President Franklin D. Roosevelt signed the "Servicemen's Readjustment Act"--the GI Bill of Rights designed to transition veterans back into civilian life--represented the federal government's first installment of now billions of dollars invested in higher education.

Critics (i.e., presidents of elite institutions) argued that the GI Bill would be money wasted because veterans were sure to lower the standard of education. To counter this fear, funds were subsequently allocated for a veteran's education only if the institution or the program were accredited. As the federal government expanded its financial support to higher education, including the Title IV student financial assistance programs, accreditation further seated itself as the assurance mechanism by which public investment was protected.

The goal of accreditation, according to the USDE, is to ensure that education programs meet "acceptable levels of quality." The USDE set the standards but has traditionally entrusted to the private accrediting agencies the development of evaluation criteria and the conduct of the peer-review to determine if standards are met.

The rules of accreditation are embedded in the Higher Education Act, which is currently facing Congressional reauthorization hearings. Although scheduled for completion by October 2004, Washington insiders say that an extension will be needed. At the national level, the Council for Higher Education Accreditation, the voluntary, independent agency--an umbrella for accrediting agencies--is facing scrutiny from Congressional committees. Specifically, how does accreditation ensure quality in a cost-effective process that can be trusted to protect students and assure the public?

While the process and focus on program accountability and student outcomes may provide needed assurances, administrators from educational institutions complain that accreditation requirements are too burdensome and costly, leading accrediting agencies to streamline their processes. Institutions that accredit multiple programs may find ways to coordinate documentation and resist duplication.

At the agency level, professionals within the specialized accrediting body push the groups to redefine scopes of practice, in some cases advocating elevated levels of career entry and professional recognition. Member programs of the NAACLS have argued for the master's or doctoral degrees to replace the baccalaureate degree as the career-entry standard for the clinical lab scientist/med tech.

In the future, accrediting units will be required to define quality--beyond sponsorship, adequate resources, and credentialed faculty. Those with control of the federal/state dollars demand that quality be defined in terms of what counts as success.

Currently, the professions enjoy a largely private and self-regulated accreditation process in the pursuit of assuring and improving quality. At the federal level, some question if students are doing well and, if so, how well. Some suggest that the mandates of the No Child Left Behind policies in elementary/secondary education be extended to higher education. This would potentially limit the extent to which the higher-education community could maintain its autonomy in developing its own criteria for quality and resulting student outcomes.

If, in retrospect, you have benefited from graduation from an accredited program in laboratory medicine, and if you would prefer a workforce with the same core values and culture of quality in which you currently practice, then you may want to pay attention to the testimony surrounding accreditation in the context of the reauthorization of the Higher Education Act--going on right now in Congress.

RELATED ARTICLE: Accrediting Agencies

Accreditation Council for Graduate Medical Education (ACGME) -- www.acgme.org

Pathologist

Accrediting Bureau of Health Education Schools (ABHES) -- www.abhes.org

Clinical Lab Tech; Med Lab Tech/Assistant Phlebotomist 

Commission on Accreditation of Allied Health Education Programs (CAAHEP) -- www.caahep.org

Cytotechnologist; Blood Bank Specialist

National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) -- www.naacls.org

Cytogentics Technologist

Clinical Lab Scientist/Med Technologist

Clinical Lab Tech/Med Technician

Diagnostic Molecular Scientist

Histotechnician; Histotechnologist

Pathology Assistant

Phlebotomist (Approval Only)

Clinical Assistant (Approval Only)

Organization of Specialized

Accrediting Agencies

Association of Specialized and Professional

Accreditors (ASPA) -- www.aspa-usa.org

Recognizing Organizations

Council for Higher Education Accreditation (CHEA) -- www.CHEA.org

U.S. Department of Education (USDE) -- www.ED.gov

Jane Adrian, MPH, EdM, MT(ASCP)SLS, a consultant and freelance writer in science, health, and education, has 30 years' experience as a manager and educator in clinical laboratories.

As has been the history of MLO's "Washington Report," this space will be devoted in 2004 to keeping readers abreast of ongoing issues and new legislation affecting the clinical laboratory and its professional managers and technicians. If there is a particular legislative question or a legislative topic of special interest to your organization, please e-mail: [e-mail].