Accreditation for SCI Accreditation for SCI Rehabilitation:Rehabilitation:
Quality, Accountability, and Quality, Accountability, and TransparencyTransparency
ESCIF Congress18-20 May 2011
De Rijp, The Netherlands
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CARF InternationalCARF International
First question what does CARF stand for? Commission on Accreditation of
Rehabilitation Facilities (CARF)
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Second question….Second question….
What is accreditation? Systematic approach to review and address
performance of organizations Uses standards that are developed in a
variety of ways Should be third party and independent Should be not-for-profit Surveyors are from outside the organization
but should have expertise in the area being surveyed
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CARF InternationalCARF International
An international accreditation and standard-setting organization• Develop and revise standards• Consultative accreditation process
1966 Private, not-for-profit, independent Health and human services accreditation across
the lifespan and continuum of care Field driven – consumers, providers, payers,
regulators Moral owners – persons served
Person centered
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CARF ValuesCARF Values
Core values: All people have the right to be treated
with dignity and respect All people should have access to
needed services that achieve optimal outcomes
All people should be empowered to exercise informed choice
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CARF International CARF International Areas of AccreditationAreas of Accreditation
Aging Services Behavioral Health Service Children and Youth Services Employment/Community Services Medical Rehabilitation Services DMEPOS (US)
Durable Medical Equipment and Prosthetic/Orthotic Supplies
Opioid Treatment Programs Quality Insurance Practices (Non-US)
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Medical Rehabilitation FocusMedical Rehabilitation Focus
Only accreditor focused on medical rehabilitation Specialty programs to differentiate yourself in the
market…for example Stroke Brain Injury Amputee Spinal Cord System of Care Interdisciplinary Pain Occupational Rehabilitation Pediatrics Health Enhancement Case Management Inpatient, Outpatient, Home and Community Services,
Residential, Vocational
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CARF InternationalCARF International
International: US, Canada, Europe, Asia, Africa, South America, Middle East
19 Countries 8.7 million people served in 2010 6,700+ organizations 48,700+ programs 20,000+ locations
More than 2,600 surveys annually More than 1,500 peer surveyors 106 accredited Spinal Cord Systems of Care
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Mission and AccountabilityMission and Accountability
The mission of CARF:• Promote quality
• Value
• Optimal outcomes of services through a consultative accreditation process that centers on enhancing the lives of persons served.
Accountable to the CARF Board of Directors
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Accreditation withinAccreditation within a Care System a Care System
Supports:• Innovation
• Empowerment
• Productivity
• Accountability
• Better ways to deal with competition through planning
• Provide a continuum of high quality care in an accessible, responsive and caring manner and at a reasonable cost
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Accreditation as an Accreditation as an InnovationInnovation
Learning new ways to get work done through:
• Creative problem solving that utilizes continuous quality improvement tools
• Critical to streamlining work processes and finding better ways to achieve success with fewer resources
• Use of accurate, complete, reliable and valid data to make decisions
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Important principle:• Understanding that the organization will
never again be “still”
• Won’t have a finish line – continuous improvement
• Will require organizations and people to look for ways to better serve their customers in a more cost effective manner
• Quality framework – ISO, Six Sigma, LEAN, etc.
Accreditation as a Accreditation as a Quality StrategyQuality Strategy
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Why Accreditation?Why Accreditation?
Quality strategy
Business strategy
Communication system
Management tool
Establishes baseline of quality for an industry
Refocuses business on person served/resident
Establishes and re-establishes relationships with stakeholders
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Design/FrameworkDesign/Framework
Section One ASPIRE to Excellence
Leadership Governance Integrated Strategic
Planning Input from Persons
Served Legal and regulatory
Requirements Financial Planning
and Management Risk Management
Section One ASPIRE to Excellence
Human Resources Health and Safety Technology Rights of Persons
Served Accessibility –
Removal of Barriers Information and
Outcomes Management – both business and clinical
Performance Improvement
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Design/FrameworkDesign/Framework
Section 2: 2.A Program/Service Structure 2.B Rehabilitation and Service Process for
the Person Served 2.C Service Process for Persons Served in
Home and Community Services 2.D Health Enhancement 2.E Case Management 2.F Rehabilitation and Service process for
Children and Adolescents
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Design/FrameworkDesign/Framework
Section 3 – Specific Programs Spinal Cord System of Care meets
— Comprehensive Integrated Inpatient Rehabilitation Program standards
— Outpatient Medical Rehabilitation program standards
— Spinal Cord System of Care standards If the SCSC has Home and Community
Services, Residential Rehabilitation Services, and/or Vocational Services in its continuum and they meet the program description they must seek accreditation in those areas
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Persons Served PerspectivePersons Served Perspective
Moral Owners of CARF – Who we can not fail to protect
Starts in leadership with the standard that says: A person centred philosophy:
— Is demonstrated by:– Leadership– Personnel
— Guides the service delivery— Is communicated to stakeholders in an
understandable manner
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Person Served PerspectivePerson Served Perspective
Active listening in ongoing way What you do with the information
Rights Removal of barriers Staff that are competent to assist with
person served meeting their goals Answering the question :
What happens for a person like me in your program? (RESULTS)
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Person Served PerspectivePerson Served Perspective
Access to services Value or Satisfaction from person
served perspective uSPEQ: The Voice of the Consumer
Member of the decision-making team Active participant in their rehabilitation Preferences
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CARF ProcessCARF Process
A consultative, peer review survey process versus “inspection”
Performance improvement/quality framework A journey … no finish line Assistance throughout the process - not just about
your survey Network and build connections Person-centered Surveyors are your peers from the field. Their
consultation adds value and quality to the survey Standards revised every 3-4 years – raises the bar
for rehabilitation
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Survey ProcessSurvey Process
2-3 days with surveyors from all over Orientation Conference Physical Plant Tour 3 components of a survey:
Interview Observation Review of documents
Exit conference
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Survey ProcessSurvey Process
Organization preparation Assigned a resource specialist to
work with you No charge for consultation via emails,
phone, use as often as you want Trainings could be through CARF
101s, webcasts, audiotapes Quick to respond and people who
answer questions are clinicians
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Survey ProcessSurvey Process
How long does it take to prepare? Depends upon how organized you are as a
business Have to have a minimum of 6 months track
record of use of the standards Start by thorough review of standards and
identify which ones you are not doing at all (if there are any like that) and begin there
Use CARF resource specialist to assist – do not hesitate to ask questions instead of wasting time trying to figure it out!
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Survey ProcessSurvey Process
Accreditation Outcomes: Three Year One Year Provisional (a second one year in a
row; third time we visit if not a three year the organization is non-accredited)
Non accreditation
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CARF InternationalCARF International
Peer review process Process emphasizes the person served,
performance improvement, business and service delivery aspects of human service, and good management process
Strong case managed approaches throughout process sets of standards as well as program standards
Framework that includes business and clinical guidance
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Always a question about costsAlways a question about costs
$995 (USD) non-refundable Intent to Survey fee (like an application)
$1950 (USD) per day per survey includes Travel Hotel/meals Survey Survey report Certificate
Typical survey 2-3 surveyors (depends upon how many programs you are getting accredited) for 2-3 days ($7800-11,600)
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Which organizations choose CARF?Which organizations choose CARF?
Some don’t choose some are “mandated” Government Payer Associations
Those wanting to differentiate themselves Those wanting a performance improvement system
that reflects their daily work ISO Six Sigma Lean
The competitor is doing it so “I have to do it” New organizations The “bad apples” usually don’t Those that already have a reputation don’t see the
need unless there are competitors in their geographic area that have it
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European organizations that have European organizations that have chosen CARFchosen CARF
National Spinal Injuries Centre Stoke Mandeville Hospital – Aylesbury England
NRH - Dun Laoghaire, Ireland Sunnaas – Oslo, Norway University of Lund - Hoor, Sweden Uppsala University Hospital, Uppsala,
Sweden
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Accreditation Not a GuaranteeAccreditation Not a Guaranteebut …but …
A foundation Identifies necessary components for
excellence Addresses stakeholder needs around
accountability in efficiency, results or outcomes of services, satisfaction with services and the organization
Uses a quality framework that is embedded in all quality awards
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Specific topics in CARFSpecific topics in CARF
Scope: Medical/
physiological Functional Psychosocial Research capability Aging with a
disability Case management Resource
management Transition planning Life-long follow-up
Scope: Life-ling health
promotion Resources for
independent living and community integration
Prevention related to potential risks and complications
Safety for persons served and environments in which they participate
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Specific topicsSpecific topics
Provide directly or link: Behavioral health Independent living centres Clinical research centres Consumer advocacy groups Driver rehabilitation
Arranges for or provides diagnostics Specialty physicians and staff Ventilator persons served
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Specific TopicsSpecific Topics
Education program for person served and families/support systems based on needs:
Access to benefits and systems
Autonomic dysreflexia
Bladder and bowel management
Cardiovascular risk factors
Chemical use/abuse/dependency
Consumer advocacy organizations
Depression
Education: Diabetes prevention Edema management Emergency
preparedness Follow-up medical
care – — need for and
access to Independent living Life care planning Medical nutrition
therapy Musculoskeletal
issues Pain management
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Specific TopicsSpecific Topics
Education: Psychosocial
issues Pulmonary care Self-advocacy and
consumer competency
Self-management of health
Sexual counseling and education including information about reproductive issues
Education: Skin care and
prevention of pressure ulcers
Spasticity management
Spinal cord injury research, including access to current research
Use of leisure time Weight
management
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Specific topicsSpecific topics
Services Opportunities to try
new equipment and technology
Demonstrate expertise in:
Assistive technology
Electronic aids to daily living
Environmental controls
Environmental modifications
Personal care attendants
Peer counseling Work with community
on emergency preparedness
Leadership role in adaptive sports and recreation
Lifetime information on health and wellness resources
Life long follow-up Comprehensive annual
reviews Educate community
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What does CARF mean for What does CARF mean for improvement?improvement?
Standards revised so “raises the bar” Internal structure for performance
improvement on both business and clinical practice
Opportunity to network and work with others in the field Presentations Articles Webcasts
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How are people engaged?How are people engaged?
International Standards Advisory Committee
Field Review Use their resources in standards
National Spinal Cord Injury Association
Could develop a system like we have in pediatrics of “Liaisons”
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Contact usContact us
Chris MacDonell – Managing Director [email protected] 202-664-3314 mobile www.carf.org www.uspeq.org
Cathy Rebella – Resource Specialist for Europe [email protected]