The Accreditation Association for Ambulatory Healthcare recently announced it accredited its 5,000th organization. Jack Egnatinsky, MD, president of the AAAHC board of directors, discusses the significance of this milestone, the importance of accreditation, where organizations have improved their quality care efforts and where improvement still needs to be made.
Q: Congratulations on AAAHC accrediting its 5,000th organization. What does this milestone mean to your organization?
Dr. Jack Egnatinsky: We are tremendously encouraged that more and more healthcare organizations are becoming accredited by AAAHC. While we continue to serve those organizations that are now accredited, we are firmly focusing on those organizations still to accept the process. The 5,000th milestone is a stepping stone, not a destination. To paraphrase Robert Frost's poem: We have promises to keep, and miles to go before we sleep.
Q: What does the milestone say about the importance of accreditation and the accreditation process?
JE: Without a doubt, it underscores the fact that accreditation is becoming necessary to healthcare organizations: federal legislation, the growing number of states now requiring it, third-party payor requirements and the increasing awareness among healthcare facilities themselves — hopefully these trends point to a day when all ambulatory care centers will attain accreditation as a matter of course.
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Q: Reflecting over the last several years, how have organizations improved their efforts to ensure patient safety and quality care? What would you say organizations do better now than they did just 5-10 years ago?
JE: Although risk management has always been a part of our standards, we recognized the need for expanded standards for patient and staff safety and infection control. This has helped organizations prepare safety programs to meet the needs of the populations they serve and to also meet our standards. Quality care including continual review of patient satisfaction, complications and unscheduled admissions and an active quality improvement program are part of our survey process and often represent opportunities for us to provide advice and education to our surveyed organizations.
Q: In what areas do you think organizations are still coming up short, areas that need more focus?
JE: Many organizations still do poorly on documentation of their governance and fail to read the standards. A frequent suggestion of our surveyors is that they designate one meeting a year of the governing body as the "annual meeting" and have a checklist of all required areas to review and approve. Credentialing decisions should be documented by the governing body as they occur. Although organizations are doing better with peer review than they have in the past, there is generally room for continued improvement. Although most organizations are doing better with continuous quality improvement programs, they often do not understand internal and external benchmarking and do not document their efforts in this area very well.
Q: What AAAHC standard(s) does history show to be the most challenging for organizations to meet and what advice can you give to organizations to help them meet these requirements?
JE: Historically, many organizations have been lax in granting privileges for specific procedures. Those organizations that have previously undergone accreditation or have attended one of our Achieving Accreditation seminars have very few problems with this. Complete medication histories, including over-the-counter medications and dietary supplements, is often incomplete or requires multiple locations (patient information form, H&P, nursing admission form and anesthesiology pre-op evaluation) to find this.
Although "allergies" are generally documented, the type of reaction is often not noted separating true allergies from adverse side effects. And one final area, although in my experience it has been less of a problem in recent years, is the documentation of review, verification or authentication of test results and consults by the physician directing or directly providing the care.
My advice: Remember that the accreditation survey is an "open book" test.
Before undergoing your survey, make sure you have looked at all of the current applicable standards and determined how your organization matches up — what we refer to as the self evaluation. Our standards are revised every year so it is important to have the current AAAHC Accreditation Handbook.
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