Choosing the Right Accreditation


COLA, CAP, TJC… which is best for you?

Your laboratory’s quality performance depends on the expertise of its employees. It also depends on the systems put in place to maintain that quality. Accreditation is one way to help ensure your quality standards are maintained and continue to improve. Comparing agencies and considering your needs will help you make an informed choice that fits your lab.

Your Lab, Your Needs

Laboratories are diverse, depending on the setting and need for testing. The Centers for Medicare and Medicaid Services (CMS) reports that 64% of laboratories are physician office laboratories, as summarized in Table 1. Sixty seven percent of laboratories hold a CLIA certificate of waiver.1

Table 1

Laboratory By Type10
Laboratory CLIA Registered % Registered
Physician Office 114461 64.4
Skilled Nursing Facility / Nursing Facility 14888 8.3
Hospital 8722 4.9
Home Health Agency 13716 7.7
Community Clinic 6380 3.6
Other 19467  11.0


Hospital laboratory workers arguably occupy a niche market. Limited State and local resources force you to depend on the expertise of your medical director, technical consultant, and staff to make your laboratory inspection-ready. These resources are less obvious if yours is a physician office laboratory.

Whether a physician office, hospital or other laboratory, choosing an accrediting agency ensures not only that inspections are passed but that a high quality standard continues regardless of personnel changes. As pointed out by one author, “quality must be built into, not inspected into, work processes to ensure quality and patient safety.”2


In a competitive market with patients becoming informed consumers of medicine and public reporting of quality indicators, it can make good sense to use accreditation to give your laboratory a marketing edge.

St. Elizabeth Community hospital in Red Bluff, California, announced their inspection in the Corning Observer, stating, “We are proud of this distinction and have always focused to ensure the highest standard of care.”3 San Jacinto Methodist Hospital in Baytown, Texas, announced their 20th year of accreditation, stating “this accreditation recognizes excellence of services being provided.”4 And in Fayetteville, Georgia, Piedmont Fayette Hospital’s CEO announced in a press release that accreditation “further demonstrates our commitment to providing patients with quality healthcare.”5

Bragging rights aside, accreditation also forces an administrative commitment to quality that improves your reputation and credibility within your organization, always a plus when you need personnel, equipment, or other support.

CAP, COLA or Joint Commission?

Each accrediting agency has strengths to benefit your laboratory, providing assistance to pass inspections and more. It’s smart to consider all three to decide which one appeals to your particular mix of tests and technologists.

CAP laboratory accreditation, for example, is considered by many to apply the strictest interpretations of CLIA law, going far beyond regulatory compliance. They will create a pre-inspection checklist designed for your laboratory, and when the time comes you’ll be inspected by peers. CAP has a unique approach of using practicing laboratory professional teams from another CAP-accredited laboratories as inspectors. Indeed, your staff is eventually educated on both sides of the process. This can be an advantage in larger laboratories with sub-specialties. The CAP website claims over eighty three percent of teaching and large community hospitals choose their agency.6

COLA is approved for core laboratory specialities only (chemistry, urinalysis, hematology, microbiology, immunology, blood bank). Most COLA-accredited laboratories are in physician offices. But COLA provides excellent educational support and self-assessment tools as a cost competitive alternative. (Like other agencies, pricing is based on test volume and sub-specialties.) COLA also has a unique “COLACentral” website that includes an online document repository and other resources to help you stay in compliance.7

The Joint Commission has been inspecting hospital laboratories since 1979 and freestanding laboratories since 1995. Surveyors are Joint Commission-employed medical technologists with at least a bachelor’s degree and certification by the American Society for Clinical Pathology (ASCP).8 Inspectors will survey all laboratories in one visit in a comprehensive approach that includes “tracers” that follow laboratory results all the way to the patient’s chart. Like CAP and COLA, the Joint Commission offers a self-assessment annually to help your laboratory remain in compliance.

Each agency offers expert assistance for laboratories to enhance normal processes for passing inspections and improving quality in general, such as assessment tools, education, online resources, and pre-inspection checklists. The agencies are summarized in Table 2.

Table 2

Comparison of CAP, COLA, TJC
Deemed Authority 1995 1993 1995
All specialties Yes No Yes
Number of labs11 6,000+ 6,600+ 2,400+
Inspectors Other CAP Labs Yes Yes
Checklists Specific to your laboratory Yes Yes
Off-Year Assessment Yes No Yes
Education Yes Yes  Yes
 Key Point Strict quality standards Great for physician office labs Focused on patient outcomes; all labs can be surveyed in one visit

The Right Fit

But which choice is the right fit? With some exception–COLA does not accredit all sub-specialties–there is no wrong answer. Accreditation should help your laboratory pass inspections without deficiency, improve quality and add prestige. These are all good things.

CAP, COLA, and Joint Commission are not, however, equivalent. If cost is a factor, your choice may be COLA. If you want a laboratory to meet the strictest standards and like the idea of exchanging inspection teams with peers in other laboratories, CAP may be for you. And if you manage a large number of laboratories and prefer a seamless inspection process, Joint Commission may be the easiest all around.

Like any good shopper, you need an idea of what you’re looking for to get the best bargain. A brainstorming session with your staff can help identify issues. These, along with your concerns can be added to a spreadsheet to create a comparison tool that you can present to administration. You’ll need it if trying to justify a more expensive service.

In addition, here are general questions to ask a sales representative:

  • What is the cost? Are their discounts on other services as a membership benefit?
  • What education does your agency offer? Does this provide continuing education credits?
  • What resources does your agency offer for method specific questions?

Asking other laboratories what they like or don’t like can give you helpful information. COLA, for example, has an online search for accredited laboratories through their web site.9 A frank conversation may reveal pros and cons you won’t hear from the corporate sales staff.

Sharing the information with your staff and encouraging their honest input can let you know if the change is welcome or merely more work. As our aging workforce retires, building quality into the system with the help of an accrediting agency can be part of a strategic secession plan that ensures better patient care.


  1. Centers for Medicare and Medicaid Services. CLIA labs by certificate type (graph). Available at: Last accessed: 8/10/11.
  2. Berte L. Laboratory quality management: a roadmap. Available at: Last accessed 8/10/11.
  3. Corning Observer. Area hospital earns accreditation. Available at: Last accessed: 8/10/11.
  4. The Vindicator. San Jacinto Methodist Hospital laboratories receive accreditation. Available at: Last accessed: 8/10/11.
  5. Piedmont Fayette Hospital. Piedmont Fayette Hospital laboratory awarded accreditation. Available at: Last accessed: 8/10/11.
  6. CAP. Benefits of CAP accreditiation. Available at: windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=laboratory_ accreditation%2Flap_info%2Fbenefits.html&_state=maximized&_pageLabel=cntvwr. Last accessed: 8/10/11.
  7. COLA. COLA accreditation improves your laboratory. Available at: Last accessed: 8/10/11.
  8. The Joint Commission. Facts about laboratory accreditation. Available at: Last accessed: 8/10/11.
  9. COLA. Search for a lab. Available at: Last accessed: 8/10/11.
  10. Centers for Medicare and Medicaid Services. CLIA laboratory registration self-selected laboratory types (graph). Available at: Last accessed: 8/10/11. Centers for Medicaid and Medicare Services. Number of CLIA Certificate of Accreditation Laboratories by Accreditation Organization (graph). Available at: Last accessed: 8/7/11.

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About Author

Scott Warner, MLT(ASCP)

Scott Warner grew up in Western Maine. After a stint in the Air Force, he moved to the Maine coast. He has been a hospital laboratory generalist for more than 30 years and manager since 1998. As a freelance writer, his work has appeared in Advance for Medical Laboratory Professionals and other publications. He now lives in northern Maine with his family.

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