Volume 84 - Spring/Summer 2003	Download

Credentialing, Accreditation, Certification, Licensure Their Importance to the Practice of Clinical Laboratory Science by Dr. Kathy V. Waller President, NAACLS Board of Directors

A "credential" is a statement of value that warrants confidence. It establishes that a person or institution has achieved professional recognition in a specific field. In the United States, a credential in health care may take the form of one of the following:

Educational Credential
A diploma or degree document attesting that designated requirements have been met
through satisfactory completion of a program of study, e.g., a BS degree.

Institutional Credential
A certificate indicating an institution has met the standards of an accrediting agency, e.g., the North Central Association of Colleges and Secondary Schools.

Accreditation
This is the process by which an agency or organization evaluates and recognizes a program of study or a facility as meeting certain predetermined qualifications or standards. It is voluntary. Accreditation is performed by a nongovernmental agency such as the Joint Commission on the Accreditation of Health Care Organizations (JCAHO), which accredits hospitals, or the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), which accredits clinical laboratory science education programs.

Certification
This is the process whereby a nongovernmental agency or association grants recognition, usually to an individual who has met pertinent qualifications specified by that agency or association such as passing a national certification examination. Examples of agencies that certify laboratory personnel are the National Credentialing Agency for Laboratory Personnel (NCA) and the Board of Registry (BOR) of ASCP. Certification can also be awarded to a laboratory that has achieved the requirements of a recognized laboratory accrediting agency such as the College of American Pathologists (CAP).

Licensure
This is the process in which a state or local government recognizes an individual or institution through legislation enacted to protect the public. Licensure either controls entrance into a profession through testing or enforces standards of practice. It is mandatory. California is one of 11 states that currently require licensure of laboratory personnel. If one does not hold a license, he/she cannot legally practice in that state.

Accreditation is voluntary in that the facilities or programs being evaluated have requested to be reviewed. Likewise, certification is a voluntary process for individuals. Licensure is a governmental procedure and is required by law.

History of Credentialing
In the United States the Flexner Report of 1910 did much to evaluate as well as to criticize, medical school education programs of the late 1800s and early 1900s. Abraham Flexner independently evaluated all of the medical schools in the U.S. and Canada and graded them A, B, or C, best to worse. He strongly recommended the joining together of science, research and hospital practice and advocated for university-based medical programs. Out of the Flexner Report came more rigorous criteria for evaluating medical school in the United States, together with the closing of sub-standard schools. The setting of education standards would be followed by other health care programs as well.

In clinical laboratory science, the earliest education programs, prior to 1920, were apprenticeships, with persons, mainly women, learning basic laboratory techniques from physicians. In 1921 the first baccalaureate program of four years duration was established at the University of Minnesota, with its first two students graduating in 1923.
Early leaders in the laboratory profession recognized that there were inconsistencies among educational programs and in the qualifications of some graduates. These leaders believed that national and uniform standards were required. In 1928 the American Society of Clinical Pathologists established a Board of Registry to certify individuals who met qualifications for certification, including passing of a national certification examination. The BOR credential was intended to be acceptable within all states, entitling certificants to work in various laboratories across the United States.

In 1976, the American Society for Medical Technology (ASMT), the forerunner of the American Society for Clinical Laboratory Science (ASCLS), recognized the importance of laboratorians credentialing laboratorians (not pathologists certifying laboratorians). Together with the American Genetic Technologists, ASMT initiated the National Credentialing Agency for Laboratory Personnel (NCA).

Thus one can see that national credentialing of laboratory personnel in the United States is complex and sometimes confusing. In addition, the "identification" of names of practitioners is inconsistent, e.g., clinical laboratory scientist versus medical technologist.

When we look at educational programs we are examining whether they meet pre-determined standards established by peers in order to become "approved." Precedence for NAACLS was first set by the Board of Schools, established in 1949. For example, the Board of Schools determined that the baccalaureate degree should be the entry level standard for laboratory practitioners starting in 1963. In 1973 the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), with a broader membership and representing educators, practitioners, employers and the public, was established. We believe NAACLS remains the preeminent agency to accredit educational programs for the 4-year CLS/MT, 2-year CLT/MLT, histotechnician, histotechnologist, cytogenetics technologist, pathologists' assistant, and diagnostic molecular scientist.

Finally, because this column involves terminology, I wish to distinguish between a "site visit" and an "inspection." Accreditation by CAP, for example, involves an inspection - a thorough investigation of the facility and its various components. NAACLS does not use the word inspection or inspector, which may connote a more punitive nature to an investigative process. Instead, NAACLS uses the phrase site visitor as the individual who, by going on-site, verifies the Self-Study Report submitted earlier by a program. We think this expression better represents the NAACLS accreditation process.

Current Status
Does a credential contribute to quality control? Many persons would reply "Most assuredly!" Just as laboratorian practitioners are familiar with laboratory quality assurance measures, so must educators, employers, administrators and government regulators be familiar with credentialing in its many facets. In program accreditation, the educational "process" is evaluated; in certification or licensure the "product" (graduate) is evaluated. The interrelationships of these credentialing mechanisms are seen in Table 1.

Finally, both accreditation of programs and certification of individuals are geared to "entry-level" practice. This means the standards set are for new graduates and not the experienced laboratory practitioner.

Thus, credentialing of educational programs and laboratory personnel is important - not only to validate what we do and whom we educate, but also to ensure the public that our processes are appropriate and our graduates are competent. Together they provide value and trust.

Table 1 illustrates that program or institutional accreditation assesses the "process" of education, i.e., if the program or institution meets standards established by peers. Certification and licensure assess the product (graduate) of the educational process. Together they serve as quality control measures to provide value to employers, various governments, and the public, that each is meritorious and that programs and graduates will engender confidence.

Top of the News
			CEO's Corner by Olive M. Kimball, PhD, EdD NAACLS Chief Executive Officer
			Credentialing, Accreditation, Certification, Licensure Their Importance to the Practice of Clinical Laboratory Science by Dr. Kathy V. Waller President, NAACLS Board of Directors
			New Policy for Inactive Programs by Dan Tice Administrative Liaison
			Programs to be Site Visited Fall 2003/Winter 2004 Cycle
Features
			Annual Report From Programs is a NAACLS Requirement
			Board of Directors Update (From the April 10, 2003 Meeting)
			Dr. NAACLS Advice for Accredited and Approved Programs
			Including a Research Component in the CLS/MT and DMS Curricula by Karen Madsen Myers, MA, MT(ASCP)SC, CLS(NCA) Member, PARC Committee
			Information Services Update by Elizabeth Everson Information Services Coordinator
			NAACLS Elections Held by Olive M. Kimball, EdD, PhD Chief Executive Officer
			NAACLS Meeting Dates
			NAACLS to Conduct Workshop in Chicago
			Newly Accredited NAACLS Programs

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