Accreditation and Continuous Quality Monitoring

 Health care facilities are under constant pressure to improve and maintain patient safety.  In order for facilities to accomplish this task they must have resources that are able to measure different levels of care.  Accreditation and continuous quality monitoring (CQI) are two ways health care facilities can make sure they are giving the best care and receive maximum insurance reimbursements for improved methods of patient safety and monitoring.   

Accreditation is an external independent review of the delivery of health care against nationally-accepted standards which includes periodic reviews of performance, processes, and outcomes (“Accreditation Association”, n.d.).  Organizations such as the Joint Commission on Accreditation of Health care Organizations (JCAHO) (which is the most common) are aimed at improving health care through basic safety standards and methods.  Their goals are to increase patient safety and quality control.  JCAHO was established  in 1951 for the primary goal of setting a standard for safety within hospital settings and in 1981 was changed to include other ‘healthcare organizations’ which included home health and hospice agencies  (“What is NCAQ”, n.d.).  Hospitals and health care entities seek for this approval since the Department of Health and Human Resources Center for Medicare and Medicaid (CMS) base reimbursements and preferred providers on this accreditation.

Health care providers want to seek accreditation approval since CMS relies heavily on the JCAHO surveys to ensure that health care facilities have met the health and safety standards they require.  CMS requires facilities to participate in accreditation authorities for maximum reimbursements.  One reason this approval is important is because other insurance companies tend to follow the lead of CMS guidelines for reimbursement procedures.  Accreditation ensures communities the safest care possible.  

As health care continues to change and the requirements to get maximum reimbursements are more difficult it is even more important that health care facilities achieve and maintain accreditation standards.  Every three years facilities are subject to an ‘on-site’ visit and given plenty of warning before the visit is to take place, allowing for plenty of time to get things in order if necessary.  Some of the items to be checked are:

Patient rights, governance  administration, quality of care, management and improvement, clinical records and health information, infection prevention and control, professional improvement, facilities and environment, and anesthesia and surgical services  (“Accreditation Association”, n.d.).  As you can see the inspections will consist of all areas to make sure the facility is doing everything they can to minimize errors and maximize safety.  Another area they use to ensure safety is continuous quality control or CQI policies.

Here is a link to a power point that can help explain in a little more detail the specific areas that accreditation is looking to assess and improve: Understanding Accreditation

Continuous quality improvement methods started to gain momentum in 1991 realizing these strategies could improve health care facility operations.  According to Vanderveen  “CQI is as an approach for examining interactive systems, layer by layer, in achieving improvement at all levels…. a step-by-step flow model that aids institutions in arriving at solutions in an orderly and systematic fashion” (para, 3).  Facilities are required to monitor their performance as part of accreditation which consists of brainstorming activities, structuring issues, problem focus, uncovering issues, and lessons to be learned (Vanderveen, 1991).  In order to implement CQI processes you must have a strong leader and a diverse team to work on it.  The reason for CQI is not to expose things individuals are doing incorrectly but to fix processes that can work more efficiently and safe (Vanderveen, 1991).  CQI is just as it is stated: continuous.  Facilities must continually reassess their work through teams, patient surveys, and outcomes to seek where they can find ways to make improvements.

Bottom line is accreditation and CQI are processes that health care entities must comply with in order to receive maximum benefits and safety for patients according to CMS.  The reasoning for this is to protect the public and give them access to the safest care possible. 

Thanks Chelley

 References

Accreditation Association for Ambulatory Health Care (n.d.).  What does accreditation mean for my care. Retrieved from http://www.aaahc.org/en/my-care/

What is NCQA and JCAHO ( n.d.).  Retrieved from http://www.healthcare-information-guide.com/NCQA.html

Vanderveen, L. (1991). CQI system puts process into improving hospital. Health Care Strategic Management, 9(2), 16-8. Retrieved from http://search.proquest.com/docview/226922337?accountid=32521