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.

New Resources Section on Governance!

Kim and I have had the honour of being engaged in a number of recent projects involving Boards of Directors from non-profit organizations.  From facilitating Strategic and Tactical Planning to policy development work to Board training events, it has broadened our understanding of both the needs and challenges that Boards of Directors face.  With that in mind, we are starting a new section in the Resources page of our website dedicated to Governance materials.  We started with posting a sample policy on conflict of interest.  We plan to populate it with many more resources over time.  We’re interested in your feedback about the kinds of resources or articles that would be helpful.

Some Gifts to Mark the Season!

Just wanted to take a minute to wish everyone Happy Holidays!!!  Here is a funny Christmas video to keep you entertained (warning… it’s reflects my warped sense of humour), and a link to a couple of new resources (sample policies) on the Free Resources page.  We’ll have at least one new article sometime in January and many more are in the pipeline!  Take care and stay safe.

Goals, Goals, Goals!!!

I’m headed to Vancouver in two weeks to present at the revamped CARF Canada Advanced Outcomes Training.  That training event includes a discussion about the use of client goals to measure program outcomes, so I thought I would get my rant about the limits of that approach out of the way ahead of time!

The overwhelming majority of programs and services I’ve been involved in evaluating over the past several years use some form of client goal achievement to measure their success. I get the attraction. It’s a ‘two-fer’ for many programs! Staff have to define goals for the work they do with clients as part of case management and program accountability expectations (e.g., accreditation), so why not get some extra mileage by using them for outcomes measurement? But the devil is in the detail. Most of the programs I’ve worked with have taken advantage of software that has some form of goal scaling built in. Many software programs (and most in-house solutions) simply require users to indicate whether a goal has been fully achieved, partly achieved, or not achieved at some point in time after the goal is set. Some provide opportunity to indicate why it was achieved or not achieved. There are few (if any) parameters around what achievement means or what a reasonable timeframe for full achievement might be. The system then produces a report counting how many goals are achieved (or not) and links that to program level outcome statements based on categories of goal type that the worker chooses when entering the goal. [Read more…]

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!

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