1998 Conference Proceedings

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Beyond Accreditation: CARF's Quality Improvement Products for the New Century

Dale Dutton, National Directors
CARF Employment &Community Services Division
4891 East Grant Road, Tucson, AZ 85712
Phone(520) 325-1044, FAX (520) 318-1129
Internet addresses:http://www.carf.org 

Quality improvement is the real outcome of today's CARF accreditation. Today's accreditation product from the Employment and Community Services (ECS) Division of CARF is a close-up look at the organization and the results of the services it delivers. In the fast-changing ECS field, CARF standards remain in the vanguard of changes in the way our field delivers services. In fact, no single ECS standard or section of standards has been left untouched from 1997!

The value of accreditation has to be much more than a certificate on the wall. Organizations seeking accreditation from CARF must demonstrate a clear focus on their customers, their customer's expectations, and the results of services provided in terms of the achievement of desired goals, and customer satisfaction.

As a first step, an organization seeking accreditation makes a commitment to enhancing the lives of the persons served-as defined by the person served. Organizational values are developed or revised to reflect this commitment.

Next, the organization examines its structure and mission in light of current environmental factors. To do this, stakeholders are identified, their needs identified and prioritized, and changes in service delivery are implemented when appropriate.

The organization sets up an outcomes measurement system to observe changes in the lives of persons served, the organization, or the community as a result of services provided. The results from these observations drive changes to individuals' service plans and services, as well as the organization's daily operations and future plans.

The role of the CARF site survey visit is to provide an impartial, external review by a team of professional peers. This review is made using accepted standards and accessing the organization's policies or value statements. In other words, is the organization walking its walk and not just talking its talk? It becomes, in effect, a celebration of past success, and a guide to future improvement.

Conformance to the standards is demonstrated through team observations; interviews with consumers, families, staff, and other stakeholders; answers to questions about important points in the standards; and a review of appropriate documentation.

The Survey Report from these observations contains commendations to reinforce the organization and staff for their best practices. It contains suggestions for improving services based on the experiences of the Survey Team and questions from the organization, and it also contains recommendations for improvement in areas that the Survey Team identified to be in need.

Equipped with this information, the organization prepares a Quality Improvement Plan to address these recommendations during the term of the accreditation award. Using its outcome measurement system, the organization continues to refine and improve its services, operations, evaluation, methods, organization, and policies.

Throughout the term of accreditation, training and publications are available from CARF to help the organization implement its own QI plans and continue to improve customer-focused services for its stakeholders.

Today's dynamic "Learning Organization" uses the CARF accreditation process and results for its marketing, staff development, and strategic planning activities to improve the quality of life for each person it serves!

So - What's New?

The 1998 CARF Standards for Employment and Community Services reflect the basic content, values, and expectations of a four-year conversion and consolidation process to a greater emphasis on outcomes (results of services) and consumer satisfaction.

Also considered were major changes in the field, including the emergence of "Managed Care" concepts, and "One-Stop" Community Service Centers, which have occurred since the present standards were developed and reviewed by the field. New standards for Service Coordination were included beginning in 1996, which have allowed accreditation of many of these new service designs.

The field response from accredited organizations, funding sources and surveyors has been very favorable to the new approach, which resulted, among other things, in a major reduction in the number of standards. A significant amount of work was done during the conversion to eliminate duplication within the body of standards. With fewer standards or "quality data points", the surveyor teams have been better able to provide constructive consultation to organizations redesigning their Outcome Measurement Systems and focusing on service quality improvement as indicated by customer satisfaction.

Four CARF Employment and Community Services National Advisory Committees were held in Tucson in January, 1997. The groups focused on revision of existing standards as needed, overall manual reorganization, format and design, and the significant quality outcomes for accreditation in three new program areas for 1998:

The emergence of these new accreditation opportunities signals additional needs in our surveyor recruitment, training, and continuing education. New "Best Service Practice" manuals are being designed and developed during 1997 & 1998. If you are currently providing services in these areas and would like to become a surveyor or contribute to a CARF publication on the topic, please let us know.

In addition, the 1998 ECS Standards Manual features a separate section on Outcomes, focusing attention to this very important factor in quality service design and delivery, as well as successful accreditation. The Community Services section is reorganized in a life span sequence, moving from Children's Services to Older Adult Services, with flexible opportunities for accreditation in Assistive Technology and Service Coordination in either or both of the general areas of Employment and Community Service.

A coordinated Survey Guide provides information and structure to the service provider in preparing for the survey team visit, as well as for the surveyors while they are on site.

The CARF Sourcebook will answer many questions about accreditation in general, and CARF specifically, for the provider organization seeking accreditation for the first time. CARF staff are available by phone, email, fax, and regional appearance to answer specific questions as well.

And - What's Next?

CARF SCoRS(SM): A project is underway to develop a new quantitative standards conformance rating system, CARF SCoRS(SM) , field test the system, and phase in the rating system over the next two years. The system is expected to enhance the reliability of the survey process, and provide a foundation for differentiating the levels of conformance by programs seeking accreditation, for example, highlighting programs with excellent conformance. CARF SCoRS(SM) will rely on a 4-point rating scale for each standard. As we evolve the use of SCoRSSM, we will retain CARF's hallmark consultative accreditation procedures.

Performance Indicators: The extensive input received from CARF's constituents in the early phases of the Strategic Outcomes Initiative identified the need for a limited set of uniform indicators (based on quantitative measures) of rehabilitation program performance. During 1997/98 CARF is conducting a project across all three divisions to identify such performance indicators for rehabilitation. Performance indicators are those structure, process or outcome topics used to point to program quality. They represent a limited set of data items or measures that the persons served and their payers/sponsors can look to for key information to assess the quality of a rehabilitation program, and to compare or shop for the program best suited to their needs.

This is an exciting and challenging period for the Employment and Community Services Division of CARF. We value your support and participation.

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