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 cmacdonell@carf.org 202-664-3314 mobile www.carf.org www.uspeq.org

Cathy Rebella – Resource Specialist for Europe crebella@carf.org