Health Services Accreditation Research Articles

Impact of short-notice accreditation assessments on hospitals' patient safety and quality culture-A scoping review: A scoping review of the current literature to understand the impact of short-notice accreditation processes on health service organizations patient safety and quality culture.

To explore the published evidence describing the impact of short-notice accreditation assessments on hospitals' patient safety and quality culture. Arksey and O'Malley (2005)'s scoping study framework and Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping reviews (PRISMA-ScR). A scoping review was conducted to identify papers that provided an evaluation of short-notice accreditation processes. All reviewers independently reviewed included papers and thematic analysis methods were used to understand the data. PubMed/MEDLINE, CINAHL, and ProQuest databases were searched to identify papers published after 2000. Totally, 3317 records were initially identified with 64 full-text studies screened by the reviewers. Five studies were deemed to meet this scoping review's inclusion criteria. All five studies reported variable evidence on the validity of health service or hospital accreditation processes and only three considered the concept of patient safety and quality culture in the context of accreditation. None of the five included studies report the impact of a short-notice accreditation process on a hospital's patient safety and quality culture. Limited evidence exists to report on the effectiveness of hospital short-notice accreditation models. No study has been undertaken to understand the impact of short-notice accreditation on patient safety and quality cultures within hospital settings. Understanding this topic will support improved hospital quality, safety, policy, and governance. To provide an understanding of the current knowledge base of short-notice accreditation models and its impact on hospital patient safety and quality culture. PRISMA reporting guidelines have been adhered to. No patient or public contribution.

Assessment of the compliance of a hospital pharmacy with the pharmaceutical assistance requirements of the national accreditation organization

Introduction: Accreditation of health services is carried out on the basis of pre-established criteria and standards for the continuous improvement of quality and safety. Objective: To assess the compliance of a hospital pharmacy with the requirements of Level 1 Pharmaceutical Assistance of the National Accreditation Organization (ONA). Methods: This was a quantitative and cross-sectional study, carried out in the pharmacy of a public hospital in Campo Grande, Mato Grosso do Sul, Brazil. The 34 total requirements and 05 priority requirements (CORE) of the ONA Manual were assessed through individual interviews and evidence analysis. Each requirement was rated and scored on: Exceeds (1.2 points), Conforms (1.0 points), Partially Conforms (0.5 points) and Non Conforms (0 points). Compliance was calculated by averaging the requirements scores, multiplied by 100. Results: The hospital pharmacy presented 77.58% of compliance in relation to the total requirements Level 1 and 84.00% in relation to the CORE requirements. Of the total, 61.76% of the requirements were classified as Exceeding or Conforming, 23.53% as Partially Conforming and 11.76% as Non-Conforming. Conclusion: ONA sets minimum compliance standards of 80.00% (total requirements) and 90.00% (CORE) for accreditation. The institution's hospital pharmacy did not meet the minimum standards required. It is suggested that the identified shortcomings could provide an opportunity for the formulation of intervention strategies aimed at the continuous improvement of processes and results, contributing to the advancement in the quality of the services provided.

Accreditation as a lever for change in the development of the collaborative practitioner in the Australian health system.

ObjectivePatient expectations in the Australian healthcare system are for coordinated, collaborative practice. There is a need for education institutions, health services, accreditation authorities, and consumers to work together to achieve this goal. As part of a larger body of work, we sought to understand how these stakeholders contribute to the development of collaborative healthcare practice.MethodNineteen focus groups were conducted in 2022 with 84 participants consisting of education providers (n=62), consumers (n=10), representatives from the Health Profession's Education Standing Group (n=8), and health service practitioners (n=4). Framework analysis was initially undertaken to understand facilitators of, and barriers to, collaborative practice and learning. In a secondary analysis, the themes were re-organised according to the Bolman and Deal domains of organisational practice, to make explicit the structural, human resource, political, and symbolic factors deemed useful for re-imaging a process for learning about and incentivising collaborative practice.ResultsThere are multiple factors across healthcare settings that both facilitate and challenge the development of collaborative practice. Co-location of professions and participation in formal interprofessional processes such as team meetings and handovers facilitated learning collaborative practice, although traditional cultures which perpetuate siloed models of healthcare, power differentials between the professions, funding structures, and information sharing limited opportunities. The 'value' of collaborative practice was facilitated through both consistent curriculum messages throughout health professional courses and positive role modelling.ConclusionsEducation institutions, health service practitioners, accreditation authorities, and consumers can work together to facilitate the development of collaborative practice through attention to policy and processes, curriculum activities, student participation, health service activities and practice, and resource allocation.

Building Toward a Disaster Resilient Health System: A Study of Hospital Resilience.

This research evaluated the resilience of 6 tertiary and rural health facilities within a single Australian Health Service, using the World Health Organization (WHO) Hospital Safety Index (HSI). This adaptation of the HSI was compared with existing national accreditation and facility design Standards to assess disaster preparedness and identify opportunities for improvement. This cross-sectional descriptive study surveyed 6 hospitals that provide 24/7 emergency department and acute inpatient services. HSI assessments, comprising 151 previously validated criteria, were conducted by Health Service engineers and facility managers before being externally reviewed by independent disaster management professionals. All facilities were found to be highly disaster resilient, with each recording high HSI scores. Variances in structure, architectural safety, continuity of critical services supply, and emergency plans were consistently identified. Power and water supply vulnerabilities are common to previously reported vulnerabilities in health facilities of developing countries. Clinical, engineering, and disaster management professionals assessed 6 Australian hospitals using the WHO HSI with each facility scoring highly, genuine vulnerabilities and practical opportunities for improvement were identified. This application of the WHO HSI, intended for use primarily in developing countries and disaster-affected regions, complimented and extended the existing Australian national health service accreditation and facility design Standards. These results support the expansion of existing assessment tools used to assess Australian health facility disaster preparedness and resilience.

Perbedaan Mutu Pelayanan Kesehatan Terhadap Puskesmas Terakreditasi Puskesmas Dan Puskesmas Tidak Terakreditasi Di Kabupaten Kolaka Utara Tahun 2021

Accreditation is an acknowledgment given by an independent institution that administers the accreditation which is determined after meeting the accreditation standards. The purpose of the study was to determine the difference in the quality of health services to accredited and unaccredited health centers. This research was carried out in North Kolaka Regency. The type of research that will be used is quantitative research with a comparative approach, which is to compare two groups with certain variables. The results showed that the average quality of health services in accredited health centers was 85.17, with a standard deviation of 6,304, a minimum value of 70 and a maximum value of 94, the average quality of health services in unaccredited health centers was 66.65, with a standard deviation deviation of 5.252, a minimum value of 56 and a maximum value of 79 and there is a difference in the quality of health services for accredited health centers and unaccredited health centers with a value of = 0.000 where < (α = 0.05) in North Kolaka Regency in 2021. Suggestions in research are that it can become information material for puskesmas to be able to improve the quality of health services provided to be even better, can be additional reading in the library and is expected to add insight to readers, especially regarding accreditation and quality of health services at health centers and can provide useful information to increase knowledge and encourage and help further research in terms of developing research methods.

Turkey implementation model for the centre of excellence in healthcare services

Abstract Today, in many countries, centres of excellence that can serve as a reference are determined in order to ensure easy access and quality healthcare services for patients whose diagnosis and treatment require advanced expertise, trained health human resource, experience, and high technology. Centres of excellence provide better health outcomes and equitable and easy access for patients. In addition, they provide very important advantages such as improving the quality of health services and health outcomes at the country level by increasing the provision of effective, efficient, high-quality health care services, increasing international competitiveness and health tourism potential in the field of health, and reducing catastrophic health expenditures. In 2018, a series of studies were initiated in cooperation with the Turkey Health Services Quality and Accreditation Institute and the Republic of Turkey Ministry of Health to identify centres of excellence in Turkey. The aim of this manuscript is to share the national implementation model that is being designed for Turkey for the studies of centers of excellence in health services.

Good practices in Italian therapeutic communities. Outcomes 2020 of quality accreditation program “Visiting DTC Project”

PurposeThis paper aims to present results achieved by the first, and to date only, Democratic Therapeutic Communities (DTC) quality improvement program developed in Italy, in the past 10 years, named “Visiting DTC Project.” Process of bottom-up identification, definition and evaluation of good practices of TCs for adult users with long term severe mental disorders will be described. In addition, a five-phase clinical care pathway will be presented for the same user category, developed by the “Visiting DTC Project” to comply with Italian National Health Service accreditation standards for TCs.Design/methodology/approach“Visiting DTC Project” involved 40 Italian TCs, since 2012 until 2020, in an action research on good practices developed throw a democratic and bottom-up methodology. Project’s methodology is the “Democratic Peer-to-peer Accreditation,” a kind of professional scientific quality accreditation and continuous improvement process for community mental health services. Scientific model for the definition of service standards and principles of treatment is the British “Democratic Therapeutic Community,” which the “Visiting DTC Project” is organizationally inspired by.FindingsIn the eighth annual cycle of the program for TC with adult users of mental health services a significantly effective good practice procedure (GPP), with good practical efficacy, was finally identified (for the first time after eight years), but still no best practice. GPP with the title “Multi-family Community Meeting” is the Good Practice of the year 2020. No Best Practice has yet been identified. An integrated clinical care pathway for Adult DTCs Users in five phases is also presented. This care pathway organizes advanced standards of Community Group Quality in a map, to support the description and planning of the five phases of the user’s clinical work in DTC treatment.Originality/valueCooperation with local community services, organizations and networks, as well as a therapeutic environment based on informal coexistence and cooperation between TC members, are thus, together with care of family relationships, the main characteristics of the Italian experience of implementing and developing the Italian DTC treatment model. These characteristics make it clear how fragile Italian DTCs are at this moment. They are still in an early stage of development. All the most applied and effective best practice procedures are dependent on a wide and dense network of relationships, formal and informal, which cross the therapeutic environment and interconnect TC members with all other stakeholders.

Documenting patient risk and nursing interventions: record audit

Objective: The aim was to explore and compare documentation of the nursing process for patient safety in two nursing documentation systems: paper and digital records. Background: The ‘nursing process’ (assessment, planning, intervention, and evaluation) is recommended by professional nursing registration and health service accreditation bodies as a key component of understanding nurses’ clinical reasoning. Nurses’ responsibility for patient safety must be supported by comprehensive documentation practices. Study design and methods: A retrospective audit of twenty clinical care records (N = 20) randomly selected from a single acute medical ward at a tertiary hospital in Australia; ten from a digital trial that replicated selected paper forms and ten paper records as controls. The audit was conducted by two nurse researchers using a purpose built data extraction tool. Results: Patient age, gender and primary diagnoses were similar for the digital and paper care records. Documentation of the full nursing process was low in both record types, and comprehensiveness of nursing documentation was similar across the paper and digital records. Compared to the paper documents, the digital documents were more often rated as ‘complete’ (p<0.05). Documentation of risk to skin integrity (p<0.05) and evidence of completed nursing interventions to address risks were more frequent (p<0.05) in digital records. Discussion: The findings of this study highlight an important gap in comprehensive documentation of the nursing process that supports and informs the clinical reasoning of nurses for patient safety. Improvements in digital documents reflect future opportunity to enhance the quality of nurse documentation using technology specific strategies such as prompts, visualisation and nudge. Conclusion: This research identifies that both paper and digital systems of hospital documentation may fail to capture and communicate the clinical reasoning of nurses. Digital systems have the potential to improve capture of the clinical reasoning and nursing process. What is already known about the topic? Professional registration and healthcare accreditation bodies recommend nurses’ clinical decision making is underpinned by processes of assessment, planning, intervention and evaluation. Poor capture of nurses’ clinical decision making in their documentation has negative consequences for the continuity, quality and safety of care; including inadequate detection of deterioration and escalation of care. Electronic systems are expected to enhance capture of nurse decision making in documentation. What this paper adds: Nurses’ clinical reasoning was poorly captured in both paper and digital documentation systems. Nurses documented their intervention responses to identified patient risks more often in the digital system compared to paper records. Digital systems offer an opportunity to proactively nudge nurses towards improved documentation of nursing processes.

Making the move to a learning healthcare system: has the pandemic brought us one step closer?

The notion of a learning healthcare system (LHS) is gaining traction to advance the objectives of high-quality patient-centred care. Within such a system, real-world data analysis, clinical research and health service research are core activities of the health system. To support the transition to an LHS, the Australian Government is implementing the National Clinical Trials Governance Framework, which extends health service accreditation standards to the conduct of clinical trials. This initiative encourages the integration of clinical trials into clinical care and the fostering of a culture of continuous improvement. However, implementing this initiative may prove challenging if health system leaders, clinicians and patients fail to recognise the value of clinical trials as a core health system activity. In this article we describe the enduring value of clinical trials and how the COVID-19 pandemic has enhanced their value by addressing longstanding deficiencies in the way trials are conducted. We also summarise best-practice advice on the embedding of trials into routine health care to enable their integration into health system operations. What is known about this topic? Many healthcare organisations seek to transition to a learning health system. In Australia, National Safety and Quality Health Service Standards, which support the embedding of clinical trials as a core health system activity, have been implemented to catalyse the move. What does this paper add? Because there is little practical advice on how to embed clinical trials into health system operations, this paper summarises best practice. It also provides a rationale for embedding trials as a core health system activity, because the creation of a strong research culture is an important determinant of success. What are the implications for practitioners? The successful transition to an LHS would significantly advance the goals of value-based care.

The unrecognized power of health services accreditation: more than external evaluation.

While it is widely recognized that accreditation enables an organization to improve its performance and sustain a culture of quality, changing healthcare practices to align with evidence-informed guidelines (clinical and administrative) is a complex process that takes time. The true value of accreditation lies in its contribution to healthcare safety and quality as a means to prompt and support 'knowledge to action', a key value of accreditation that 'has yet to be articulated'. Using the 'knowledge to action' cycle, a planned action framework, we illustrate that accreditation is a knowledge translation (KT) or implementation intervention that seeks to improve and increase the uptake of evidence in healthcare organizations. The accreditation components, including the quality framework, standards, self-assessment process and on-site survey visit, ultimately serve to improve quality, decreasing variation in practice and strengthening a culture of quality. With a unique perspective and alignment obtained through the implementation lens, we examine the accreditation process and components relative to the 'knowledge to action cycle' with implications for enhancing the value of accreditation beyond current appreciation to both accreditation bodies worldwide and those organizations that participate in accreditation programs. Until organizations and accreditation bodies embrace the accreditation process as a knowledge to action intervention to bring about meaningful and sustained change, the full benefits of the process will not be optimized nor achieved.

Options to enhance the veracity of Australian health service accreditation assessments.

Assessment processes applied within some health service accreditation programs have been criticised at times for being inaccurate, inconsistent or inefficient. Such criticism has inspired the development of innovative assessment methods. The Australian Commission on Safety and Quality in Health Care considered the use of three such methods: short-notice or unannounced methods; patient journey or tracer methods; and attestation by governing bodies. A systematic search and synthesis of published peer-reviewed and grey literature associated with these methods. The published literature demonstrates that the likely benefits of these three assessment methods warrant further evaluation, real-world trials and stakeholder consultation to determine the most appropriate models to introduce into national accreditation programs. The subsequent introduction of models of short-notice assessments and attestation by governing bodies into the Australian Health Service Safety and Quality Accreditation Scheme in January 2019 demonstrates how the findings presented in this article influenced the national change in assessment practice, providing an example of evidence-informed accreditation development.

Health Services Accreditation: What is The Evidence That The Benefits, Value and Impact?

Bu çalışma, akreditasyonun yararı, önemi ve etkisinin sağlık hizmeti sunan bir kuruluşta hasta bakım kalitesini nasıl iyileştireceğini ve Türkiye’de sağlık hizmetleri akreditasyona yönelik ne tür kazanımlar olduğunu değerlendirmek amacıyla yapılmıştır. Çalışma sağlık hizmetleri akreditasyonunun yararı, değeri ve etkisi ile ilgili literatürün tematik bir incelemesini sunmaktadır. Aynı zamanda literatür araştırması bu konulara odaklanmıştır. Bu kapsamda 2003'ten 2018'e kadar İngilizce ve Türkçe dillerinde iyi bilinen veri tabanları (örn. EBSCOHOST, ScienceDirect, ERIC, Springer LINK, Scopus, Web of Science) araştırılmıştır. Kaliteli sağlık hizmeti sunmak isteyen kurum ve kuruluşlar, sunduğu hizmetin kalitesini ölçmek, çalışan, klinik ve kurum düzeyinde iyileştirmeler planlayıp uygulamak ve yeniden değerlendirme sürecini bir sistem dahilinde sürekli hale getirmek durumundadır. Sağlık hizmetlerinde güvenilir bir değerlendirmenin gerekliliği; sağlık profesyonellerine, uzmanlarına ve kurumlarına güvenin sağlanması ve sürdürülmesi açısından önemlidir. Yayınlanan kanıtlara göre akreditasyon, sağlık kuruluşlarını değerlendirmede kullanılan araçlardan birisidir ve akreditasyonda üçüncü bir taraf, standartlara uygun hizmet sunulduğunu yapılan denetimlerle doğrulamaktadır.

Health service accreditation stimulating change in clinical care and human resource management processes: A study of 311 Australian hospitals

ObjectiveThis study aimed to establish whether longitudinal participation in an accreditation program is translated into improvement in continuity of quality patient care and human resource management (HRM) processes outcomes. Materials and methodsThis was a secondary data analysis of accreditation panel data from acute hospitals participating in the Australian Council on Healthcare Standards’ Evaluation and Quality Improvement Program (EQuIP). EQuIP criteria data from 311 hospitals were collected by external surveyors across 2003–2006 (Time 1) and 2007–2010 (Time 2). Mandatory accreditation criteria ratings at Time 1 were used to determine hospital performance group membership (1 = below moderate, 2 = moderate, 3 = above moderate). Analysis was undertaken of ratings across continuity of quality patient care and HRM process criteria, at Time 1 and 2. ResultsContinuity of quality patient care and HRM processes improved across time in the three performance groups. Lower performing hospitals improved at a greater rate than moderate and higher performing hospitals. The groupings and performance order did not change over time. ConclusionsAn accreditation program is an external driver that facilitates continual and systemic quality improvement changes to sub-systems with an organisation.

The 9-criteria evaluation framework for perceptions survey: the case of VA’s Learners’ Perceptions Survey

ABSTRACT For its clinical, epidemiologic, educational, and health services research, evaluation, administrative, regulatory, and accreditation purposes, the perceptions survey is a data collection tool that asks observers to describe perceptions of their experiences with a defined phenomenon of interest. In practice, these surveys are often subject to criticism for not having been thoroughly evaluated before its first application using a consistent and comprehensive set of criteria for validity and reliability. This paper introduces a 9-criteria framework to assess perceptions surveys that integrates criteria from multiple evaluation sources. The 9-criteria framework was applied to data from the Department of Veterans Affairs’ Learners’ Perceptions Survey (LPS) that had been administered to national and local samples, and from findings obtained through a literature review involving LPS survey data. We show that the LPS is a robust tool that may serve as a model for design and validation of other perceptions surveys. Findings underscore the importance of using all nine criteria to validate perceptions survey data.

Recording Vital Signs: A Neglected Nursing Practice?

Vital signs are patient’s health status indicators and their measurement and interpretation at opportune moments contribute to the early diagnosis of clinical deterioration and implementation of interventions. The IQG surveyors observed the lack of registration of vital signs during their visits, noting the need to evaluate this practice in IQG’s Health Services Accreditation Programs. The objective of this study is to verify the recording of vital signs in the patient’s chart considering the completeness at the opportune moments. The data was obtained between April 2017 and March 2018 by IQG surveyors during national and international accreditation visits to 141 hospitals participating in Health Services Accreditation Programs. The recording completeness of the eight vital signs (blood pressure, respiratory rate, heart rate, body temperature, pain, pulse oximetry, level of consciousness and urinary output) was checked by hospital. At each visit, between 05 and 07 records of patients admitted to open clinical and surgical care units were randomly examined. In the absence of registration of vital signs in one of the medical records, it was considered that the hospital does not present completeness. Evidence for the recording of vital signs at the appropriate moments (hospitalization, transfer of care, immediate postoperative period, nursing prescription and risk score result) defined the completeness criterion in a sample of 141 hospitals. The data were collected from 141 hospitals. At appropriate times, heart rate and blood pressure was recorded in 96% of hospitals and heart rate, blood pressure and body temperature in 81%. The completeness of vital signs at opportune moments was evidenced in 65% of the hospitals. The next challenge of IQG will be to understand the reasons that lead the nursing team to neglect the measurement, recording and interpretation of vital signs in clinical practice.

Evaluation of Patient Information System in Public Health Service Using the COBIT 5 Framework

The purpose of this study is to describe the current system process with the COBIT 5 domain, calculate the level of capability, link the assessment of COBIT 5 with the Public Health Service Accreditation instrument, and identification of resource support. Research design using qualitative methods and how to collect data using observation, interview and questionnaire. Stages performed in conducting the evaluation by conducting research planning, determine the scope of evaluation, data collection and processing, assessment report and evaluation, mapping the relationship with the guidance of Accreditation assessment at the Public Health Service. From the results of research using balanced scordcard on COBIT 5 instrument, the selected domains are EDM02, EDM04, AP001, APO06, APO07, DSS01, DSS02, DSS05, and DSS06. COBIT 5 users on Public Health Service Accreditation, supporting assessment activities in Chapter II and Chapter VII. Assessment of resources in the patient information system shows activities that still do not meet the level of capability.

First experiences of accrediting district hospitals for excellence in newborn care in KwaZulu-Natal, South Africa: Successes and challenges

Objective: Providing quality health care is what all health facilities seek to achieve. Accreditation of health services are used to assess and improve the quality of health care in different settings. This study describes experiences of developing and conducting accreditation for excellence in newborn care in district hospitals in KwaZulu-Natal (KZN), South Africa following a 3-year programme of support to all nurseries in KZN.Methods: A facility review was conducted in district hospitals in KZN to evaluate the quality of care provided to newborn babies to accredit hospitals in newborn care. Multiple tools were used to assess different components of care from different perspectives, including record reviews, assessment of staff skills and interviews with mothers. Awarding accreditation was based on scores achieved in various domains, which contributed to an overall score. Compliance with key priority indicators was required for accreditation to be awarded.Results: Overall scores for accreditation ranged between 57%-93%. Mothers reported high levels of satisfaction with care received. Record reviews identified shortfalls in care provided, and skills assessments showed poor resuscitation skills in labour wards in some hospitals. Of 39 district hospitals, eight were awarded silver and five were awarded gold accreditation status.Conclusions: This accreditation of newborn care provides a workable model for undertaking accreditation in district hospitals and can be used by managers to identify and address shortfalls in care. Regular accreditation would support ongoing quality improvement (QI) in neonatal care and such a process could be applied to other aspects of care in health facilities.

Health care accreditation system in Australia

Increasing focus on patient safety, quality of health care and improving health outcomes around the world has led policy makers, stakeholders and health care providers to create standardized processes. Accreditation is defined as an intervention that promotes patient safety and health care delivery at a high level. Despite the fact that national accreditation studies have been started in our country since 2015, the first examples in the world are based on 40-50 years ago. One of the first examples was the accreditation of health services in Australia in 1974. This study provides information about the Australian Health Care Accreditation System in the light of observations of Australian Commission on Safety and Quality in Health Care made during the 6 month period in 2016 in Sydney. It is thought that the research results will be useful for health policy makers, health professionals, academicians and students.

What's in a name? An overview of organisational health literacy terminology.

Organisational health literacy (OHL) is a relatively new concept and its role in improving population health outcomes is gaining recognition. There are several terms being used in relation to OHL but there is no consensus about the definition of OHL nor agreement on a single approach to its application within health services. This contested space continues to create discussion and debate between health literacy researchers worldwide. Increasingly, health service accreditation standards are moving towards including OHL and so services need to clearly define their roles and responsibilities in this area. Inherent in this is the need to develop and validate quantifiable measures of OHL change. This is not to say it needs a 'one-size-fits-all' approach but rather that terminology needs to be fit for purpose. This paper reviews the literature on OHL, describing and contrasting OHL terminology to assist practitioners seeking OHL information and health services clarifying their roles and responsibilities in this area.

The Development of Model and Measuring Tool for Specialists Accreditation in Area of Public Health Services

The main purpose of the paper is to present some theoretical approaches and some methods providing assessment optimization in specialists’ accreditation in area of public health services. The results of research presented in this paper, include the model of multistage adaptive measurements and two methods for reliability and validity analysis, providing high justice decisions in accreditation and corresponding to requirements in High-Stakes Testing procedures. The assessment optimization intends for minimization time of assessment and for reliability and validity data increasing. For optimization the special model of measurements based on multistage adaptive testing is offered. The using of offered model in assessment design allows to realize the advantages of traditional adaptive testing and linear testing, while minimizing their disadvantages. So, this model is recommended as dominating for assessment in accreditation. For validity increasing in assessment in accreditation the approach based on Structural Equation Modeling is offered. This method allows to analyze the significance of relations between observed and latent variables that have any interpretation as causal effects, and to construct the model of their relations. The example of model of casual relations between disciplines, latent variables (competencies) and factors is offered. The model helps to increase construct and content validity of measuring tool using in public health services accreditation. The methods of reliability estimation in multistage measurements, offered in paper, has innovative character. It has branching structure as the value of reliability in multistage measurements depends not only on reliability of separate stages, but also from correlations between them. The presented approaches allow to increase validity and reliability of decisions in public health services specialists’ assessment or in other spheres of assessment during accreditation.