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“That’s how the light gets in”

Accreditation Shines a Light on Opportunities

Sundials work when sunlight creates a shadow, thereby allowing us to tell time. Light and shadow are equally important.  Without the shadow, the sundial doesn’t work.

Similarly, accreditation shines a light on what works, it is an overall indicator of excellence.  Equally important, accreditation is a mechanism for acknowledging the shadows — identifying areas that are opportunities for creativity and innovation.  The two crucial aspects of accreditation, the program’s self study and the confirmatory site visit, are evaluation mechanisms that shine a light on specific strengths and identify “shadow areas” that merit further scrutiny and development.

One of the challenges in program development, especially as programs prepare for accreditation, is to create an environment where the goal is achieving meaningful and sufficient adherence to the accreditation Standards, with a clear-eyed realization that there are always opportunities for improvement and innovation.  The goal is not achieving perfection – it is delivering meaningful training that fosters compassionate, patient-centered, competent healthcare.

Philosophers and writers over the centuries have captured the essence of this challenge.  Neil Patel reminds us of three well known quotes in his Entrepreneur article of August 31, 2015,

  • Voltaire: “The best is the enemy of the good.”
  • Shakespeare: “Striving to better, oft we mar what’s well.”
  • Confucius: “Better a diamond with a flaw than a pebble without.”

Further, Patel writes:

“Trying to make something perfect can actually prevent us from making it just good. Perfection in its elusive glory is like a unicorn. Sure, it sounds great, but who’s actually seen one? I’d rather ride a real horse than wait for an imagined unicorn.

So, if you can’t achieve perfection, don’t sweat it. Go for good instead…

In fact, this is the exact point at which we need to remind ourselves that the perfect is the enemy of the good. Instead of idolizing the pinnacle of perfection, be content with something good.”

Be bold. Try out a new idea.  Embrace its imperfections when implementation isn’t perfect.  Be strong. Identify and explore the shadows, the “weaknesses”. They provide a time stamp in a program’s developmental process and offer opportunities for innovation, improvement and growth.

If something is not working perfectly, one’s perception creates the opportunity for growth.  Is the glass half empty or half full?  Both are true.  Mixing my metaphors, embrace both – acknowledge that it is half empty with the room to grow.  Or it is half full – with a solid foundation that serves as the basis for growth.

Gestalt psychologist Kurt Koffka is credited with writing: “The whole is other than the sum of the parts” or as frequently translated: the whole is greater than the sum of the parts. In the image below three partial circles are arranged in such a way that, taken as a whole, an image of a triangle is perceived.  Without the circles, there is no triangle.  Each separate circle standing alone does not make a triangle.  It is only when they are seen as a whole that the triangle exists.

As in the example of the image above, programs are more than the sum of their parts. A program is a gestalt of the passions, competence, commitment and actions of everyone involved in the program.  It is the combination of systematic didactics and clinical experiences and mentorship.  It is the patients, the larger community being served, the physical plant, and the healthcare atmosphere of caring and being cared for.

Just as the program is more than the sum of its parts, programmatic accreditation is much more than a designation that the sum of the parts meets standards.  Accreditation reflects a holistic judgment of excellence for the program as a complete entity in and of itself.

The accreditation standards were designed to address essential parts of a training program – the curriculum and evaluation, the administration and operations, staffing and trainee services.  However, the individual standards are not accreditation.  When taken as a whole, they provide an opportunity for programmatic evaluation – to see light and shadow – strengths and weaknesses.

Accreditation is a mechanism for shining the light and confirming that the essential programmatic components are present while exploring the shadows to envision future success.

In closing, I am reminded of Leonard Cohen’s classic song, “Anthem”:

You can add up the parts
You won’t have the sum
You can strike up the march
There is no drum
Every heart, every heart to love will come
But like a refugee

Ring the bells that still can ring
Forget your perfect offering
There is a crack, a crack in everything (there is a crack in everything)
That’s how the light gets in
Ring the bells that still can ring (ring the bells that still can ring)
Forget your perfect offering
There is a crack, a crack in everything (there is a crack in everything)
That’s how the light gets in
That’s how the light gets in
That’s how the light gets in

Until next time, wishing you health and well-being,