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DNV surveyors focus on CoPs, process measures
Hays, KS-based Hays Medical Center was accredited by The Joint Commission for more than 30 years, but in November 2008 decided to go with Houston, TX-based DNV Healthcare. "We basically decided to make the change because where we are in our journey of quality; we're very interested in the ISO standards and implementing those in our institution. We thought this was a good time for us to go with a different organization," says Judith Purdy, RN, director of risk and quality management.
"We believe that implementing ISO will help with quality structure from the inside out," she adds. The 194-bed hospital was surveyed by DNV Oct. 6-8, 2008.
As for preparing for the survey, a question she is often asked by peers, Purdy says it was minimal. "There's nothing to get ready for the survey. Any organization that is already accredited, they should be able to do fine on the DNV survey because the DNV survey is surveying the [conditions of participation] CoPs, which hospitals already should be compliant with."
Another question she often hears is whether your facility must by ISO-compliant to be accredited by DNV. "The thing is, you do not need to be ISO compliant for two years after your initial survey with DNV. You have those two years to become ISO compliant," she says. "The thing, too, is people have more access to ISO in place that they realize. Some is terminology. They've already got a lot of the documentation and processes in place that they need."
Focusing on the CoPs, DNV surveyors used the tracer methodology. "Of course they did patient care visits, patient care interviews, facility interviews, or walkthroughs to make sure you're meeting all of the environments of care you need [required by] both the government, OSHA, life safety codes. Nothing that anybody isn't used to already. I would say that the survey is definitely process-oriented," Purdy says.
They look for evidence of the standard CoPs that CMS looks at, Purdy says: blood usage, mortality review, restraint usage. "They're also looking at, and that's when you get into the ISO usage, process — how the patient moves through the entire system," she adds.
What she likes about the DNV process is that it encompasses non-clinical areas — "your entire organization," she says. Financial services, such as the process of billing a patient, are reviewed during the survey. "Nobody ever looks at the financial services, like the process of billing a patient. How does that all work? So I think that will be a good thing because typically those parts have not been involved in the survey — materials management, administration, those aspects."
What they look at in terms of financial services depends on what the facility has determined it would like to look at in depth. "The nice thing, too, is within this DNV survey process you do your internal audits of those processes," she says. One component of a successful audit process, she says, is having different disciplines review process instead of auditing their own area. For example, if you're looking at the inpatient surgical care process, Purdy might not use a nurse but maybe a pharmacist or a respiratory therapist.
Internal audits are required components of ISO. And what is audited is decided on by the hospital itself. Purdy says typically hospitals identify 10 to 12 areas they'd like to analyze.
Another emphasis is documentation management — not an easy task, Purdy says, and one the hospital is working on. Especially in health care, "it's challenging to make sure everybody's following the current policy with the most current revision and likewise on forms that everybody is using the most current form with the most current revision," Purdy says. The best way to do it, she says, is putting everything online.
Beyond preferring an annual survey vs. a triennial one so everything stays fresh in the minds of hospital staff, Purdy agrees with the DNV principle that while hospitals are required to comply with CoPs and become ISO compliant, "hospitals are allowed the ability to do it in a manner that works for them; however they can accomplish it, which is very attractive to physicians for one thing," Purdy says.
"It's always better if you can do it how it works in your organization and not someone being prescriptive and saying you can only do it this way when maybe that does not make sense with your organization, your patient population," she says. "We like the ability to determine for ourselves which national goals we find to be valuable, evidence-based, and important that we want to collect data and make improvements with rather than somebody indicating what those will be and how you will do it."