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Accrediting bodies' latest initiatives

August 1, 2008
by Brion P. McAlarney
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Some of what the Joint Commission, CARF, and COA have in the works

Accrediting organizations rarely sit still; they continuously refine their standards and requirements to improve patient care and organizational practices, as well as look for ways to improve the accreditation process itself. Below are highlights of what's happening at the Joint Commission, the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Council on Accreditation (COA).

Giving Providers Time to Digest Changes

Mary cesare-murphy, phd
Mary Cesare-Murphy, PhD

It's been a busy time at the Joint Commission. Beginning this October, the Joint Commission is implementing measures for inpatient psychiatric care (see sidebar). It also is taking advantage of evolving technologies to make its standards more user-friendly, clear, and concise by implementing a standards improvement initiative.

“We are going through a process of reviewing our standards for clarity and relevance to the field, tailoring the standards' language a bit more, deleting redundant standards that are mentioned in more than one place,” explains Mary Cesare-Murphy, PhD, executive director of the Joint Commission's behavioral healthcare accreditation program.

The Joint Commission will provide more information on the standards themselves in terms of rationale and overview. Most changes will appear in the 2010 manual, although an enhanced scoring process will be introduced in the 2009 manual. Starting next year, the scoring process will be based on the “criticality of survey findings.” Accreditation decisions and the timing of follow-up requirements will be evaluated as they relate to the immediacy of the threat to patients' care and safety, as the result of noncompliance with Joint Commission requirements. For instance, “immediate threat to life” situations, such as inoperable fire alarms or high rates of infection, would result in an expedited preliminary denial of accreditation decision, while “less immediate impact requirements,” such as failing to set priorities for data collection, could be addressed within 60 days.


Also in 2009 a new leadership standard addressing a culture of safety and quality will debut, and it includes disruptive and inappropriate behaviors in two of its elements of performance. In fall 2009, accredited organizations will receive a complimentary electronic version of the 2010 manual. This new electronic version will have a search capability that will allow providers to focus on the standards that apply to their programs. “We got feedback that people really wanted an electronic version that would tell them what's applicable to them,” reports Dr. Cesare-Murphy. “There's better technology today, and we wanted to respond to that just as we respond to other trends that occur in the field.”

Because of these new changes, the 2010 manual will not have any new requirements. “That's enough change for people to digest,” Dr. Cesare-Murphy explains. The Joint Commission is, however, identifying areas for future work, affectionately called “parking lots.” These include standards for working with people with intellectual disabilities, expectations pertaining to best practices and evidence-based practices, and standards for treatment planning. The Joint Commission is encouraging providers to visit http://wikihealthcare.jointcommission.org to provide their feedback on what areas Joint Commission accreditation should focus on to improve healthcare quality.

Setting a New Standard for Seclusion and Restraint


Nikki migas
Nikki Migas

Looking toward its 2009 standards, CARF's major area of change will be seclusion and restraint. It has been several years since CARF has changed these standards.

“Because of the significant changes that were going on in the field related to the whole area of seclusion and restraint, and the fact that so many organizations are focusing on eliminating the use at all of seclusion and restraint, we had a group of providers and regulators and persons served come together to review those standards,” says Nikki Migas, CARF's managing director of behavioral health and child and youth services. “We ended up focusing on standards that would be more in line with nonviolent intervention.”

The standards will describe steps that should be taken first to avert the need to implement a seclusion and restraint procedure, as well as educate providers to view seclusion and restraint as a treatment failure because of an inability to appropriately connect with the person being served, Migas explains.

Later this year CARF will post the proposed standards at http://www.carf.org for about three weeks, allowing for provider feedback. The standards will be published in January 2009 and become effective in July 2009.

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