Improving Outcomes: The Importance of Accreditation, Certification and Licensure

Linda Kaplan, M.A.Senior Public Health AdvisorSAMHSA/CSATOctober 21, 2009Strategic Planning for Providers to Improve Business Practices Conference

Session Overview

Introductions Format Definitions Group Discussion Summary

Introductions

Name Position Expectations for this session

Accountability and Outcomes

Funders, Accrediting Bodies and the Public-All want to know results and expect fiscal responsibility

Good Business Practices Ingredients

Recovery-Oriented Systems of Care Improving quality Improving Outcome Meeting Standards

Improving Processes- NIATx

Organizations exist to serve customers 85% of problems are due to processes To better serve customers, organizations should

solve problems that improve processes Customers-External (clients, families, referral

sources, payers, community) and Internal (Staff) Problems-Gaps or discrepancies between actual

and desired performance

Overview of Licensure, Certification and Accreditation Licensure and certification for professionals:

protect the public and ensure that practitioners have meet standards for practice.

Licensure and accreditation of programs: ensure that they meet regulations and standards to operate.

Licensure and Certification of Professionals – Key Definitions Licensure: “ A license is a property right of

an individual, and as a property right, a license is backed by the laws of the State in which it is granted.” (Shimberg & Roederer, 1994) “…it is illegal for a person to practice a profession without meeting standards imposed by the State.” (Schoon & Smith, 2000)

Licensure and Certification of Professionals - Key Definitions Certification: A process established by a

private sector body that defines standards for professional practice. It may prohibit the use of a title or designation but often does not restrict someone from practicing a profession. (Schoon & Smith 2000)

Purpose of Licensure and Certification Provides assurance that practitioners have

met standards of practice Can perform scope of practice established for

the profession Has demonstrated knowledge and skill to

practice Provides public protection from incompetent

and unscrupulous professionals

Benefits

Licenses and certifications assure program administrators that the clinicians have met the standards to function within their respective disciplines.

Program Accreditation

Accreditation: extensive process using performance-based standards to

evaluate the quality and safety of care by assessing an organization’s compliance with national standards of care.

voluntary process that measures institutions against established quality and safety standards and requires that organizations engage in continuous quality improvement.

Trained surveyors conduct the assessment using clearly defined and established protocols.

Funders and third party payers usually require that behavioral health agencies be accredited.

Program Licensure

Licensure is “a right or permission granted by a competent authority (such as a government or a business) to engage in some business or occupation, do some act, or engage in some transaction which would be unlawful without such right or permission” (Merriam-Webster, 1996, p. 293).

States regulate the licensing of programs, and hospitals and agencies must meet these regulations and standards in order to operate.

Regulations may include required policies and procedures, types of staff, facility safety standards, and types of care allowed by programs.

Benefits of Accreditation

JCAHO – informs and protects clients/consumers, educates providers

Enhances performance Often a condition of State licensure and

requirement for payment from insurers or other third party payers

Data-driven management system

Accreditation

"The mission of The Joint Commission is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations."

Staff Infrastructure Issues

Recruitment and retention of qualified staff are integral to building a treatment infrastructure

Improving treatment outcomes will require qualified, trained staff

Workforce Issues

Recruitment Diversity Status Compensation Career Ladder Pre-service and

continuing education

Retention Compensation Supervision Recognition Career Ladder Continuing education

Recruitment Strategies

Need to recruit more diverse staff IOM Report found that professionals from

minority racial and ethnic backgrounds more likely to work in underserved areas and access to care is improved

Racial and ethnic minorities report higher satisfaction when staff is more diverse

(IOM 2003 In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce)

Recruitment Strategies

Provide intensive orientation to new staff Provide ongoing clinical and administrative

supervision to new staff Ensure adequate in-service training and

support for ongoing continuing education Recognize that counselors want to work with

clients rather than spend time doing paperwork

Management Practices to Improve Retention Provide Clinical Supervision Provide staff development/training More job autonomy Recognizing and rewarding staff for strong

job performance Better communication between management

and staff

Management Practices to Improve Retention Develop career paths that are built on skills

and competencies Supervision is critical-

staff need clarity about expectations earning potential feedback about performance regularly scheduled meetings

Management Practices to Improve Retention Ensure a fair and equitable environment Show appreciation for employees Provide clear performance expectations that

relate to a coherent organizational mission An environment that allows two way

communication

Clinical Supervision

Clinical supervision Improves retention Serves as a motivational/feedback mechanism Reduces stress Assists with counselor wellness

(Kaplan, L. (2003) Substance Abuse Treatment Workforce Environmental Scan. Bethesda, MD: Abt Associates

Knudsen, H.K., Johnson, J.A., Roman, P. (2003) Retaining counseling staff at substance abuse treatment centers: effects of management practices. Journal of Substance Abuse Treatment 23 (Feb) 129-135)

Infrastructure Issues

Technology EHR Economy of Scale (Size) Administrative Structure

Discussion

Summary

Process Improvement-key to better practices Accreditation - protects public, provides

quality assurance and improves performance Credentialing/Licensure – protects public;

upholds standards of practice; provides measure of competency