Your first CARF accreditation or Joint Commission accreditation survey is an exciting milestone. It shows you are stepping up to meet top international standards for quality care, excellent service, and accountability.
To take some stress out of the process of accreditation preparation, think of CARF or the Joint Commission like a food critic rating a restaurant for Michelin Stars. The good news for health organizations is that, unlike a surprise visit from an anonymous food critic, survey dates are scheduled in advance.
Preparation Readiness
Preparation for an accreditation survey is critical to success, with the goal of exceptional service for your clients and efficient reimbursement, like the expectations for an outstanding restaurant. The accreditation body (CARF or Joint Commission) is the food critic — checking not just the flavor harmony (patient outcomes), but also the ingredient quality (infection control), the mastery of technique (policies and protocols), and whether the penne pasta sauce is consistently smooth (compliance and safety practices). Your healthcare organization is the restaurant, and your clients are the guests. And yes, a healthcare organization provides much more critical outcomes than a filet mignon cooked medium rare or caramelized crème brûlée!
Timing
It is best to start preparing 9-12 months to prepare before the accreditation survey. This gives you time to review and understand the proper accreditation standards manual that applies to the programs or services to be accredited. Use this time to complete a self-evaluation, spot any compliance gaps, and create an action plan to address them well ahead of the survey.
Develop a detailed improvement plan with specific steps, responsibilities, deadlines, and allocated resources to address the identified gaps. Then, put the plan into action, ensuring all necessary changes are made and documented well before the survey date.
Documentation
There’s a smorgasbord of documents needed to complete and share with the surveyor. They are outlined in the standards manual and address effectiveness of service, efficiency, health and safety, and accessibility. Keep the paperwork labeled and organized, matched to the corresponding CARF or Joint Commission element numbers. An easy to review presentation will deliver precise accreditation readiness for the surveyor.
Present the information requested at the beginning of the accreditation process, indexed and available electronically. Using the prescribed standards formats demonstrates that your facility is organized and ready for the survey.
Personnel
Appoint a leader in your organization who has a thorough understanding of the specific standards manual. Staff who may be interviewed should also be knowledgeable and able to discuss details and expectations confidently.
Key details include client treatment plans, progress notes, assessments, and discharge processes. And just as a chef’s personality can influence Michelin ratings, the professionalism and care demonstrated by your staff make a strong impression during accreditation.
Accreditation standards are reviewed under two headings, Administration and Program, with the potential for two surveyors on-site. Be prepared and appoint appropriate personnel as a liaison to each surveyor for a smooth operation.
Inform all staff of the survey date and post a visible invitation for board members, staff and even clients to attend. This reinforces your facility’s commitment to Joint Commission or CARF accreditation.
Mock Survey
After your organization implements its improvement plan and prior to the survey, a mock survey is recommended to catch any potential flaws. Conducting a survey like the actual process will familiarize your organization with the paperwork and processes to achieve the best outcome.
Hire A Consultant
To complete the above steps, it’s quite valuable to hire accreditation consulting services for CARF or Joint Commission accreditation help. Document preparation, personnel readiness, and conducting mock survey assistance will support your organization and facility preparation. A Joint Commission or CARF consultant will take care of the details while you attend to the most important part of your organization – your clients.
PowderHorn Consulting has an exceptional team, including CARF and Joint Commission surveyors. Our accreditation consultants can guide you through the accreditation process successfully and answer any questions along the way.
Pursue Accreditation
The seal of approval from CARF or the Joint Commission is even more valuable than Michelin Stars. While the steps may differ slightly depending on which survey you’re preparing for, the most important part is understanding the standards and how to apply them. With the right preparation and support from accreditation consulting, you’ll be well-positioned for success in your first accreditation survey.
A strong accreditation result, like a good review, attracts more clients and builds community trust.
PowderHorn Consulting is staffed by professionals who have an extensive history as CARF surveyors, with over 1000 surveys completed by the team. In addition, they have served as providers and executives for mental and behavioral health organizations and can assist and answer any questions you may have regarding the CARF accreditation process.
