The Value of Accreditation

Accreditation is a process in which certification of competency, authority or credibility is evaluated against official standards. Organizations seek accreditation to provide objective evidence that they meet or exceed industry recognized quality standards to those who seek their goods and services. Accreditation processes are used in a variety of fields, and are administered by a variety of accreditation bodies that are recognized as authorities in their field.

When evaluating the relevance of an organization’s accreditation claims, one must consider the focus of the accrediting body. For example, the International Organization for Standardization (ISO) is a well-known, worldwide organization that has a wide variety of accreditation standards covering almost all aspects of technology and business. A search of the ISO Standards Catalogue using the search word “healthcare” returns 53 standards, all of which apply generalized standards to specific components of a healthcare business, such as Data Exchange standards, Medical Electrical Equipment standards, or ergonomics standards. A search in this catalogue using the search word “Medical Assessment” or “Insurer’s Examination” returns “no matching results”.

If you were looking for a company to provide high quality healthcare or insurer’s examinations, there are accreditation organizations that will provide a much more comprehensive and integrated measurement of a company in this field.

Who is CARF?

According to its web site, the Commission on Accreditation of Rehabilitation Facilities (CARF) was founded in 1968. CARF International is an independent, nonprofit accreditor of health and human services. The CARF family of organizations currently accredits close to 50,000 programs and services at more than 22,000 locations. More than eight million persons of all ages are served annually by more than 6,500 CARF-accredited service providers. CARF accreditation extends to countries in North and South America, Europe, Asia, and Africa.

CARF International accreditation provides a visible symbol that assures the public of a provider’s commitment to continually enhance the quality of health and human services and programs. CARF surveyors use a consultative approach during the survey process. Each survey team is selected based upon a match of the surveyors’ areas of expertise and the organization’s unique needs. Service providers earning CARF accreditation are recognized for their ongoing innovation and continued conformance to the standards.

CARF’s roots and primary focus started with rehabilitation and grew within the health care treatment industry. In the 40 years that CARF has been in existence, the Independent Examination Service has emerged within the medical community, providing independent medical opinions to the insurance industry, Workers Compensation Boards, employers and other stakeholders. Stakeholders have expressed need for an accreditation process for this sector of medical services for quite some time.

In September 2011, CARF met this need by convening an International Standards Advisory Committee (ISAC) to develop CARF’s first set of standards for Independent Evaluation Services. This ISAC included representatives from Independent Medical Examination (IME) companies, the Financial Services Commission of Ontario (FSCO), Insurance companies, the CARF Surveyor Roster and CARF Resource Specialists.

The Independent Evaluation Services program standards focus on evaluating an assessment company’s practices to coordinate and facilitate objective, unbiased evaluations based on the following:

• Individualized referral questions.

• Effective and efficient use of resources.

• Regulatory, legislative, and financial implications.

• Relevant communication with stakeholders.

In view of the multiple stakeholders involved, the Independent Evaluation Services standards require that the company supports transparency and exchange of information. As of August 14, 2013 only three organizations worldwide have achieved accreditation for this new program; one in each of Canada, England and the USA.

CARF Accreditation Process

The CARF accreditation process starts with a provider’s commitment to continuous improvement and culminates with external review and recognition that the provider’s business and service practices meet international standards of quality — with all the steps in between focused on optimal outcomes for the persons the provider serves. The core CARF standards have been developed over 40 plus years by international teams of service providers, policy makers, payers, family members, and consumers. The standards have also been submitted to the public for review to validate relevancy and ensure input from all interested stakeholders.

After a service provider commits to accreditation, the accreditation process begins with a thorough self-evaluation that applies the relevant CARF standards against the organization’s practices. Once the organization is in conformance to the standards, a request for a CARF survey is submitted at least three full months in advance of the desired date for an on-site survey. By the date of the survey, the provider should be in conformance with the standards for at least six months.

The survey team comprises industry peers who follow a consultative (rather than an inspective) approach in conducting the on-site survey. In addition to interviews of staff, persons served and their families, the surveyors observe organizational practices, review appropriate documentation, answer questions, and suggest ways to improve the provider’s operations and service delivery.

Following completion of the survey, CARF renders an accreditation decision and delivers a report that identifies the service provider’s strengths and areas for improvement and its level of demonstrated conformance to the standards.

To demonstrate its ongoing conformance to the CARF standards, an accredited provider completes a Quality Improvement Plan after receiving the survey report and submits an Annual Conformance to Quality Report each year throughout the accreditation term.

Accreditation Decisions

To be accredited by CARF, an organization must satisfy each of the CARF Accreditation Conditions and demonstrate through a site survey that it meets the standards established by CARF. The number of surveyors and the length of time it takes to undergo the site survey depends on the size of the organization being surveyed and the type and complexity of programs being evaluated. A typical survey is conducted by 2 surveyors over the course of 2 to 3 days. he accreditation decision will be based on the balance of its strengths with those areas in which it needs improvement.

CARF uses the following guidelines to determine each accreditation decision.

Three-Year Accreditation. The organization satisfies each of the CARF Accreditation Conditions and demonstrates substantial conformance to the standards. It is designed and operated to benefit the persons served. Its current method of operation appears likely to be maintained and/or improved in the foreseeable future. The organization demonstrates ongoing quality improvement and continuous conformance from any previous period of CARF accreditation.

One-Year Accreditation. The organization satisfies each of the CARF Accreditation Conditions and demonstrates conformance to many of the standards. Although there are significant areas of deficiency in relation to the standards, there is evidence of the organization’s capability to correct the deficiencies and commitment to progress toward their correction. On balance, the services benefit those served, and the organization appears to protect their health, welfare, and safety.

An organization may be functioning between the level of a Three-Year Accreditation and that of a One-Year Accreditation. In this instance, accreditation will be awarded for one year. An organization will not be a
warded a second consecutive One-Year Accreditation.

Non-accreditation. The organization has major deficiencies in several areas of the standards; there are serious questions as to the benefits of services or the health, welfare, or safety of those served; the organization has failed over time to bring itself into substantial conformance to the standards; or the organization has failed to satisfy one or more of the CARF Accreditation Conditions.

Gaye Sydenham is vice president of accreditation & professional development for Centric Health, a health care company with a complete range of innovative and whole-life solutions centred on patients and health care providers (www.centrichealth.ca).