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(Editor’s note: Yolande K. Bestgen, MS, vice president for strategic development at CARF The Rehabilitation Accreditation Commission in Tucson, AZ, discusses some of the recent accreditation changes for rehab facilities and some new trends in the rehab industry in this Q&A interview.)
RCR: In 2000, the CARF board adopted a new goal to increase consumer participation and cultural diversity in all of the accrediting body’s activities. Would you please explain how this might change some of the day-to-day operations and clinical work done in rehab facilities that are accredited through CARF?
Bestgen: At CARF we support consumer involvement and have established a goal of enhanced consumer involvement at all levels of CARF. This goal reflects our belief that consumers being involved only with the survey itself limits their involvement to just one aspect of the accreditation process.
We have standards that address services directed to the individual’s needs. CARF can assist rehabilitation facilities through the process of continuous quality improvement to enhance consumer involvement and to address the cultural needs of patients.
The reason we are focusing on diversity has to do with the changing demographics of our workforce and consumers. For example, in the year 2000, one-third of the nation’s population
represents a racial minority group, a significant population that includes both workers and consumers of service. So when you talk about day-to-day operations in clinical work, it’s important to look at the strategic planning of rehabilitation facilities to make sure they are responding to the needs of consumers of services and also to what is becoming a diverse workforce.
We have people at international conferences, skilled in the area of cultural competence. They offer recommendations to organizations through presentations, work groups, and seminars. They provide guidance and techniques for organizations to expand their abilities in the area of cultural competence for the people they serve and in their workplace.
CARF’s consumer involvement touches all areas, including the actual accreditation process.
RCR: Many rehab facilities already monitor patient satisfaction through surveys. What are some other strategies they can employ to better reach consumers and learn what consumers want?
Bestgen: One of the strategies we have seen successfully employed by rehabilitation facilities is the use of focus groups within their service area. Focus groups allow providers to obtain direct feedback from the consumer on what it is the consumer would want them to do within the community. The rehab facility explains to the focus group that this input will help the facility plan for its future. The consumers become a planning partner in regard to where resources could be allocated.
When we’re discussing the aspects of a facility’s operations having consumer involvement, this doesn’t mean that you have to have a consumer on staff in every place. It doesn’t mean you have to have a consumer shadowing the facility’s chief executive officer. But it does mean you use as many of the methods you can to maximize the consumer’s input, including the focus group example.
RCR: The federal government now expects hospitals to accommodate non-English-speaking patients by offering translation services or hiring bilingual staff whenever possible. CARF also has shifted its focus to diversity. What are some of the industry trends that have encouraged rehab facilities to make diversity training and programs a priority?
Bestgen: We need to be sensitive to the people we’re serving. For example, in New York City one accredited organization has a high number of people of Chinese descent who are the facility’s consumers. They have staff skilled in translating information so that all of their consumers are fully informed. It would appear that the federal government wants hospitals to be sensitive to their own demographics and to respond to the needs of the individual.
RCR: When the prospective payment system (PPS) finally is implemented, rehab facilities will need to make a number of major changes, requiring time-consuming staff education and training. How can facilities manage all of these new issues at the same time they continue to prepare for accreditation surveys and maintain their accreditation? Has all of the required documentation grown to be too much for many rehab facilities to handle, and if not, how can they best cope?
Bestgen: The PPS changes are on the front burner for inpatient rehabilitation providers. Meeting CARF standards and PPS requirements are not necessarily mutually exclusive. Effective blending of the CARF standards and the systems that are mandated relative to PPS implementation could be approached as a way to integrate systems and strengthen the program, as well as enhance the delivery of services.
Clearly, this will involve open minds, teamwork, and increased flexibility on the part of providers as well as CARF.
It is now more critical than ever in this changing environment that rehabilitation facilities have continuous quality improvement efforts and a long-range planning process in place. These are concepts that are already imbedded in the CARF standards.
We expect some growth in the outpatient rehabilitation arena as organizations are shifting some of their services to outpatient.
Also, consumers are asking for services that are more accessible. Some rehab facilities are extending services on-site to employers with large numbers of employees. I think we’re going to see some interesting changes as to how services are going to be delivered and where they’re going to be delivered. It will be a challenge.