Accreditation is a process very much in challenge today over several issues. Recently, the Association for Academic Health Centers held a seminar to review such issues across disciplines and outlined the following concerns for all accreditation processes:

• Should the nature and control of the accreditation processes be voluntary and peer-reviewed as currently offered, or be managed by governmental regulatory controls?
• Should the responsibilities for the accreditation process be regional for institutions or specialized by discipline? federal or state in purview? institutional or program specific?
• Should accreditation site visitors be objective and representative of the discipline, including each specialized program being reviewed, or are they more representative of trade associations and membership agencies just trying to secure more resources for their own interests?
• What are the assurances that accreditation works? What quality measures should be evaluated?
• How are the public stakeholders and policy makers involved in and educated about accreditation?
• Should accreditation be the linkage to certification, licensure and students' financial aid and financial loan default?

Each question could and should engage some healthy discussion; OJIN provides an excellent forum for such interchange. Let me start the process illustrating how one of the above questions could be addressed. One could ask, "Should accreditors and site visitors be from the specialized programs being reviewed?" This would imply that programs with baccalaureate, masters, primary care practitioners, nurse midwifery and nurse anesthesia would be peer-reviewed with faculty site visitors from each program type. Responses might include noting that in principle, such a strategy is reasoned. However, in practice, it is far too costly and risks the appearance of being too self-serving. What are the alternatives? Are on-site visits the only way to provide peer review?

Accreditation site visitors' quality and representativeness is one of many issue that needs dialogue and discussion. Assurances for measuring the quality productivity of accreditation is another. What measures do you believe should be evaluated and documented as outcomes and accountability of the process? What stakeholder inputs would be necessary to ensure effective quality accreditation? What sanctions should be imposed for those that don't meet these quality measures?