Accreditation for SCI Rehabilitation: Quality, Accountability, and Transparency

1. Accreditation for SCI Rehabilitation:Quality, Accountability, and Transparency ESCIF Congress 18-20 May 2011 De Rijp, The Netherlands

2. CARF International • First question what does CARF stand for? • Commission on Accreditation of Rehabilitation Facilities (CARF)

3. 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

4. CARF 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

5. 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

6. 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)

7. Medical 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

8. 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

9. 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

10. Accreditation within 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

11. 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

12. Accreditation as a Quality Strategy • 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.

13. 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

14. 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

15. 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

16. 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

17. 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: • Leadership • Personnel • Guides the service delivery • Is communicated to stakeholders in an understandable manner

18. 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)

19. 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

20. CARF 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

21. 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

22. 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

23. 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!

24. 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 non-accredited) • Non accreditation

25. 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

26. 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)

27. 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

28. 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

29. Accreditation Not a Guaranteebut … • 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

30. 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 Specific topics in CARF

31. 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

32. 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 Specific Topics

33. 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 Specific Topics

34. 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 Specific topics

35. 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

36. 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”

37. Contact 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