21st century accreditation preparation has arrived
Georgia agency prepares through Intranet
Many rehab industry experts say business survival in the 21st century health care world will require technological advances, including greater reliance on computerized documentation.
The chief obstacles to computerized documentation so far have been time and money, because developing or adapting useful software is both expensive and time-consuming. However, at least one rehab facility has found a way to make this initial investment worthwhile. Glancy Rehab Center of the Gwinnett Hospital System in Duluth, GA, now has its complete accreditation documentation and preparation process on computer.
Glancy Rehab Center was the first rehab facility to be surveyed with the use of Intranet technology by CARF The Rehabilitation Accreditation Commission in Tucson, AZ. The survey, which took place in May 2000, resulted in positive feedback about the use of Intranet technology, and the facility received full accreditation. "Our surveyor said this was the easiest survey he’s ever done," says Katrina Stone, MA, education coordinator for postacute services at the Gwinnett Hospital System.
The information is on an Intranet web site that can be accessed by staff or by others to whom staff give permission. The information is not available to the public. By having the information on-line, a surveyor can review the facility’s survey preparation materials from a hotel room on the evening before the survey visit, saving pounds of paper documentation. This also provides staff with easily accessible information on anything having to do with a facility’s procedures, requirements, and standards, Stone says.
While it takes a great deal of time to put all of the information on computer, once it’s there, future survey preparation will be substantially less time-consuming because most of the computerized documentation will be the same, and information that has changed will have been updated by staff during the interim between surveys, Stone explains.
Stone, whose husband, Lee Stone, is a computer expert who owns Web Functions in Norcross, GA, first came up with the idea of putting the rehab facility’s accreditation information on computer.
"The paper compilation process to show a surveyor your process means hours and hours of time are taken away from patient care just to show that you provide good patient care, and this doesn’t make sense," Stone says. "I’ve prepared for three surveys in my lifetime, and I was tired of standing in front of that copy machine and doing what I felt was busy work, so to avoid this busy work I suggested we do something differently this time."
CARF liked Intranet survey idea
Glancy Rehab Center’s management gave her the go-ahead to implement the idea. Before starting to develop a plan, Stone called CARF and asked whether there were any other facilities that had switched to an Intranet survey process. No one had done this before, so CARF offered enthusiastic support of the idea, Stone says.
The next step was to develop a plan, which the Stones did together. "Lee is a technological genius, and we spent a good amount of time at home discussing applications of the Intranet," Stone says. They spent about a year on the project, which had to be started from scratch because the hospital was just beginning to use networked computers. There was limited support available internally. "A lot of organizations already have webmasters on site and Intranet services that provide all kinds of technical support which I didn’t have," Stone notes.
Most of their time was spent in preparing the documentation, whereas building the web site took only a couple of weeks, Stone recalls. The main problem was that the facility’s documentation was stored in various places and in different locations within the hospital system. Some of it was in paper format, and other parts were stored on disks that were stuck in desk drawers. Stone’s goal was to take all of the documentation and put it on a computer database to shift the facility’s dependence from paper-driven data.
Here’s how the Stones developed the Intranet survey documentation project:
1. Consolidate and revise all policies and procedures. The rehab center and the other system rehab departments organized a committee — consisting of a physical therapist, occupational therapist, recreation therapist, nurse, education coordinator, and speech-language pathologist — to learn how to use all paper policies and procedures in a computerized format. Some of the files already were in electronic format, and these also were revised and consolidated. The committee focused on the policy content and improved, consolidated, and revised where necessary.
For example, the committee found 15 policies across three rehab departments that were related to performance improvement. These were consolidated into one policy. (To see performance improvement policy sample, click here.) "All of us put in our overtime," Stone recalls. "Closer to the accreditation survey time we met weekly, but most of the time we didn’t need to meet frequently because we were doing everything over the network, and everybody could read each other’s notes."
The committee took guidelines and policies from all three rehabilitation departments and consolidated them into one set of policies and procedures, eliminating all duplication. Initially there were more than 800 policies, and these have been consolidated into 120 policies.
Organizational leaders revised policies
For certain policies, the committee assigned organizational leaders who were responsible for writing the policy. Then other members of the team proofread the policy before it was sent to the medical director, the service line director, and the facility’s vice president for approval. "Now the entire rehab division staff use the same set of policies and are responsible for the same material, and life is much easier for them as a result of this change," Stone says.
The revised policies and procedures were placed into Microsoft Office software templates, which had been designed by the Stones and another organizational improvement educator. "We met way before the committee got together," Stone says. "In the organizational improvement department there was a policy and procedure class that had recommended a format for policy, and we closely followed that format."
2. Train staff to use a shared network drive. Typically, any organization that has networked computers will have more than one shared drive that groups use together, and everyone involved has access to those drives. Gwinnett Hospital System had such a network, although it wasn’t being heavily used, so Stone began to educate the staff about what a network drive is and how they can use it.
Changing the that’s my stuff’ mentality
"We convinced everybody that sharing their documents was positive, because at first the idea was threatening to people," Stone explains. "People would say, That’s my stuff, why would anybody want to see my stuff?’" Stone answered these concerns by explaining how a network drive would allow staff to cut down on paperwork through having people share documentation rather than duplicating information and forms that may already exist.
Staff also feared that other employees would lose or inadvertently ruin their data, so Stone had to explain that the hospital system backs up information on a daily basis. If something is lost, it can be easily retrieved by the information systems department. Once the staff began to use the network drive, they could see how it enabled them to spend less time copying reports or talking on the telephone to other employees when they needed information. Staff training has been ongoing with hospital computer education classes, mentoring, and one-on-one training when necessary, Stone says.
3. Create grid structures for documentation and put these on a web site. The facility bought an electronic version of an accreditation preparation guide from CARF. The accreditation preparation guide was used to cut and paste CARF standards information into a three-column table created in Microsoft Word. This part of the process was tedious, but necessary, Stone says.
The grid lists the standard in the first column. It has a short narrative on how the facility meets that standard in the second column, and then in the third column it includes a list of the documentation that provides proof of compliance with that standard. (To see sample performance improvement plan grid chart, click here.) With the grids, they created web pages with hyperlinks so that a surveyor reviewing any particular standard could click on any piece of documentation that is offered for proof and open it for review.
"The biggest challenge was to make it intuitive," Lee Stone says. "A really good web site is one where things are easy to find, and the bad ones are where you can’t find anything you need." So the Stones took structures that were navigable and replicated those examples in the web site for the rehab facility. By the time they completed putting all of the facility’s documentation and charts and standards into the web site, they had reduced 18 feet of binders on a shelf to one CD-ROM.
The web site includes information about the rehab facility, pictures of the facility, instructions on how to use the web site, and other basic information, Lee Stone says. "Surveyors can access the policy and procedures, the standards/compliance section, a general information page about Glancy Rehab Center, and a section about the team and leadership of the hospital with digital photos of the preparation team and their biographies," he adds. "Our next goal is to have it all maintained on a continuous basis so during the next survey you would not have to do anything extra," he says. "All the benefits that derive from using the application are used on a daily basis."
The facility still will have to review the standards before an accreditation survey to make sure the facility is in compliance, and there are always new standards to meet, but that will be all that remains of survey preparation, Katrina Stone says. "What we’re cutting out is all that busy work, and what we’re getting in return is a product that your staff can use on a daily basis," Stone says.
4. Make new forms and documentation instantly available to staff.
An additional benefit of the Intranet web site is that when someone develops new forms, guidelines, documentation, or educational materials, they are put on the web site and are immediately available for staff use and review, Stone says. Any information that needs to be kept private from all but certain employees, such as financial information, is password-protected on the network, so only the people who need access can get it, Stone adds. In the event the computer network is inaccessible because of a mechanical problem, staff still have access to the paper versions of some files. Soon, however, paper access will be all but unnecessary, Stone notes.
Now that the hard work is complete, Stone says staff and management are pleased with the results, particularly because their Intranet accreditation survey was so successful. "This was a whole lot of fun," Stone says. "It was a wonderful process, and it got us a lot of attention, as well as an Intranet our staff can use each day."
Need more information?
— Katrina Stone, MA, Education Coordinator, Postacute Services, Glancy Rehab Center, Inpatient Program, Gwinnett Hospital System, 3215 McClure Bridge Road, Duluth, GA 30096. Telephone: (678) 584-6796. E-mail: firstname.lastname@example.org.