Comprehensive Study Notes on Health Policy and Healthcare Accreditation

Conceptual Framework and Impact of Health Policy

• Health Policy Definition: Actions taken by government bodies and other societal actors to attain specific healthcare goals.
• Driver of Quality: Health policies directly drive the availability, safety, and quality of provided healthcare. This is due to the involvement of various stakeholders at all levels, including:
  • Local communities.
  • Politicians.
  • Consumers.
• Consequences of Policy Gaps: A poorly constructed policy or the absence of a needed policy can have significant negative impacts on the health and well-being of individuals and entire populations.
• The Nurse's Role in Policy:
  • Nurses must understand how healthcare policy affects patients, their own professional practice, and the organizations in which they work.
  • Nurses can influence change by working with public officials at local, community, state, and national levels.
  • Influencing methods include acting as representatives of professional organizations or as individual citizens.

Overview of Public and Private Health Policy

• Public Health Policy:
  • Established in law and regulation.
  • Enforceable by the government agency responsible for its implementation.
  • Subject to influence from various societal actors.
  • Has a powerful effect on healthcare delivery systems, professional nursing issues, and the health and well-being of United States citizens.
• Private Health Policy: May be developed by private agencies independently of government mandates.
• Legal Foundations:
  • Public healthcare policy is generally first established in law through bills passed by Congress or state legislatures and signed by the President or a state Governor.
  • Presidential vetoes, executive orders, and judicial interpretations of the law also carry the force of law.
• Regulations vs. Laws:
  • Laws provide broad mandates and are typically written in general terms.
  • Once a law is passed, an executive branch agency (federal or state) implements it.
  • Regulations provide the specific details describing how the agency will carry out the mandates of the law.

Developing Health Policies

• Government and Political Origins: Public healthcare policies are the product of both government processes and political forces.
• Initiation: Development may begin when legislators or executive branch health agency leaders commit to solving a specific problem or bridging a gap in services.
• Stakeholders and Resources:
  • Major stages in policymaking involve formal and informal relationships between stakeholders.
  • The determination of how resources are allocated and to whom is decided within a political framework.
  • Critical factors must be determined before the first draft of a bill is even constructed.

Federal, State, Local, and International Regulatory Agencies

• Federal Agencies:
  • U.S. Department of Health and Human Services (DHHS): The principal federal health agency.
  • Occupational Safety and Health Administration (OSHA): Tasked with ensuring health and safety in the workplace. OSHA legislation covers most private-sector employers and their workers, as well as some public-sector employers and workers.
  • Centers for Disease Control and Prevention (CDC): Involved in disease control and prevention efforts.
• State and Local Agencies:
  • Each state mandates its own health policies and regulations in accord with federal policies.
  • State departments of health and human services generally report to the governor as part of the executive branch.
  • Responsibilities: Includes enforcing regulation of county health departments and licensing/registering hospitals, long-term care facilities, child care centers, and clinical laboratories.
  • Local DHHS: Responsible for administering county and city health departments, overseeing child care sanitation, food safety, and offering community-wide disease and injury prevention programs.
• State Offices of Emergency Medical Services (EMS):
  • Establishes training and certification standards for EMS personnel.
  • Accredits training programs.
  • Oversees the state's trauma system.
  • Licenses medical transportation systems.
• International Health Agencies:
  • Multilateral Organizations: Part of the United Nations (e.g., World Health Organization or WHO).
  • Bilateral Organizations: Government agencies based in one country providing aid to developing countries.
  • Nongovernmental Organizations (NGOs): Also known as private voluntary organizations. They are independent of government and may be faith-based.

The Role and Process of Accreditation in Healthcare

• Definition: A process of gaining recognition through a peer-review process that evaluates the quality of an organization based on the standards and criteria of the accrediting organization.
• Key Characteristics:
  • Accreditation is private and voluntary.
  • Reputable organizations use evidence-based processes to establish standards.
  • Achieving accreditation certifies that an organization is competent to provide offered services and meets high-quality criteria.
• The Evaluation Process:
  • Organizations must be reevaluated periodically.
  • Includes an on-site survey to validate the organization's self-assessment and performance.

Nursing Education and Professional Organizations

• Nursing Education Program Accreditation:
  • Commission on Collegiate Nursing Education (CCNE): Accredits baccalaureate and graduate programs.
  • Accreditation Commission for Education in Nursing (ACEN): Accredits clinical doctorate, master's, baccalaureate, associate, diploma, and practical education programs.
  • National League for Nursing Commission for Nursing Education Accreditation (NLN-CNEA): Provides standards of accreditation for practical/vocational nursing programs through clinical doctorate degree programs.
• American Association of Colleges of Nursing (AACN):
  • The national voice for America's baccalaureate and graduate nursing education.
  • Membership: Over 840 member schools of nursing.
  • Policy Focus: Nursing education, research, and nursing workforce development.
• National League for Nursing (NLN):
  • The first nursing organization in the United States.
  • Membership: Nursing education programs, faculty, students, and leaders.
  • Focus: Building a strong and diverse nursing workforce.
  • Structure: Includes state "branch" associations affiliated with the national body.
  • Policy Efforts: Influencing policies affecting workforce development, nursing education, and healthcare for underserved populations.

Comparative Analysis of Healthcare Accrediting Organizations

The Joint Commission

• Focus: Single industry (Healthcare). Collaborated with organizations for over half a century to focus on safe, quality care for the American public.
• Structure: Not-for-profit.
• Accredited Entities: Nearly 5,000 hospitals and approximately 10,000 other healthcare organizations.
• History: Established by healthcare professionals; awarded unique deeming authority in 1966.
• Governance: Board of Commissioners comprises physicians, nurses, healthcare leaders, and public representatives.
• Accreditation Requirements: Leading standards and National Patient Safety Goals developed with stakeholders; these exceed the Conditions of Participation (CoPs).
• Survey Process: Uses "Tracer Methodology" to follow a patient's experience; provides a patient-centered rather than paper-intensive survey.
• Frequency: On-site surveys every three (3) years; hospital prepares an annual Periodic Performance Review (PPR).
• Surveyors: All are employees; must pass a certification exam. The Join Commission is the first and only body to certify its surveyors.

Healthcare Facilities Accreditation Program (HFAP)

• Focus: Nationally recognized with deeming authority from CMS. Focuses on objective application of standards for quality care.
• Structure: Not-for-profit.
• Accredited Entities: Nearly 200 hospitals and more than 200 other healthcare facilities and laboratories.
• History: Accrediting for more than 60 years; authorized to survey clinical labs under CLIA.
• Governance: Managed by the AOA Bureau of Healthcare Facilities Accreditation (physicians and administrators from various specialties).
• Accreditation Requirements: Standards include CMS and other nationally recognized standards; exceed CoPs.
• Survey Process: Comprehensive, non-biased, and educationally focused reviews; least disruptive to the facility.
• Frequency: On-site surveys once every three (3) years.
• Surveyors: Paid volunteers (not employees), often recruited from HFAP-accredited facilities.

Det Norske Veritas Healthcare, Inc. (DNV)

• Focus: Safeguarding life, property, and the environment. Uses integrated standards from the ISO 9001 quality management system.
• Structure: Operating company of Det Norske Veritas.
• Accredited Entities: Accredited more than 27 hospitals since receiving deeming authority in 2008.
• History: Operating in the U.S. since 1898; received CMS deeming authority for hospitals on September 26, 2008.
• Governance: Managed by degreed professionals in healthcare management, law, ISO certification, and engineering.
• Accreditation Requirements: Standards are directly related to CMS CoPs; less prescriptive to allow for organizational innovation.
• Survey Process: NIAHO and ISO surveys performed together through Tracer Methodology. Evaluates clinical and non-clinical areas.
• Frequency: Performs an annual on-site survey.
• Surveyors: Must complete NIAHO Surveyor and ISO 9001 Lead Auditor training. Requires 45 hours of continuing education every three years.