1999 Conference Proceedings

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BEYOND ACCREDITATION: CARF'S QUALITY IMPROVEMENT PRODUCTS FOR ASSISTIVE TECHNOLOGY SERVICES IN THE NEW CENTURY

Dale Dutton
National Director
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 
email: ddutton@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 1999 CARF Standards for Employment and Community Services reflect the basic content, values, and expectations of a five-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. Three new program areas were added in 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 for publication in 1999. 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 1999 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?

In January of 1999, a Nationa Advisory Committee will review the Residential standards and service descriptions. This is now the largest, and fastest growing category of CARF accredited services, reflecting the growth of individual supported living options and service designs. Revised standards will be field reviewed during the Spring and submitted the CARF Board of Trustees for adoption in August. If you would like to comment on these new standards, please let us know.

The CARF "Quality and Accountability Initiative" in Employment and Community Services

For more than 30 years, CARF has served as the "preeminent standards-setting and accrediting body promoting and advocating for the delivery of quality rehabilitation services". In fulfilling this mission, CARF has facilitated the development of standards which have defined "quality" in the area of Employment and Community Services. During recent months, CARF stakeholders have increasingly demanded greater amounts of unbiased and reliable information about rehabilitation services, service provision, and the costs and results of services. In response, an ambitious "Quality and Accountability Initiative" has begun to take shape within CARF.

This initiative comprises four distinct components - each carefully designed to work together to define and improve the quality and accountability of service provision now expected by consumers, advocates, funders, and providers. The initiative also enhances the value of CARF accreditation to our stakeholders.

A New Definition of Quality - The first component is the dramatic shift from defining quality by the process of service delivery to a definition based on "outcomes" or the results of services. CARF's Employment and Community Services (ECS) accreditation products in 1998 are a result of two complete iterations of this change since 1994. Each 1998 ECS standard represents an observable, positive occurrence in the life of a consumer, the service provider organization, and/or the consumer and organization's community.

Performance Indicators - In the daily work of accrediting more than 16,000 programs and services throughout the US and Canada, CARF comes into contact with demographic and results data that are not readily accessible by the public. By facilitating national consensus on a uniform set of Performance Indicators, the stage will be set to begin to gather, study, and use this data in ways which will empower consumers and their families as they exercise increasing choice of services and providers.

Scorable Standards - The Standards Conformance Rating System (SCoRS ) will allow the CARF survey process to identify and track exemplary, innovative, and creative service delivery at the individual standard level for the first time, moving CARF accreditation farther away from a model that only identifies deficits. At the same time, SCoRS will allow surveyors to identify an organization's marginal or partial conformance with the standards. CARF accreditation will require, by a report recommendation, that the organization address the issues within its Quality Improvement Plan, and show improvement in the next survey, thus "raising the base" from inside accreditation.

Public Information - These moves toward quality and accountability would be greatly diminished without an enhanced public information mechanism to put this valuable data into the hands of the consumers and their families. Current public information concerning accreditation status and survey results is limited to organizational location, services accredited and the length of the accreditation.

Public information in the future will likely focus on information that consumers need in order to make informed choices in selecting the services they want and need. The four components of this new direction are currently "works in progress". We need your input as to what kinds of information would be useful, the format and location of this kind of information, and any refinement, validation, or additional knowledge you may suggest to make the information more relevant to your needs. Timelines for implementation of the individual components of this Quality and Accountability Initiative vary, but with your help, we expect to greet the year 2000 with a much enhanced set of CARF products and services for our Employment and Community Service customers.


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