AAHA revamps hospital accreditation standards

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Jan 01, 2003

Fast-food service mogul Ray Kroc once said the quality of a leader is reflected in the standards they set for themselves.

The American Animal Hospital Association (AAHA), in its mission to mass-produce leaders of the veterinary profession, has taken to heart the McDonald's founder's credo.

In its most substantive undertaking in a decade, the association has trashed, tweaked, rewritten and carved out its most comprehensive set of accreditation standards for companion animal practices to date.

"It's very substantial. It has probably the greatest opportunity to improve the quality of care of practices across the country - as great an opportunity as anything that has ever been seen within the profession," says Dr. Link Welborn, chair of the AAHA Standards Enhancement Taskforce, and owner of three companion animal practices in Tampa, Fla.

Raising the bar

AAHA's board of directors approved the revisions in November. The number of standards will jump from roughly 300 to 1,200 when the revisions take effect this spring.

"There was a feeling among the leaders of the association that the time had come to raise the bar for the standards within practices," Welborn says.

One of those leaders, Dr. Steven Holmstrom, a taskforce consultant, says the standards position the profession at the proverbial fork in the road.

"We have a choice when practicing," says Holmstrom. "Through our careers we can either practice 40 years of veterinary medicine or one year 40 times. That is, we can either progress in our skills and equipment or we keep doing the same thing, year after year. These standards are a way of ensuring that we continue to grow."

The association is the only veterinary organization to provide practice accreditation, what some consider the lifeblood of the organization.

About 40 specialists from varied disciplines nationwide provided input for the standards overhaul, which currently apply to companion animal practitioners only. Updated standards relevant to specialty practice are slated to arrive in late 2003.

Nuts and bolts

The standards, according to AAHA, precisely measure how the profession, or at least accredited practices, should be held accountable in traditional areas of practice, such as laboratory, pharmacy and medical records protocols, and previously unmeasured categories, such as pain management, ethics, contagious disease and leadership.

"For the first time, the profession will have access to a road map to high quality medicine," says Dr. John Albers, executive director of AAHA. "For many years the impression (of AAHA) has been - and it's not unjustified - that our standards have focused more on facilities and equipment and procedures. These standards for the first time are really all about quality of care issues."

In reviewing ethics standards, for example, Welborn says the goal is not for AAHA to take liberties to provide blanket ethical guides but to allow each practice to develop custom measures.

"While we would not decide whether these guidelines were right or wrong we would say, 'Yes, this practice has taken the time to give some thought about ethical questions that face the profession and has developed guidelines to address it within their practice,'" says Welborn, AAHA president-elect.

Dr. Robert Lofton, another taskforce member and AAHA director, adds that the new standards consider the people behind the practice. "(The standards) will help us become better veterinarians, because they deal more with patient care and quality of patient care and not so much with bricks and mortar -the building, facility, whether you have certain physical things within your hospital."

The new standards additionally incorporate methods outside veterinary medicine. AAHA extensively perused standards of its human counterparts in the Joint Commission for the Accreditation of Healthcare Organizations. Apparently, many of its standards now draw direct correlation to human medicine, according to taskforce members who declined to elaborate.

Give standards a chance

There's no question the new standards may at first appear daunting to unacquainted veterinarians.

"If I were going to be accredited for the very first time and realized the difference in the volume (of standards), at first it would take me back," says Lofton, who has worked on previous accreditation standards. "But once you start to read the standards, you'd find they're very easy to comply with if the veterinarian is conducting quality medicine."

AAHA touts quality medicine, or quality of care, as the pinnacle toward which veterinarians should aspire. Quality of care by definition, according to Holmstrom, is "practicing the best medicine, surgery and dentistry possible using state-of-the-art equipment and techniques."

Something old, something new

In the past, AAHA primarily intended to accredit AAHA-member practices only. Currently, 15 percent of all practices in the United States and Canada are accredited.

Some changes and additions to the new standards:

* Accessible online. The association plans to post all standards on its Web site at www.aahanet.org, available to all members.

* Open to other associations. AAHA also intends to set up the Web site such that members of other associations can gain access, including the American Veterinary Medical Association and the Canadian Veterinary Medical Association.

"What we're talking about is allowing the standards to be distributed very widely within the profession so that if practices are just curious about what the standards are like, then they can go to the Web site, view the standards, print them out and can view their practice and say, 'Yes, accreditation is something I would like to pursue,'" says Welborn.

He adds, "Even if they just look at the standards and say I'm not really ready for accreditation just yet, but only pick out a few things and implement those changes in their practice, then we feel that we've made a difference in a lot of practices that we may not have touched in the past."

* New protocols within standards.

"For example, there's a new way to prep for surgery, i.e. an FDA-approved soapless, waterless means," says Dr. Dennis Feinberg, AAHA vice president-elect and current member of the taskforce. "What we're doing is substantiating these types of things."

To paraphrase, the AAHA standard recommends that a practice use a protocol to ensure proper preparation of surgeons and surgical assistance.

"As soon as we have the word 'protocol,' "says Feinberg, "what we're doing for our members is creating a template."

They can create their own protocol, he adds.

* Point-based system. AAHA is eliminating the former tiered system, which classified and assessed practices in two-, three- or four-year cycles, according to the amount of effort the practice expended. By early 2003 all accredited practices will be assessed every three years according to a newly established point system. An assessment typically involves a practice consultant who conducts a site visit and practice survey to ensure compliance.

"Every veterinarian I meet indicates that they practice high quality medicine," says Albers, who has reviewed the standards. "This will provide them with an objective assessment of whether or not in fact they do."

With the point-based system, practices will not have to fulfill every standard in the new accreditation program, which means all standards are not mandatory. However, practices cannot opt out of an entire section.

Although the changes are hardly minor, Feinberg says there's no reason for premature fretting from veterinarians.

"We're hoping that by giving these resources, it's not, 'Oh, my gosh, in April I'm going to be evaluated.' It's that you're embracing it, because it allows you to feel good about what you're doing," he says.

The standards won't be finalized until AAHA completes beta testing of numerous practices to develop point totals for all sections as well as a pass/fail level, according to Welborn, whose practice was first to undergo trial tests. Once editing and testing is completed, AAHA will market its standards online as well as via CD-ROMs that will be distributed to accredited practices and at its annual meeting in March.

Team effort

The taskforce has had little time to sleep in the last 16 months while preparing the final version of the standards.

"The standards represent an incredible amount of work on the part of the taskforce that put them together," says Albers. "I really think that the profession will benefit from them, whether they choose to become AAHA members, accredited members or not."

Adds Feinberg, "We're trying to make change within the organization quicker than change outside the organization," says Feinberg. "There's that old saying, if the change outside the organization is moving at a quicker pace than change inside the organization, the end is near."