The agony and the ecstasy – of accreditations

Earlier this week, I was catching up on my computer at home when I received an e-mail notifying us that we had received a couple of important accreditations (more on these below). That got me thinking about writing a blog about the process of obtaining such accreditations. By chance, my eyes landed on an old book on my bookshelf – The Agony and the Ecstasy – a novel by Irving Stone about the life of Michelangelo. The title reflects how the artist’s life was divided into the agony of dealing with the politics and society of the day, and the ecstasy of completing his incredible masterpieces. Once it got into my brain, I just couldn’t shake the silly metaphor of linking the process of obtaining accreditations with painting the Sistine Chapel. So, despite the totally understandable puzzled expressions on the faces of my colleagues when they first heard of my plans for this blog, here we go…

As a cancer center, we are involved in many activities involving patient care, research and education. We monitor our success over time in these efforts using a broad range of measures. Outside groups that accredit and rank us also track such measures. Examples include clinical outcomes of our patients, patient satisfaction with our care and service, thoroughness of our quality monitoring efforts, number of patients served, reputation among experts, grant funding, major publications, research findings that change patient care, impact on the burden of cancer and success of our trainees.

There is no question that these are all important factors to follow. The challenge is in the details, particularly when going from broad goals to specific metrics. This is where the “agony” comes in. Our own institution has established definitions for many of these measures. We have systems to track them so we can assess our own performance over time and use the resulting information to continually improve. This is a difficult but vital task. Outside accrediting organizations often request different metrics. There are times when the metrics requested by these organizations are designed differently from those we use internally. In some cases, we feel these metrics do not effectively reflect our strengths, yet we have little choice but to respond as requested.

Clinical outcomes is one example. Holden cancer patients are often sicker than cancer patients seen at community cancer centers. Some are referred to us because they have more challenging cancers or other illnesses such as heart or lung disease. This makes management of these patients more difficult. The fact that we care for sicker patients can impact on our metrics for “outcome” and “quality of life,” but not all outside groups take this into account.  Another is “reputation score” that is based on the opinion of peers obtained via a national survey. There are a number of cancer centers across the country that have been around longer, and are better known nationally, than we are. These centers historically do very well on reputation score metrics even if they are struggling. In contrast, the reputation score for an up and coming cancer center (I believe like Holden) increases quite slowly.

Given that the measures we track, and the metrics outside organizations require are not always aligned, it takes considerable effort to modify our internal measures and gather additional data so it is compliant with the metrics required by these organizations. Our team works very hard to be sure this is done thoroughly and accurately even when we feel such metrics do not fully reflect our performance. Some of the more significant accreditation processes involve a site visit from the accrediting organization. Preparing for such site visits requires an additional major commitment of time and effort. OK -Enough of the “agony”.

The “ecstasy” comes when the result of the hard work is awarded with a highly desirable accreditation. In fact, this blog was conceived when we received notification of accreditation from two organizations. The CEO Roundtable awarded us with its Cancer Gold Standard recognizing UI Health Care’s effort to support a healthier workplace by focusing on cancer risk reduction, early detection, access to clinical trials and high-quality care for our faculty and staff The Foundation for the Accreditation of Cellular Therapy (Fact) accredited our Adult and Pediatric Blood and Marrow Transplant (BMT) program based on our outstanding outcomes and the rigor of our quality programs that are in place to assure these complex and risky therapies are being used carefully and safely.

Our accreditations and rankings extend broadly across other aspects of our mission. The list of our current accreditations includes (but is not limited to) our status as an NCI-Designated Comprehensive Cancer Center, National Accreditation Program for Breast Centers, US News and World Report Best Hospitals for Cancer, and American College of Surgeons Commission on Cancer.

OK, OK… maybe my colleagues were right about this being a really strained metaphor. Nevertheless, if I am going to go with it, I might as well go all in. Once the agony of the scaffolding representing the hard work that goes into preparing for these reviews is gone, it is exciting to step back and see the full picture of excellence across the spectrum of our efforts reflected by this broad range of accreditations. While accreditations are no Sistine Chapel, the word “ecstasy” does come to mind when the excellence reflected by such accreditations translates into better care for those we serve.