I Don’t Want to Get Accredited… Here’s Why!

As the CEO of a nationally recognized accreditation consulting company, I am often confronted with questions about the benefits of a human service provider becoming accredited or I am asked to address perceived barriers to accreditation.  While earning national accreditation from organizations like The Joint Commission, CARF International, COA Accreditation (a division of Social Current)) or Accreditation Commission on Health Care (ACHC) can bring numerous benefits to behavioral health organizations, child welfare organizations, for-profit, nonprofit organizations and governmental agencies.  There may be valid reasons why some might choose not to pursue accreditation, and here are my responses to these top five fears:

1. Cost: We can’t afford it!

The accreditation process can be expensive, with costs related to application fees, facilities improvements, staff training, implementing necessary changes to meet accreditation standards, and potential consulting services. Some organizations, especially those operating on tight budgets, may fear the financial burden associated with accreditation to be a barrier.

Myth Buster – You can’t afford NOT to be accredited!

Accreditation is essential for organizations due to its pivotal role in enhancing credibility, competitive advantage, and access to opportunities. It ensures regulatory compliance, improves processes, and mitigates risks while fostering trust among stakeholders. In essence, it’s a strategic investment that bolsters reputation, expands market reach, and ensures sustained excellence in operations and performance.

2. Administrative burden: We are too busy running the organization and providing services!

Yes, it requires an investment of time, money and effort. Preparing for accreditation can be time-consuming and may require significant administrative efforts. Staff may need to find time to focus on compliance with accreditation standards, which could affect day-to-day operations.

Myth Buster – The heavy lift is with the initial accreditation; after that, proactive maintenance allows for the organization to fully benefit from the process and reaccreditation efforts should be much less of a lift.

Internal financial controls, governance, HR and training, strategic planning, risk management, ethical practices, outcomes measurement, and additional areas all require attention to be ready for review by your selected accrediting body.

Note: Many organizations seeking initial accreditation may find that they need to do more preparation work on the administrative/management side of the business rather than programs and services, due to the predominate focus of state licensing reviews on an organization’s programs.

3. Staffing constraints: We don’t have enough people to devote to accreditation efforts!

Health and human service organizations, especially those in underserved areas, may struggle to allocate the necessary human resources, time, and effort to meet accreditation requirements. Staffing shortages, high turnover, or limited access to training resources can make the accreditation process challenging.

Myth Buster – Accredited organizations regularly report that becoming accredited resulted in lower staff turnover and better recruitment efforts.

TJC Study on Accreditation ROI

TJC Infographic

Accreditation signals to employees and potential hires the organization’s commitment to quality, professionalism, and continuous improvement. Meeting standards often involves investing in employee training and development, which can increase job satisfaction and career advancement opportunities. Additionally, accreditation enhances the organization’s reputation, making it more attractive to top talent seeking stable and reputable workplaces. By showcasing adherence to industry standards and a dedication to excellence, accreditation strengthens recruitment efforts by positioning the organization as an employer of choice within the industry.

SMART PEOPLE LIKE TO WORK IN WELL-MANAGED, WELL-SUPERVISED, WELL-ORGANIZED AGENCIES!

4. Already meeting state regulations – Isn’t this enough?

Behavioral health, child welfare and other human service organizations are often subject to extensive state regulations and oversight. If an organization is already in compliance with state regulations, they might question the need for pursuing additional national accreditation, especially if they perceive the state’s regulations as rigorous and comprehensive.

Myth Buster – Meeting standards is compliance with the bare minimum.

Accreditation goes beyond mere compliance, offering a myriad of benefits that elevate the organization’s operations, services offered and reputation. It often unlocks access to additional funding streams and referral sources that prioritize accredited providers, expanding the organization’s financial resources and client base. Moreover, accreditation signals a commitment to excellence and best practices. By going above and beyond licensure requirements, accreditation distinguishes the organization from competitors, affirming its dedication to superior service delivery and continuous improvement. This distinction is increasingly important to individuals, families, and communities seeking reputable and reliable services. While meeting state standards is essential, accreditation propels human service organizations to new heights by securing funding, enhancing credibility, and ensuring unparalleled quality and distinction in service provision.

5. Philosophical differences

Some organizations may believe they have philosophical or ideological differences with the accrediting bodies and fear they may not align with the accreditation standards or requirements. They might prefer to operate independently, based on their own principles and values, rather than adhering to external accreditation criteria.

Myth Buster – Rejecting accreditation based solely on ideological differences risks limiting growth, impact, and credibility.

Operating independently based on an organization’s principles and values is admirable, but rejecting accreditation due to perceived philosophical differences can be short sighted. Accreditation standards are designed to ensure the highest quality of service delivery, client safety, and organizational effectiveness. By aligning with these standards, organizations demonstrate their commitment to excellence and accountability, which can enhance credibility and trust among stakeholders. Accreditation also provides an objective framework for self-assessment and continuous improvement, which will help them identify strengths, weaknesses, and areas for development.

The accrediting bodies research and develop standards in a way to allow for unique programs and services; they are not written to standardize program delivery. It is possible to find an accrediting body that aligns with your values! It’s essential for organizations to carefully weigh the benefits and drawbacks of an accrediting body before making a decision, considering how it aligns with their mission, vision, values, and goals for serving their communities. At Accreditation Guru, our experts will gladly help you find the right fit.

 

Ultimately, the decision to pursue or not pursue national accreditation should be carefully considered in the context of the organization’s unique circumstances, mission/vision, and priorities. This decision will certainly have implications for funding, reputation, and the ability to attract clients. It’s essential to weigh the potential benefits of accreditation against their specific circumstances and priorities before making a final decision.

Where to Start if You’re Considering Accreditation for the First Time

Starting the accreditation process can be overwhelming: from determining which accrediting body to work with, to obtaining buy in from the board of directors and staff, to creating your team. In this video Jennifer highlights initial items to consider when beginning the road to national accreditation.

For assistance with any aspect of accreditation preparation or maintenance of accreditation, please contact us or schedule a free 30-minute consultation meeting.

How Accreditation Supports Mergers and Acquisitions

Since 2018, there has been significant merger and acquisition activity in the behavioral healthcare field, but why? Individuals are becoming more aware of healthcare issues; there is less stigma about seeking help for mental health struggles; and more effective treatments are now available. This has created increased demand for and use of mental health and addiction treatment services, as well as channeling more funding towards meeting the demand and growing need. Not only this, but as individuals, including professionals, gain understanding of the link between mental and physical wellbeing, more integration of physical and behavioral health care is occurring. So, where does accreditation come in?

There are a number of accrediting bodies that work to ensure providers of substance use disorder treatment and mental health services meet specific, nationally accepted standards, including The Joint Commission, CARF International, Council on Accreditation (a service of Social Current) and others.

Accreditation requirements (standards of safety and quality of care) center around three main areas: documentation, facilities, and people. Documentation standards focus on written plans; polices and procedures; clinical records; and personnel files. For people, standards address not only the care of the persons served, but also those that provide it. Facility standards ensure that the physical environment where care is being provided is safe, healthy, and therapeutic for everyone within. All these standards create stability within an organization, which is a favorable factor in M&A activity.

Achieving accreditation also gives a behavioral health organization a framework for growth and management of their internal resources. It helps to standardize clinical processes and documentation and provides an external validation of the quality of services provided. Accredited organizations will often see increased efficiencies from improved practice consistency, tightened administrative practices, and an increased emphasis on risk management. Because of accreditation requirements, organizations will inevitably have a broader view and a more detailed approach to risk mitigation and risk management than they’re doing on their own.

For an investor looking to acquire a service provider, seeing that a facility is accredited can provide peace of mind. Accreditation indicates that an organization has gone through the work to create a strategic plan, comply with legal and regulatory requirements, and has implemented quality monitoring practices. All of which assist with due diligence, both on the administrative and clinical sides. Investors can also be assured that the facility’s finances are well managed, as accreditation speaks to sound financial management practices. There are even a number of reports that say accreditation reduces staff turnover, which can save an organization money and maintain a high-quality workforce.

Another part of due diligence is examination of litigation and claims history of an organization. Have there been any lawsuits filed or any pending? What is the frequency and severity of claims? Are there identifiable patterns and trends? What steps were taken to reduce the chance of reoccurrence? Accreditation supports this type of investigation by helping to maintain a positive history by proactive identification of risk and finding ways to mitigate or eliminate it where possible. Secondly, it encourages a performance improvement process that requires collection and analysis of key data and then taking action for improvement. Additionally, accreditation promotes a safe and healthy physical environment with requirements for emergency and disaster planning.

If your organization is going through a merger or considering accreditation, you are not alone! Accreditation Guru operates nationwide and provides a number of services to guide you through the process, such as:

  • Individual accreditation consultation
  • Mock surveys
  • Development of accreditation-compliant plans and policies
  • Risk assessment
  • Strategic planning facilitation
  • And more…

If you would like to have a conversation, please feel free to contact us via our website or schedule a free Zoom consultation with one of our experts.

For more information or questions about the contents of this article, please write Peggy Lavin @ peggy@accreditationguru.com.   This post contains original content and was written for Accreditation Guru, Inc. Use of this copy is permitted with credit and reference within the same body of copy to Accreditation Guru, Inc.

How to determine which accrediting body is the right fit for your organization

Selecting a national accrediting body to work with is a significant undertaking. The commitment goes beyond the initial accreditation cycle and, in most cases, it continues for many more years, sometimes even decades. Because of the investment in time, money and effort involved, the selection process should not be taken lightly. Watch our video for tips on determining which accrediting body is the right fit for your organization.

 

Is Your Accrediting Body Still the Right Fit?

Your organization is not the same one it was 10 or 20 years ago (or likely even 3 years ago!). New programs/services may have been opened and staff changes have taken place. There are new requirements from payors, licensing bodies, the federal government, etc. Perhaps there has been a merger or acquisition, or new partnerships developed with other entities to ensure the continuum of care. Or, you may have directly integrated physical health care into your service delivery or begun to offer telehealth services as a result of the pandemic.

Likewise, the accrediting bodies may have changed over time:

  1. Standards are updated annually – do they still fit with your current program/services?
  2. Has there been a shift by the accrediting body to be more closely aligned with your line of business – toward behavioral health or toward child welfare, for example?
  3. Perhaps there has been a new approach to sales and marketing that could have affected customer service?

When you initially selected your accreditor, you likely considered such things as cost, reputation in the marketplace, and may have had a recommendation from another organization. (See our blog article on 10 Things to Consider When Selecting an Accrediting Body for more information.)

I’m sure that the intent was to do your research and find the best fit for a long-term relationship. However, relationships can change.

So, when do you know if it is time to look around? And, if you do, what questions should you ask?

If you are asking yourself these questions, might I suggest that you consider the following:

  1. Standards – your programs and services’ fit with the current accreditation standards
  2. Reputation – current feedback from other accredited organizations
  3. Mandates – is there a current mandate for accreditation or one on the horizon, and if so, does it specify a particular accrediting body or bodies?
  4. Effort – how much work will it take to switch vs. remain with your existing accreditor*
  5. Costs – fees always matter, but what is the true value of the accreditation process and experience and what is the cost to maintain your accreditation?
  6. Timing – how long have you been with your existing accreditor?

Note, I do not recommend making a change simply for the sake of change. However, it never hurts to look around and ask a few questions to make sure that your accrediting body is still the right fit for today and for the future of your organization.

 

*If already accredited and deciding to make a switch, it is important to focus on the similarities and differences between the two accrediting bodies’ standards and processes for the most effective use of time and resources. It is also critical to understand the different approaches and philosophies from one accrediting body to another.

To further discuss any of the above items, or if you are interested in assistance with switching from one accrediting body to another, please contact us at Info@AccreditationGuru.com / 212.209.0240. This post contains original content and was written for Accreditation Guru, Inc. Use of this copy is permitted with credit and reference within the same body of copy to Accreditation Guru, Inc.

What does accreditation mean for human service organizations?

Achieving accreditation is recognition that your organization adheres to a higher level of standards; that you are producing high quality services; and are operating at an effective level as recognized by an expert outside agency.

How Accreditation Supports Recovery Principles

The national accrediting bodies have been among the moving forces in the integration of the recovery model into the care, treatment and services for people with mental health and/or substance use disorders. Recovery principles can now be seen throughout behavioral health standards of accrediting bodies as well as the outlined expectations that an organization will demonstrate conformance/compliance to these standards. And, the integration makes sense – this model not only complements the more traditional model of medication and “talk” therapies, but also expands the focus to include the person’s own goals and strengths and empowers them to be actively involved in the process.

The US Substance Abuse and Mental Health Administration (SAMHSA) has also integrated the recovery model in their publications, requirements for certified community-based behavioral health clinics, training materials, and grants. To that end – they’ve developed the Working Definition of Recovery. Several of the guiding principles shown here are addressed in the accrediting bodies’ standards.

Accrediting bodies’ implementation of such a model involves workforce training so that staff can fully understand and embody the organization’s philosophy, thus permeating service delivery to positively impact the recovery of the people served.  In addition, the accreditation survey process itself supports the recovery principles. Surveyor(s) not only review written documents, but also observe interactions amongst staff at all levels and persons served and share their observations with the organization. This external survey can confirm, enhance, and strengthen the organization’s intent and commitment to recovery principles

While accreditation as a whole supports the recovery model, below are specific examples of ways in which accreditation and the recovery model intersect:

Person-Driven – An individualized plan of care, treatment, and services based on the needs, strengths and abilities, preferences/expectations and goals of each person being provided care, treatment or services is a core accreditation requirement. “Boiler plate” plans that repeat over and over the same information for each person served will result in survey findings (unsatisfactory conformance/noncompliance with standards) and the need for correction to achieve full accreditation. Furthermore, it’s an expectation that an accredited organization actively involve the person served in identifying their needs and preferences for aftercare and, as much as possible, making choices about where, type, and by whom.

Holistic – The needs of the person in relation to various life domains, such as physical health and housing, are addressed in case management/care coordination standards (assessment of the person’s needs and assistance in meeting these identified life domain needs). Since access to routine and needed physical health care can be a challenge for those who need it, the accrediting bodies offer options for the integration/coordination of physical health care. Health Home standards have been established to facilitate successful integration of physical health care with an organization’s traditional behavioral health programs.

Culture and Respect – Accreditation standards emphasize that the person served encounters respect in all aspects of their care, treatment, or service experience and this is reflected in the organization’s policies, procedures, rules, and expectations as well as the rights and responsibilities of the person served. Standards clearly emphasize that service delivery is provided by staff in an atmosphere of respect and understanding and sensitivity to cultural values, beliefs, and preferences.

Trauma – The approach of the accrediting bodies to trauma centers around their screening and assessment, planning and delivery of services, and workforce training standards. Standards require a screening and assessment process to identify people whose lived experiences either currently and/or in the past may have included trauma(s). Also, organizations need to demonstrate that the impact of trauma on the person served is considered in the planning and delivery of care, treatment, or services.

Peer Support – Peer support services are an important component of the recovery model. These services are part of the plan of care, treatment, or services, and are provided by trained individuals who share similar lived experiences with mental health and substance use challenges. Accrediting bodies not only recognize the utilization of this type of service by mental health and substance use treatment providers, but also have developed standards addressing the integration of these services into the planning of care with the active involvement of the person served.

The accrediting bodies require written plans, policies, or procedures promoting these recovery principles to form a framework for implementation and a communication to staff and people served of the philosophy, beliefs, and values of an organization.

For more information on the recovery model and/or how accreditation can benefit your organization, visit AccreditationGuru.com.

 

For more information or questions about the contents of this article, please write or call Jennifer Flowers @ Jennifer@AccreditationGuru.com / 212.209.0240.   This post contains original content and was written for Accreditation Guru, Inc. Use of this copy is permitted with credit and reference within the same body of copy to Accreditation Guru, Inc.