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    David N. Gans, MSHA, FACMPE


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    Best practices in healthcare administration tend to address the wide range of potential problems and outcomes when delivering care. In countless ways, the COVID-19 pandemic has put the entirety of a medical practice’s policies and procedures to the test, determining if they remain appropriate under trying circumstances.

    Since September 2017, Noel M. Adachi, MBA, has served as chief executive officer and president of the Accreditation Association for Ambulatory Health Care (AAAHC). She recently joined the Executive Session podcast to discuss her role in leading the organization, which accredits almost 6,700 ambulatory surgery centers (ASCs), office space surgery facilities, endoscopy centers, student health centers, medical and dental group practices, community health centers and government employee-based health clinics, retail clinics, Indian/tribal health centers and related ambulatory care organizations.

    AAAHC is recognized by state and federal agencies and insurers, as well as commercial insurers and liability insurance companies, for facility payment. Its accreditation process provides facilities and external independent review against nationally recognized standards and its own policies, procedures, processes and outcomes.

    While AAAHC has evolved its own policies with the COVID-19 pandemic (e.g., requiring vaccinations and booster doses for surveyors and other employees), Adachi tells MGMA that accreditation standards have shown resilience within ambulatory care spaces despite the challenges of the public health emergency.

    “The amazing thing, I think, is that our standards withstood the environmental changes,” Adachi said. “We really didn't have to make any adjustments to the standards — it has been more a heightened focus in certain areas so that we could make sure that our facilities continue to provide safe quality care, not only for the patients that they serve, but a safe environment for the employees working in that facility.”

    As the pandemic begins to shift to an endemic, Adachi said it will be vital to “not lose sight” of other important areas that are crucial to patient safety and quality patient care, such as pain management and opioid distribution.

    The team of more than 250 health and life safety surveyors who work with AAAHC to conduct facility site visits took some steps early in the pandemic to ensure they were implementing proper safety measures, but surveys of ambulatory care facilities largely continued uninterrupted the past two years, Adachi noted.

    This continued contact with frontline healthcare facilities helps ensure that those seeking accreditation remain engaged in maintaining policies and procedures that support continuous quality improvement through the multiyear term of accreditation.

    The ongoing work by those surveyors to be out in the field also serves to ensure that best practices from ambulatory care facilities are documented and considered for future standards development, so that evidence-based methods can be shared across the industry and implemented.

    “Because our surveyors have a lot of experience serving facilities in a variety of specialties and settings, they can share with their clients different approaches to accomplish the same intended outcome that's really valuable,” Adachi said. “All of our surveyors have worked in or are still working in the ambulatory space in a variety of settings. … Sharing that insight with our clients is a key value proposition that our surveyors deliver.”

    Learning those best practices helps tremendously in the current era of high turnover of healthcare workers, as it serves as a “risk mitigation opportunity” by engraining standardized work and best practices across the organization, Adachi added.

    “There's considerable turnover in the healthcare space. … Implementing accreditation standards allows that facility to reduce the risk of errors happening, especially as staff turns over because it will have the policies, procedures and training in place to mitigate those risks and to ensure standardization and how they onboard new employees,” Adachi said.

    The strain of the pandemic and staffing struggles in many healthcare organizations is evident to Adachi, who underscored that there must be an understanding that standards should be attainable without creating unreasonable burden on facilities.

    AAAHC’s governing body includes standards committees that consider the usability of standards. “We want to make sure that we are not putting a burden on a facility that would negatively impact their ability to deliver quality care,” Adachi said.

    Written By

    David N. Gans, MSHA, FACMPE

    David Gans, MSHA, FACMPE, is a national authority on medical practice operations and health systems for the Medical Group Management Association (MGMA), the national association for medical practice leaders. He is an educational speaker, authors a regular Data Mine column in MGMA Connection magazine and is a resource on all areas of medical group practice management for association members. Mr. Gans retired from the United States Army Reserve in the grade of Colonel, is a Certified Medical Practice Executive and a Fellow in the American College of Medical Practice Executives.

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