>> DeSCriPtion
Accreditation is a quality improvement process focus- ing on client safety and quality of work life, whereby addiction treatment centres are assessed against national standards of excellence. These standards measure clinical, operational, and governance-based performance. They provide a clear picture of strengths, areas for improve- ment, and levels of risk within an organization. The accreditation process is based on how well an organiza- tion complies with national standards and it measures the quality of services that clients receive.
In general, most accreditation processes consist of a three-year cycle that begins with an organizational self- assessment against standards of excellence. The next step usually involves a peer review that is done by external reviewers. They interview staff at all levels of the orga- nization/health service, including governance, manage- ment, staff and organizational partners, as well as clients and their family members.
Key components of a strong accreditation approach are: • Assessing organizational readiness;
• Choosing an accreditation body/organization; • Conducting self-assessment and evidence gathering; • Peer review;
• Report and recommendations; and • Follow-up and continuous improvement.
>> key ComPonentS
Assessing Organizational Readiness
The first step in an accreditation process is to gather information to find out how ready the organization is for accreditation. This generally involves the organiza- tion’s board of directors and staff having a discussion about the potential risks and benefits of accreditation. For accreditation to be successful, organizational consen- sus must exist at the very start of the process. Readiness also explores the organization’s capacity related to pol- icy, planning and measurement of specified indicators
throughout the organization, defined processes for ser- vice delivery, and linkages with partners.
Choosing an Accreditation Body/ Organization
It is important to research all the options available for accreditation since many bodies may provide accredita- tion in a given field. Organizations need to seek out an accreditation body that will be responsive to their needs, as well as Health Canada accreditation policies. Some important factors are costs, level of detail in the stan- dards, reporting time lines and the process requirements.
Conducting Self-assessment and Evidence Gathering
Once an organization selects an accreditation body, it will need to take some time to understand the standards structure and how processes will be measured within this structure. During this phase of the process, time is needed to gather policies, practices, and evidence that support organizational ratings based on a set of standards.
Peer Review
A peer review is generally set up after the organizational self-assessment has been sent to the accreditation body. One to three reviewers will visit the organization to gather more evidence. During this part of the process, they may conduct interviews with staff, board, clients, and former clients.
Report and Recommendations
Quality in addictions programming is assessed by exam- ining structure, process, and outcomes. Structure involves having the resources and infrastructure that are needed to conduct tasks, such as having the human, financial and program resources to provide care, as well as the facilities, governance, standards, and policies in place. Process involves the delivery of health services, namely how it is done, inputs-tasks-outputs and the care itself. Outcomes involve the results, such as client satisfaction, staff satisfaction, effective care, efficient use of resources and measurement of the extent to which services impact client health.
Using information from the organization’s self- assessment, combined with information gathered and verified during the peer review, the accreditation body provides a report on its findings. This report usually comes in the form of recommendations for continuous quality improvement. Depending on the accreditation body that is used, the time between peer review and the report can vary from a few days to many months.
Follow-up and Continuous Improvement
In this phase, an organization works to implement the recommendations and makes changes to policies, prac- tices or environmental supports based on the recom- mendations of the report. The process may include a re-visit from the accreditation body or the submission of follow-up evidence of how the organization has worked to address certain recommendations.
>> Current StAtuS
Accreditation is being provided for treatment centres within NNADAP/NYSAP and community based health services inclusive of NNADAP by one of three main accreditation bodies:
• Accreditation Canada (AC)
• Commission on Accreditation of Rehabilitation Facilities (CARF)
• Canadian Accreditation Council (CAC))
Health Canada has an accreditation framework docu- ment that outlines some key features of accreditation. This outline informs programs for which accreditation is mostly voluntary, and provides details on incentive sup- ports for programs that begin the accreditation process and meet the criteria.
The accreditation process is initiated by a First Nations treatment centre or community-based substance use-related service within a broader community health service and is managed by a non-government accrediting body. Centres may receive funding from Health Canada to engage in the accreditation process with an eligible accreditation body.
Among First Nations addictions programming, aware- ness of accreditation and its benefits has grown as more organizations feel proud of their success and have met standards of excellence. What started as a grassroots movement has gained force and is now seen as the model for many NNADAP/NYSAP treatment centres. The suc- cess of accreditation to date is largely due to the desire of First Nations services to provide a high level of quality health services to their clients.
Some of the challenges linked to accreditation relate to the higher costs and workload for centres and their staff during the accreditation process. Some centres ques- tion whether accreditation programs which are mostly focussed on health care services are relevant. For example, a focus on client safety within the context of a commu- nity health and residential addiction treatment centre is very different from in acute health care settings. If accred- itation is going to be seen as useful, the standards must be relevant for community services. In addition, there are concerns about the fact that program funding for accredi- tation does not cover the entire cost of compliance with accreditation recommendations.
Although accreditation addresses all structures, it does not replace evaluation of specific programs. For example, accreditation does not prescribe the best approach to offering any health care service or to addiction treatment (namely the evaluation of a spe- cific theory or of a cultural approach to health service delivery). It does, however, ask how the organization uses its knowledge of best practices to guide its ser- vice delivery and how the organization monitors and measures effectiveness.
>> reneWAl oPPortunitieS
• Support for treatment centres to bear the costs of compliance with accreditation standards. This sup- port must be fair, scalable, adaptable, and sustain- able. It must include both the implementation of accreditation and compliance with recommenda- tions stemming from this process.
• Accreditation standards that have meaning to First Nations culture can provide a holistic framework within the accreditation process, and cultural relevance needs to be integrated into assessments.
• Having standards that can accom- modate First Nations holistic health and healing practice requires ongo- ing improvements to the accredita- tion processes and standards. This will help to ensure that these standards are more tuned into the operations and realities of First Nations addictions facilities and programs.
• Ongoing evolution of the accredi- tation process will ensure that the process meets the best standards pos- sible in an ever-changing sector. The standards must be a benchmark of excellence.
• Support for knowledge exchange among centres specific to accredita- tion will help to ensure that practice- driven success can be shared broadly. This may include a national program resource centre or a centre of excel- lence that promotes accreditation champions. The goal would be to further support accreditation within First Nations communities and organizations.