Current events continue to offer haunting stories of violence and destruction. Nevertheless, in the midst of tragedy, there continue to be acts of kindness, generosity, and mutual respect. What are the lessons to be learned that can make a real difference, now and in the future? What does it take to “keep calm and carry on”? Concepts that came to mind were fairness, openness, objectivity, veracity, and mutual respect.
As an accreditation agency, our goal is to have a cohesive accreditation process that exemplifies the concepts above. First and foremost, the Consortium’s focus is protecting the public by ensuring quality training that meets commonly accepted standards of performance. In practice this means that fairness, reliability (replicability) and validity (meaningfulness) are core elements of our process. Further, best practices in accreditation emphasize objectivity, veracity and mutual respect. Philosophically, it means that the accreditation process is anchored in common ground. Merriam Webster defines common ground as a “basis for mutual interest or agreement.” Our Standards provide the common ground for the Consortium’s accreditation process. They provide a language and terminology for describing events and activities; for exploring similarities and differences; data collection, analysis and action; and for quality improvement.
I was talking with a colleague about the need for an accrediting agency to be balanced and objective. He recommended a very interesting 2008 New Yorker article written by James Surowiecki, “Parsing Paulson”. Surowiecki describes philosophies of regulation. Although it was written during the financial crisis several years ago, it is still a timely thought-piece for accreditation in general.
The article presents two regulatory systems: principles-based and rules-based. Principles-based regulatory systems “evaluate companies’ behavior according to broad principles” or standards.There are rules, but usually fewer and less prescriptive than rules-based approaches. The rules for principles-based approaches focus on whether “the company is acting in the best interest of the consumers and stockholders”. Analogously, is the program operating in the best interest of the public and the NP postgraduate trainees by following the intent of the Standards? Rules-based regulatory systems are prescriptive and replete with rules that give exacting specifications of what is acceptable and what is unacceptable – making sure that “t’s are crossed and i’s are dotted”. Analogously, have each of the elements in the Consortium’s Standards been met explicitly? While frequently cumbersome, rules-based systems are easier to administer.
Surowiecki’s final observation is that with principles-based regulation, it is more likely that ‘work arounds’ that are not illegal, but are definitely not in the best interest of the public, will be identified and managed. However, the linchpin, especially in the principles-based system, is dedicated and informed regulators who are willing to regulate. The challenge with rules-based systems is keeping the ‘big picture’ in mind while focusing on the details. The intent for both systems is to protect the public.
I’ve been thinking about the Consortium and where we fall on the continuum of principles-based to rules-based approach to accreditation. What are the implications for calibrating decision-making? What are the implications for protecting the public and our trainees? These are big questions… There are no easy answers. Pragmatically, the rules-based approach is simpler to calibrate. But, it can be easier to miss the big picture. The challenge is finding the right balance and being true to our mission.
Just two weeks ago, we brought together our inaugural group of site visitors from across the country. One of our goals was to achieve consensus about principles/rules for program evaluation and for decision-making. Experienced and novice site visitors met for a half-day workshop focused on how to approach accreditation site visits. We talked about definitions of words; about ‘evidence’; about how to make decisions. We worked through vignettes that might be encountered in a site visit as we refined our decision-making process.
Finding a workable balance for conducting accreditation reviews requires openness, listening, mutual respect and veracity. For the Consortium’s accreditation process, it means being anchored in our Standards while building bridges of understanding across the various organizational and programmatic approaches of our constituency. Creating common ground for accreditation allows us to identify truths which in turn fuel action. Where there is common ground, the past can be understood, the present experienced and the future constructed.
In closing, and in the context of recent current events, I love this quote from Robert Frost: “There is something that doesn’t love a wall.”
Until next time,