Transcript Slide 1
Accreditation for SCI
Rehabilitation:
Quality, Accountability,
and Transparency
ESCIF Congress
18-20 May 2011
De Rijp, The Netherlands
CARF International
First question what does CARF stand
for?
Commission on Accreditation of
Rehabilitation Facilities (CARF)
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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 International
An international accreditation and standardsetting 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 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
Areas 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 Focus
Only accreditor focused on medical rehabilitation
Specialty programs to differentiate yourself in the
market…for example
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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
CARF 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 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 within
a Care System
Supports:
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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
Accreditation as an
Innovation
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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Accreditation as a
Quality Strategy
Important principle:
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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.
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/Framework
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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
Design/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/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 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:
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Leadership
Personnel
— Guides the service delivery
— Is communicated to stakeholders in an
understandable manner
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Person 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 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 Process
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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
Survey 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 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 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 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 nonaccredited)
Non accreditation
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CARF 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 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?
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
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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
European organizations that have
chosen 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 Guarantee
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 CARF
Scope:
Medical/
physiological
Functional
Psychosocial
Research capability
Aging with a
disability
Case management
Resource
management
Transition planning
Life-long follow-up
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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
Specific 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 Topics
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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/dependen
cy
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
Specific Topics
Education:
Psychosocial
issues
Pulmonary care
Self-advocacy and
consumer
competency
Self-management
of health
Sexual counseling
and education
including
information about
reproductive issues
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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
Specific 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
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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
What does CARF mean for
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?
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 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]
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