1. Improving Outcomes: The Importance of Accreditation, Certification and Licensure Linda Kaplan, M.A. Senior Public Health Advisor SAMHSA/CSAT October 21, 2009 Strategic Planning for Providers to Improve Business Practices Conference

2. Session Overview Introductions Format Definitions Group Discussion Summary

3. Introductions Name Position Expectations for this session

4. Accountability and Outcomes Funders, Accrediting Bodies and the Public- All want to know results and expect fiscal responsibility

5. Good Business Practices Ingredients Recovery-Oriented Systems of Care Improving quality Improving Outcome Meeting Standards

6. Improving Processes- NIATx Organizations exist to serve customers 85% of problems are due to processes To better serve customers, organizations should solve problems that improve processes Customers-External (clients, families, referral sources, payers, community) and Internal (Staff) Problems-Gaps or discrepancies between actual and desired performance

7. Overview of Licensure, Certification and Accreditation Licensure and certification for professionals: protect the public and ensure that practitioners have meet standards for practice. Licensure and accreditation of programs: ensure that they meet regulations and standards to operate.

8. Licensure and Certification of Professionals – Key Definitions Licensure: “ A license is a property right of an individual, and as a property right, a license is backed by the laws of the State in which it is granted.” (Shimberg & Roederer, 1994) “…it is illegal for a person to practice a profession without meeting standards imposed by the State.” (Schoon & Smith, 2000)

9. Licensure and Certification of Professionals - Key Definitions Certification: A process established by a private sector body that defines standards for professional practice. It may prohibit the use of a title or designation but often does not restrict someone from practicing a profession. (Schoon & Smith 2000)

10. Purpose of Licensure and Certification Provides assurance that practitioners have met standards of practice Can perform scope of practice established for the profession Has demonstrated knowledge and skill to practice Provides public protection from incompetent and unscrupulous professionals

11. Benefits Licenses and certifications assure program administrators that the clinicians have met the standards to function within their respective disciplines.

12. Program Accreditation Accreditation:  extensive process using performance-based standards to evaluate the quality and safety of care by assessing an organization’s compliance with national standards of care.  voluntary process that measures institutions against established quality and safety standards and requires that organizations engage in continuous quality improvement.  Trained surveyors conduct the assessment using clearly defined and established protocols.  Funders and third party payers usually require that behavioral health agencies be accredited.

13. Program Licensure Licensure is “a right or permission granted by a competent authority (such as a government or a business) to engage in some business or occupation, do some act, or engage in some transaction which would be unlawful without such right or permission” (Merriam-Webster, 1996, p. 293). States regulate the licensing of programs, and hospitals and agencies must meet these regulations and standards in order to operate. Regulations may include required policies and procedures, types of staff, facility safety standards, and types of care allowed by programs.

14. Benefits of Accreditation JCAHO – informs and protects clients/consumers, educates providers Enhances performance Often a condition of State licensure and requirement for payment from insurers or other third party payers Data-driven management system

15. Accreditation "The mission of The Joint Commission is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations."

16. Staff Infrastructure Issues Recruitment and retention of qualified staff are integral to building a treatment infrastructure Improving treatment outcomes will require qualified, trained staff

17. Workforce Issues Recruitment  Diversity  Status  Compensation  Career Ladder  Pre-service and continuing education Retention  Compensation  Supervision  Recognition  Career Ladder  Continuing education

18. Recruitment Strategies Need to recruit more diverse staff  IOM Report found that professionals from minority racial and ethnic backgrounds more likely to work in underserved areas and access to care is improved  Racial and ethnic minorities report higher satisfaction when staff is more diverse (IOM 2003 In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce)

19. Recruitment Strategies Provide intensive orientation to new staff Provide ongoing clinical and administrative supervision to new staff Ensure adequate in-service training and support for ongoing continuing education Recognize that counselors want to work with clients rather than spend time doing paperwork

20. Management Practices to Improve Retention Provide Clinical Supervision Provide staff development/training More job autonomy Recognizing and rewarding staff for strong job performance Better communication between management and staff

21. Management Practices to Improve Retention Develop career paths that are built on skills and competencies Supervision is critical-  staff need clarity about expectations  earning potential  feedback about performance  regularly scheduled meetings

22. Management Practices to Improve Retention Ensure a fair and equitable environment Show appreciation for employees Provide clear performance expectations that relate to a coherent organizational mission An environment that allows two way communication

23. Clinical Supervision Clinical supervision  Improves retention  Serves as a motivational/feedback mechanism  Reduces stress  Assists with counselor wellness (Kaplan, L. (2003) Substance Abuse Treatment Workforce Environmental Scan. Bethesda, MD: Abt Associates Knudsen, H.K., Johnson, J.A., Roman, P. (2003) Retaining counseling staff at substance abuse treatment centers: effects of management practices. Journal of Substance Abuse Treatment 23 (Feb) 129-135)

24. Infrastructure Issues Technology EHR Economy of Scale (Size) Administrative Structure

25. Discussion

26. Summary Process Improvement-key to better practices Accreditation - protects public, provides quality assurance and improves performance Credentialing/Licensure – protects public; upholds standards of practice; provides measure of competency