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Table 2 CQI at the institutional level

From: Evaluation of continuous quality improvement in accreditation for medical education

Criteria Continuous quality improvement at institutional level
Pros Cons
1. Serve the public interest Aspects reviewed within CQI such as patient safety, quality of education, training, and health care may contribute to safeguarding the interests of society.  
2. Evaluate the benefits   In our cases, CQI is not associated with formal cost–benefit evaluations. CQI may introduce an administrative burden and a major expenditure of human and financial resources. Moreover, checks may reveal issues that, when addressed, appear difficult to change, leading to frustration on the part of staff and management.
3. Examine the governance structure Through a requirement for CQI, accreditation authorities can stimulate organizations and their professionals to assume this responsibility. As such, CQI can be a decentralized aspect of the governance structure of the accreditation authority. CQI at the institutional level may have overlap with other quality systems. Besides excessive bureaucracy, this may lead to conflicting interests and criteria.
4. Enhance reflection CQI can detect risks or problems earlier and enable the timely sharing of feedback and remediation within an organization. The process may be more focused and rigorous given the foreknowledge of staff in the organization about actual or potential risks and problems that need to be addressed. An ‘open culture’ in which problems are not taboo subjects and in which professionals are encouraged to speak up is necessary for enhanced reflection and subsequent action.
5. Maintain impartiality and independence Impartiality and independence in decision making are difficult to attain within an organization. Review processes are conducted by colleagues, and the risk of dependency is much higher within an organization than with reviewers from an external organization.
6. Be publicly accountable The institutions adhering to the systems we evaluated do not use CQI to achieve public accountability. In general, organizations do not often communicate the results of their CQI with external audiences.
7. Balance expectations with capacity If CQI is carried out with integrity and provides optimal information to the accreditation authority, the expectation is that the accreditation authority will need less capacity.