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
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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
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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
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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
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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
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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:
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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
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Education:
 Diabetes prevention
 Edema management
 Emergency
preparedness
 Follow-up medical
care –
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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
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[email protected]
202-664-3314 mobile
www.carf.org
www.uspeq.org
 Cathy Rebella – Resource Specialist
for Europe
 [email protected]
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