CARF Accreditation: Where do I start???

Although it seems like an obvious enough question, I realized recently that I’ve never written a post about it. I’ve addressed how to prepare for a site visit and how to maintain conformance, but haven’t started from the start. Yet it’s absolutely crucial to start things off right to avoid huge pitfalls! So here’s the basics;

Get Connected to CARF and Get the (right) CARF Manual!

The first thing you’ll need to get sorted is which standards manual you will be using (CARF has several) and which standards within that manual you will be applying to your programs (there are literally dozens of possibilities).  It’s always my very first task with a new client seeking accreditation.  You need to know the scope of the work before you can develop a proper workplan.  You can contact CARF directly to get set up and it costs you nothing.  They will assign a Resource Specialist to your organization that will walk you through the process of figuring out which manual you will be using. They will also help you figure out which of their specific program standards will apply, though I strongly suggest getting some third party advice on that topic from colleagues, other similar accredited agencies, or an experienced CARF consultant.  I’ve seen lots of folks end up under the wrong program type, and that has the potential to cause huge problems when the survey team arrives!

Do a Gaps Assessment

Once you know where you fit in the CARF standards manual, you’ll need to figure out what you have and don’t have in relation to the standards.  I suggest being methodical – going standard by standard – to figure out what’s missing.  CARF has developed a resource called the CARF Preparation Workbook that can support this process.   It isn’t required, but some people find it helpful.  I prefer a simple workplan type format that lists the standards being applied, assesses conformance, and allows you to specify who is going to do what to address gaps in conformance.  Remember to review the examples and intent statements that come after each standard in the standards manual to make sure you understand what is required.  It’s also wise to review the appendices in the back of the manual that list what documents are required (Appendix A), what the operational timelines are for time sensitive processes (Appendix B), and what training is required for your staff (Appendix C).

Decide On Your Timeline and Build Your Workplan

With your gaps assessment in hand, you’re ready to plan your work.  I STRONGLY recommend establishing a timeline at the beginning and sticking to it as best as possible.  There is never a good time.  There will always be unforeseen circumstances and challenges. Putting your timeline in writing helps keep everyone focused. The absence of a timeline gives people permission to keep putting it off. You should count on the preparation work taking between six months and one year, depending on number and size of the gaps, the complexity of your organization, and the resources you have available to get the work done.  Work backwards from your deadline to figure out when tasks need to be completed. I tend to leave document development tasks (e.g., certain policies, procedures and plans) until later and focus on process tasks (e.g., performance measurement, staff training) first except where they overlap. I DO NOT recommend working through the standards manual in a linear fashion (from A to Z) because many of the different content areas overlap.  For example, risk management and strategic planning overlap with performance measurement and management. Make sure you develop your plan with that in mind or you can end up creating re-work.

Get Educated & Get Help When You Need It!

CARF offers regular training across the US and Canada.  They also have webinars and resources you can purchase.  It’s absolutely worth it to have one or two staff get trained. It helps you to decipher CARF-ese and make sense of how to implement the standards in your organization.  You can also access your CARF Resource Specialist for free at any time as you prepare for the site visit.  These folks can be an invaluable source of information and assistance in interpreting the standards.  Other organizations that are CARF accredited or that are going through the preparation process at the same time can be a valuable source of support as well.  After all, misery loves company!

Some organizations choose to purchase the services of a consultant to support them through the process. While building up expertise internally is always wise, having outside guidance can help streamline the work and avoid pitfalls.  I’m planning to do a blog post on how to choose a consultant as I think there are more than a few pitfalls to avoid with that as well!

Consider Doing a ‘Mock’ Review

Many of the organizations I’ve worked with hire a local surveyor or consultant to do a ‘mock’ survey.  Having a dry run with someone that is objective helps to ensure that you are ready and haven’t missed anything important in your preparations.  It also helps put staff a bit more at ease as they will get some sense of what the actual survey will be like.

Submit Your Application

Once you’ve worked your plan, it’s time to submit the application to CARF.  Submitting the application is your indication to CARF that you are operating in conformance with the standards. You can expect to have your site visit from CARF inside of six months from the time you submit the application.  The specific timelines are listed in the CARF manual.

Preparing for the Site Visit (aka What to Expect When You’re Expecting… CARF)

The key task in the run up to the site visit is staying on track with all CARF related processes.  You definitely don’t want to let off the gas. If you need assistance with preparing for the actual site visit, you can refer to my blog post “Five Tips for a Successful CARF Accreditation Survey”. And if you need more info or clarification on anything in this article, don’t hesitate to reach out.

Mind The (CARF) Gap

There’s an incredible feeling of relief you feel when the taillights of the CARF survey team’s vehicle leave the agency parking lot.  You breathe a sigh of relief and hopefully celebrate your achievement with a cocktail (or two).  But that feeling of relief and achievement is quickly in your rear view mirror as you jump back in to the day to day challenges of running a social service organization.  In that day to day buzz, it’s pretty easy (and understandable) to lose sight of all things accreditation.  The problem is that they’re coming back.  And that gap in between surveys goes by with lightning speed.  As I joke when teaching CARF workshops, “This survey never ends!!!”  So, in the spirit of keeping excellence in the forefront, here are some practical tips, advice and wisdom on how best to mind the CARF “gap” so that you’re ready for their return.

Think (and build) Systems that Support Conformance – Although getting prepared for and going through a survey for the first time is quite stressful, I actually think the second survey is harder.  You can treat a first survey like an event (i.e., CARF’s coming – look busy!).  You only need to show six months of conformance, and building a set of plans on a one-off basis is relatively easy.  It’s when you have to show that you’ve lived and breathed those standards for three years that the cracks show up.  The solution is to use systems thinking to make sure that all of the various tasks are part of how business happens at your shop.  Consider using things like perpetual planning calendars or bring forward mechanisms to make sure things don’t get missed.  Some agencies establish standing agendas to ensure that key topics are always in the conversation.

Embed Conformance Deeply in the Organization’s DNA – In the end, you don’t want your conformance with CARF standards to be a thin overlay or veneer.  You want it be deeply embedded so that it’s just how you do business.  That requires making sure that all the pieces of work related to accreditation are integrated.  For example, all plans (risk management, accessibility, technology, etc.) should be integrated into your annual operational cycle, not an overlay that someone has to pay lip service to but that has no meaning outside of CARF accreditation.  In other words, there should be no such things as a ‘plan for CARF’.  They are your plans.  All document processes related to case management with clients should have conformance built in from the start, not added as an afterthought.  Operational activities such as management and team meetings, performance evaluations, supervision, and training offer a myriad of opportunities to embed conformance with numerous standards without adding extra work.

Share Responsibility for Conformance Widely – One of the riskiest strategies for managing accreditation requirements is to invest too much of the responsibility for conformance in one position.  While it will often be the case that one or more people will have primary responsibility, it’s wise to ensure there is some organizational redundancy in terms of knowledge of the standards and how the organization meets them.  The more that staff at all levels of the organization know the standards that are relevant to their positions and understand how their work helps to meet those standards, the easier it will be to consistently meet the standards and maintain a culture of conformance that has everyone contributing to the outcomes and excellence you have committed to through the process.

Stay Current with the Standards – In case you haven’t been told, the CARF standards manual changes every year!  Although missing one years’ worth of changes would likely not have a huge impact, missing three years’ worth could have major consequences.  So make sure you get informed of the changes and address any new requirements.  I would strongly suggest adding the updating process to your perpetual calendar or bring forward file.
Create or Connect to a Supportive Network – I have learned that in order to have at least one good idea, you need to generate several.  Connecting with other organizations who are also accredited can prove to be a helpful way to generate new strategies or solutions to elements of maintaining conformance.  These collaborative connections can offer opportunities to test next ideas.

Audit Yourself Against the Standards Regularly – my final tip is to audit your conformance.  I have clients that do this prior to their next survey and others that do it every year.  It depends on the complexity of the organization and your level of concern that things aren’t being maintained.  If you choose to do it prior to the survey, I suggest having it done at least four months in advance so you have time to address issues.  You may still get recommendations that are in line with the audit findings (depending on how long the you have been out of conformance with a standard), but fixing it will give the survey team confidence in your systems.  You can do the audit yourself, or consider bringing in someone from outside who knows the standards (e.g., a local surveyor or someone from another agency who knows the process and standards well).  It’s a service we offer to our clients that we get huge positive feedback on in terms of making sure the organization is ready.

Five Tips for a Successful Accreditation

Going through the CARF Accreditation Survey process can be challenging. And as if you didn’t already have enough on your plate! It sometimes seems like they end up coming at the worst possible time.  While there is no magic bullet, here are some practical tips that I think will make your life a LOT easier!

Have Your Ducks All Lined Up
If you’re smart about it, getting ready shouldn’t cause too many grey hairs. As Louis Pasteur said, fortune favors the prepared mind. I strongly suggest that agencies start out with a gaps analysis; a standard-by-standard review to determine where (and how) they meet the standards as well as where the gaps are. Although tedious, it makes your life much easier down the line. The challenge is that many standards have a logical connection to other standards. Organizations that start at the beginning of the CARF manual and make changes as they work through it, or assign responsibility for different sections of the manual to different people, will run into problems. They fail to see the interconnections and overlap until it’s too late. Seeing the bigger picture up front is critical. I also strongly recommend imbedding standards requirements in existing agency systems or processes. Ask yourself “Can this requirement be met by adjusting an existing form or adding an element to an existing client or team meeting process?”. Think ‘Two-Fers’! Minimize the impact on the front line by using what you’ve already got!

Know Thy Survey Team
About two months prior to the survey, you’ll get an email from CARF letting you know who is on your Survey Team. Although the members of the team can change right up until the survey start date, it’s worth checking out who they are. We would like to believe that all surveyors are created equal, but that simply isn’t the case. They are professionals in the field that bring their own perspectives, experiences, and biases. So check them out. Google them. Find out where they work and what they do there. Ask around to other Accredited agencies to see if they know them. When the administrative surveyor calls you to discuss the survey (roughly a month prior to your survey start date), ask lots of questions about their background and their approach to surveying. Although a prepared organization should do well regardless of who the surveyors are, having a sense of what to expect from the team can make a world of difference to how smoothly things go.

The Secret to All Good Events; Planning!
Remember that a survey, in essence, is an event. It follows a schedule, has specific elements, and involves different groups of people with different roles. Surveys go best when they are well planned. Work with the Survey Team to develop a detailed survey schedule. Do your best to make sure each part of the survey happens as scheduled. Have point people that act as a liaisons to the different survey team members. Although there are bound to be some small glitches, you want it to go as smoothly as possible.

Make It Easy
Surveying can be grueling! You fly to a place you’ve never been before to meet up with people you’ve likely never worked with before to spend several intense days at an organization you know little about. While surveyors are paid by CARF, it’s usually a meager pittance compared to what they make at their day jobs. They do it because it’s an opportunity to give back, to learn from others, and to see how things are done in other places. So make their life easy! Part of that is being prepared and planning for the survey, which I’ve already discussed above. In addition, make sure that the materials you provide them are clearly marked and ideally referenced to the standard to which they apply. Provide a nice space to work in. Make sure they have the necessities of life; coffee and a clean washroom. Help them to figure out arrangements for lunch and give them some recommendations for dinner. Make sure you recommend a decent hotel that isn’t too far away. Although leaving a welcome basket at their hotel isn’t required, I always appreciate when an agency leaves something to welcome me – a note, or some information about the local community. The little things can truly make a difference.   Most surveyors ask for some agency materials to be left at the hotel the night before the survey starts anyways, so that’s your opportunity to welcome them!

Remember, It’s Your Survey!
I can’t stress this one enough; this is YOUR survey! You are paying for it (directly or indirectly, depending on the jurisdiction). You should expect good service, both from CARF’s staff at headquarters in Tucson and from the Survey Team. They should respond to your questions and be open about the process. They should be professional and courteous. You should expect them to be fair and balanced in giving feedback. They should strive to add value to your organization by offering good advice and pointing you in the direction of additional resources wherever possible. They should also acknowledged your strengths and give you the opportunity to show off what makes you proud about your agency. While CARF does its best to match surveyor skill sets to agency needs, the process isn’t perfect. You may simply end up with someone who isn’t a good match for your organization. Or if you happen to live in a city that is a sought after tourist destination, you can end up with team members who are interested in a ‘Survey-cation’ (thankfully, that’s rare). Bottom line – if you’re not happy, let the surveyor team know about it! And if that doesn’t work, let CARF know about it.

I hope these tips help.  And if you have others that you’d like to add, please add a comment below!

Does Accreditation Matter?

As a facilitator of workshops for the accrediting body CARF, I often get asked about the value of accreditation.  As anyone who has been through it will tell, it’s a lot of work to prepare for accreditation!  And the reality is that many agencies don’t have a choice.  Their funding body mandates them to be accredited.  Regardless, given the scarcity of resources to provide much needed services, it’s fair to ask if it provides a meaningful return on the investment.

The reality is that accreditation is not a silver bullet that automatically turns mediocre (or bad) agencies into good ones.  It’s a review that focuses almost entirely on systems and processes.  There aren’t standards that can force agencies to be innovative or entrepreneurial in their approach to problems.  While there are standards that require the implementation of outcomes measurement and quality improvement processes, the accrediting body isn’t there to warrant that you’ve achieved all of the outcomes or that your improvement process has yielded significant results.  More than a few organizations have gotten through accreditation with a ‘good enough’ approach to conformance.  And at the end of the day, having a couple of people show up once every three or four years is hardly an intensive audit that could provide 100% assurance of quality services.  But that isn’t why accreditation matters.  I think it matters because it provides a time-tested tool for helping us to get better at what we do.  It supports the implementation and continuous improvement of solid and consistent service delivery systems.  While that might not be sufficient to spur innovation in service delivery, it is a necessary and stable foundation from which improvement and innovation can occur.  Through accreditation, we get a chance to take a hard look at how we do things and to learn from (and share with) others in the field.  And I think that getting accredited sends an important message about accountability to our clients and other stakeholders.  It says that we are willing to allow ourselves to be judged against international standards and that we are interested in being the best we can be.  While there are organizations that get through it without truly buying in to the opportunity it presents, that isn’t an indictment of accreditation.  It simply reflects poorly on them.

Why Leadership and the Organization Matter

Some time back, I wrote an article for the Federation of Community Social Services’ (FCSS) Research to Practice Network titled “Why The Organization Matters”. Those of you who know me are aware that it’s a topic near and dear to my heart. In fact, it’s the topic that pulled me into doing a PhD! I know – I really need a life. Anyways, that article explored some of the research on how organizational level variables (like culture, climate, structure, and leadership) had both direct and indirect impacts on client outcomes. [Read more…]

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