Certification is a process by which a recognized authority, such as a government agency, professional association, or specialty board, evaluates and recognizes either an individual or an organization as having met pre-determined requirements or criteria, usually specialized knowledge and skill and demonstrated competence in a specialty area, beyond the minimum requirements set for licensing. Certification is a voluntary process undertaken by a provider or a facility to demonstrate special competence or capability in a particular area. 

Certification of Individual Providers

The certification of health care providers recognizes that an individual has demonstrated special skill or knowledge in a specific field. The intent of such certification is to provide evidence that the provider has successfully completed an approved educational program and evaluation process and possesses the knowledge, skills, and educational experience required to provide quality patient care in that specialty. Certification may also be tied to scopes of practice, which are legally sanctioned definitions of what types of services a particular health professional may deliver.

Health care provider certification through specialty boards often requires a re-certification after a defined period of time. Such assessment typically evaluates an individual provider on a number of levels, including experience, skills, professional standing, clinical performance, and even outcomes. Although certification is voluntary, an individual who does not meet re-certification requirements may encounter negative consequences such as withdrawal of certification, which could have implications for the individual’s ability to legally deliver certain services if licensure for a specialty area is tied to certification.

Professional societies in many countries exercise a function of certifying competence in their specific clinical specialty. Certification of professional nurse-midwives by the American College of Nurse Midwives, for example, requires graduation from an accredited teaching program, passing a national certification exam, continuing education, and, more recently, re-taking the certification exam every eight years. Medical specialty boards in the United States assure maintenance of professional competence in specialized clinical areas through evidence of professional standing, continuing medical education, self-assessment, and voluntary practice performance assessment.

Interest in provider certification or recognition has also grown recently as part of pay-for-performance programs. The National Committee for Quality Assurance (NCQA), a non-profit, health care quality oversight organization in the United States, offers Physician Recognition Programs for specialists and primary care physicians that involve self-assessment and reporting of quality measures data. Health insurance plans and the United States Centers for Medicare and Medicaid Services now accept data reported through NCQA Physician Recognition Programs as evidence of eligibility for incentive payments to reward providers who demonstrate the highest levels of performance against evidence-based clinical standards.

Certification of Health Care Organizations

When applied to an organization or entire facility, certification usually implies that the organization has additional services, technology, or capacity beyond those found in similar organizations. Certification distinguishes the organization as capable of practicing or delivering services in a specialty area and may even grant the organization the legal authorization and funding to perform specialized activities. For example, a laboratory may pursue specialized certification that allows specialized staff to conduct procedures and permits the use of specific equipment and materials. In many countries, certification of readiness to provide HIV/AIDS treatment and care is a prerequisite for the facility to receive and be able to dispense antiretroviral drugs. Government authorities and insurance companies may create an incentive for organizations to seek certification as a requirement for reimbursement for specialized services.

In recent years, many countries have become interested in applying standards established by the International Organization for Standardization (ISO) to health sector processes and organizations to certify that they conform to the requirements specified in ISO standards. ISO 9001 standards for quality management systems have attracted particular interest of health care organizations that see the establishment of a quality management system (QMS) as an opportunity to improve the quality of health care while reducing the costs.

• Licensure, accreditation, and certification: Approaches to health services quality
• International Organization for Standardization
• National Committee for Quality Assurance