Accreditation FAQ

The fees cover survey expenses and allow for reinvestment in the mission of accreditation. In addition to the stated fees, the program is also responsible for reviewer travel expenses.

While there are some organizational policies and procedures that can be cross­‐referenced to apply to the simulation program, other policies and procedures must be developed specifically for the Program. The list for the Program specific policies that are required can be found in the standards and elements. These have been determined by the Accreditation Council to be significant to the operations of simulation programs, and thus required.

Five years with annual self-study reports.

A program must be in existence for 2 years before seeking full accreditation. The program must also have at least 2 years experience in each area (Assessment, Research, Teaching and Systems Integration) for which the application is submitted. Based on input from new centers that grew organically or relied heavily on consultants, even with a well-developed strategic plan and a high-level business plan, it takes an average of 18 months to be fully operational.  Programs with less than two years of experience or outcomes data can apply for provisional accreditation.

We believe it is appropriate to seek recognition as an accrediting organization.  While there are no specific accrediting bodies that have been identified to perform an accreditation specific to the SSH Accreditation Program, there are ISO standards that may apply and are being reviewed.

Systems integration includes aligning organizational goals and simulation activities, with bidirectional feedback. These are examples of several ways that simulation can be used to support organizational goals when integrated into a bi- directional process (e.g. using a feedback loop):

1. Simulation can be employed to help people learn or practice methods that could be helpful in attaining an organizational goal, such improving the process of central line access as means of reducing the number of hospital- acquired infections. It is not necessary that simulation occur as an isolated intervention; it could be a component of a multi-pronged effort.

2. Simulation could be used as an intentional in-situ probe before opening new or renovated patient care units, providing practice to the participants as well as information to the organization to support improvements before actual patient care occurs in those units.

3. Simulation content could be based on Serious Safety Events, precursor events, pro-active identification of possible latent hazards, etc.

4. System hazards or latent conditions could be identified during simulations, and that information provided to appropriate organizational leaders for remediation. Identification of these conditions could be intentionally sought, or recognized serendipitously.

5. Virtual, tabletop or other types of simulations could be used as a component of a modeling process intended to better understand or improve patient flow, hospital systems or other aspects of patient care.

6. Simulations can be designed to cross the boundaries of multiple patient care areas, disciplines and/or support systems such as a simulation which begins at the helicopter landing pad, and progresses into the ED, including transport and security officers as well as healthcare providers.

A program can be considered for Systems Integration accreditation (see glossary) if it demonstrates consistent, planned, collaborative, integrated, and iterative application of simulation-based assessment, research, and/or teaching activities with process improvement and safety principles to improve clinical care, patient safety, and/or outcome metrics across the healthcare system(s).

Yes, SSH offers several online Accreditation courses. For information about the course offerings please visit the Online Accreditation Courses page.

A strategic plan is the process of comprehensive, integrative program planning that considers the future of current decisions, overall policy, program/organization development and links to operational plans. The process should align with and allow the program to fulfill its mission and achieve its vision. All areas of accreditation including core standards, assessment, research, teaching/education, and systems integration and patient safety should be aligned with the strategic plan of the Program.

Based on the pilot study findings, the use of the statement of accreditation will be further defined, and accredited institutions as well as interested applicants will be informed of the potential uses.

No. A Program may be in a stand-alone facility or may be inside a hospital or school. Although facilities or simulation activity locations must be adequate to meet the goals and objectives of the Program, the defining characteristics of an accredited program is the work it does, not the physical structure.

“Accredited” or “Not Accredited.” We will or will not grant accreditation.

The goal is accreditation. The definition of “Accreditation” is believed to be consistent with other accreditation bodies such as Council for Higher Education Accreditation (CHEA) or the International Organization for Standardization (IS). When fully implemented, the SSH accreditation processes will include: 

1. Completion of a self-study
2. A site visit
3. A report from the reviewers
4. A review of the team report by the Board of Review
5. A decision by the Board of Review

An appeal process is also available.

The Council members agree that this may be difficult area to address as there are people who have been doing credible work and leading the field without an advanced degree in the specialty of simulation or education. Similar to the processes developed with many newer medical specialties, individuals who have been developing this field will be evaluated via review of portfolios, résumés, curricula developed, etc. To credibly achieve accreditation, we have to assess the qualifications of instructors, faculty and others who perform vital roles in the Program in the context of that program. Applicants must have a formal process to document, evaluate and review the qualifications, training and experience of all staff.

Application for accreditation in Assessment will be limited to those centers creating, validating, and/or performing human performance assessment using explicit, preferably validated, criteria. Assessment leadership and assessors must have specific and substantial training, expertise, and demonstrated competency in the art and science of human assessment. Assessment tools may be

1. Internally created if justified by expert panel review or
2. Defined by professional societies, licensing bodies, or certification organizations

Externally created standardized and marketed courses, and the standardized assessment tools associated with such courses, will be considered, but may not be sufficient, in the accreditation of programs in Assessment.

The Council agreed that it is important to determine and document the value of on-site visits. In general, we believe that the purpose is to clarify and verify three elements: 

1. Site characteristics, by observation
2. Outcomes, by speaking with learners and observing training sessions or videos
3. Organizational support and alignment, by meeting with key individuals

We are evaluating our findings to determine whether to continue this aspect of our process.

In order to be considered for full accreditation, a Program needs to have been in existence for two years and be able to demonstrate that it has the requisite systems and processes in place and that it is achieving its stated goals and demonstrating outcomes. In addition, the program must have at least 2 years experience in each area (Assessment, Research, Teaching and Systems Integration) for which the application is submitted.  However, programs that have not yet operated for two years or have not yet compiled two years of outcomes data where required to meet the standards can apply to become provisionally accredited.

This is viewed as sensitive information by a number of respondents. The goal in this element is to ensure that the Program has the means necessary to support its mission and assure stability. The Program must be able to demonstrate that there are sufficient financial resources currently and in the foreseeable future to ensure the continued operation of the Program.

The accreditation designation is limited to 5 years with proof of maintenance and improvement via an annual report and annual renewal fee.

It was agreed that there is not the same level of evidence in simulation as there is in diabetes care, for example. The Best Evidence in Medical Education (BEME) project outlines the challenges in this regard. Educational materials or methods that have been proven through rigorous interventions and research will be integrated into accreditation standards and consultation as deemed appropriate and generally applicable by the Accreditation Council.

Yes. If your Program documents compliance with the core standards as well as the standards associated with Teaching/Education, and your program also supplies evidence of compliance with the standards for System Integration and Patient Safety, SSH will consider your Program for dual accreditation in Education as well as Systems Integration and Patient Safety.

As an emerging discipline, some of these terms are hard to define. While we believe that it is important for the Programs to supply their rationale for judging their administrators, instructors, and resource persons “qualified” or “expert,” this is an area where we need some input from involved stakeholders. Although we have collectively defined these terms in our glossary, we welcome your feedback for operational definitions that we should use for these terms.

In order to assure programs have adequate time to come into compliance with the standards, programs must wait one year from the decision notification to reapply.

While specialty or domain specific requirements will continue to vary by specialty, Simulation as a specialty is the recognized expertise of SSH. The unique value of accreditation by SSH is the recognition of simulation expertise as opposed to domain expertise.

The accreditation of a simulation program by SSH offers to both interprofessional centers and parent institutions the advantages of economy of scale, whereby the “common denominator” of excellence in accredited simulation-­‐based processes can provide important local stature and well-­‐deserved credibility. SSH is openly willing to cooperate and coordinate with specialty organizations in facilitating a conjoint function of accreditation processes, such that duplication of efforts is avoided where possible.

SSH views accreditation by this organization as uniquely valuable, and a benchmark to which every simulation center should aspire for many reasons, including the following:

• The integration of simulation into healthcare systems and processes is increasing and will progressively become part of the training, assessment, research, and process improvement infrastructure of all disciplines, although at varying trajectories. Over time, because all disciplines will value the impact of simulation-­‐based processes, there will be a natural tendency to both coordinate and dictate simulation-­‐related processes according to each discipline’s perceived needs. This may, in fact, include accreditation, potentially emerging from every distinct discipline.
• Logistically, it may become unwieldy and expensive for any one simulation center to devote the required energies to obtaining certification in many distinct disciplines through entirely different pathways. Strategically, for any parent institution, it may be financially stressful and administratively inefficient to allow (or expect) every distinct discipline within its sphere to acquire unique accreditation status, discipline by discipline.

Currently there is no evidence that establishes a minimum amount of time necessary to assure a quality Program. Given the variability of programs and organizational structures, we feel that it is reasonable to assess the adequacy of time commitments based on the overall quality of Program’s structure, processes, and outcomes. Through the accreditation process, the Program will be asked to demonstrate how it meets its stated goals and is in compliance with the established standards. As we collect data over time, however, we believe that we may be able to identify a threshold for dedicated time necessary from the Program Director. If we do, we will integrate that evidence into future accreditation standards.

The Council understands that this concern is not atypical for any group beginning accreditation and/or certification processes. It is the express intent of everyone involved in the process that participation, objectivity, transparency and due process will be built into SSH’s accreditation policies. Council members have recused their associated institutions from applying for accreditation during the Pilot Phase, but will be eligible for accreditation in future years. Site reviewers must sign a conflict of interest attesting there is no real or perceived conflict when performing an on-­‐site review. In no circumstance will a site reviewer or council member be involved in the review of their associated institution.

Although SSH is an international organization, payments may only be made in US dollars since the bank utilized by SSH resides in the United States.

In alignment with the Program’s mission/vision and strategic plan; the Program has a process for prioritizing simulation courses, activities, and requests in a systematic manner. The program is able to describe this process and provide documentation of prioritizations made that follow the described process.

It is the expectation that the cost will be reasonable for the service.

The Council continues to grow the pool of qualified and trained reviewers, and to build their experience over time to ensure adequate numbers of reviewers for growth.

After a period of one year from Board of Review decision.

Yes. SSH is an international society. SSH is actively working with other international organizations and has accredited programs in many countries. We are integrating international site reviewers to perform on-­‐site reviews of applicant programs.

No. A Program cannot only seek accreditation in the area of System Integration and Patient Safety. This is not a stand alone accreditation designation. A Program must also meet the core standards and the standards associated with at least one of the three functional areas: Assessment, Education, or Research. If your Program meets all the requirements in one or more of these areas, and your Program provides supporting evidence related to the standards for System Integration and Patient Safety, your Program can be considered for recognition in the area of Systems Integration and Patient Safety.

The SSH Accreditation Standards have been revised multiple times since the initial standards were released for use in 2010.  The process for the evolution and improvement of the standards includes the capture of evidence from Programs that have been evaluated; Subject Matter Expert (SME) input and review of this information and the evolution of evidence-based simulation practice in healthcare simulation; review and commentary by individuals from affiliated organizations around the world; and compilation and consensus on the final standards for each iteration as released.

The Council members believe that if multiple departments are using one facility, that the need for an oversight body and standard policies and procedures would be critical. There is no single way in which a Program should provide oversight for activities. The Program would need to describe in the Self Study how this oversight is accomplished and evaluated.

SSH has developed an appeal process for programs that are denied accreditation.

The following comment was received by the Accreditation Council: “The introduction to the SSH accreditation standards states that a Simulation Program is defined as an "organization or group with dedicated resources whose mission is specifically targeted towards improving patient safety and outcomes through assessment, research, advocacy and education using simulation technologies and methodologies"(refer first page, second paragraph). The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is concerned if this statement means that SSH will specifically accredit nurse anesthesia programs with simulation centers and that programs that seek SSH accreditation will have to meet SSH educational requirements that may conflict with COA requirements. While the current draft standards are very general this also leaves the requirements for compliance up to interpretation. It is also important to note that the standards are subject to future revision and may become problematic if when revised they conflict with COA requirements.

To help address these concerns a "Simulation Program" needs to be more clearly defined and a statement added that defers the establishment of a specialized educational programs' educational requirements to the specialized accrediting organization such as the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) that is recognized by the U.S. Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA) to accredit nurse anesthesia educational programs.”

The Accreditation Council believes that accreditation by SSH provides a unique value. We do not foresee a conflict with the standards of other specialty accrediting organizations.

We encourage applications from simulation centers across the globe. We do not yet have the resources to support all the possible languages for programs seeking accreditation. Therefore documentation for review must be submitted in English, and our visiting team will require your center to provide someone with knowledge of your simulation center who is fluent in English as well as your primary language to translate for the team.