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Ensuring Canadians receive equitable care

For clinicians and administrators, participating in the SCI Standards accreditation process can unify care teams and improve patient care

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In 2011, Rick Hansen Institute partnered with Accreditation Canada to develop comprehensive and evidence-based standards for spinal cord injury care in acute and rehabilitation settings. The SCI Standards are part of the range of service excellence standards that are available for organizations to use when they participate in the organization's Qmentum Accreditation Program. Like all other service excellence standards, they focus on the essential components of safe and effective health care, based on five attributes of excellence—clinical leadership, people, processes, information and performance.

Accreditation is granted for the entire organization, as an overall assessment of quality that reflects the programs and services that an organization delivers. The SCI Standards were designed to align with other clinical service standards, with common Required Organizational Practices and service excellence themes, so that they can be seamlessly integrated into how sites already prepare for site visits. Choosing to include the SCI Standards should not significantly impact workload for clinical teams.

To help facilitate optimized and standardized care at all acute and rehab facilities treating people with SCI in Canada, the key indicator of success for RHI's Care Program is to have 50% of SCI centres accredited by 2018, according to the SCI Standards.

To date, three facilities have received site accreditation: London Health Sciences – Victoria Hospital (Acute Standards); Capital Health – Queen Elizabeth II Health Sciences Centre (Acute and Rehab Standards); and University Health Network – Toronto Rehab-Lyndhurst Centre (Rehab Standards).

Shining a spotlight on your facilities SCI care best practices

The SCI Standards allow sites to showcase specialized services for which they are already recognized as centres of expertise – shining a spotlight on high-functioning teams that may not otherwise have a chance to be featured during the site visit. This is an especially advantageous opportunity for large, multi-site or multi-service organizations, where surveyors may only get to conduct tracers at a small sample of the organizations' overall acute and rehab services. By utilizing the SCI Standards, organizations effectively ensure that their site visit will showcase those areas of excellence with focused tracers.
Teams at Halifax's Capital Health and Toronto Rehab contributed to the early development of the SCI Standards. Going through this process enabled both teams to see the value in becoming an accredited site according to SCI Standards.

"We would whole-heartedly recommend the use of SCI Standards to other [Rick Hansen SCI Registry] sites. The standards provide achievable targets for best practice care," said Halifax research coordinator Ginette Thibault-Halman.

Added Halifax's Division Head of Physical Medicine and Rehabilitation, Dr. Christine Short: "It is very important when dealing with unique populations like SCI that a site can ensure they are meeting a standard of care. This treatment cannot just be done anywhere. Therefore, it is very important for other sites across Canada to participate."

Short also felt that participating in the process will also "help grow the collaborative relationship between SCI acute care and rehabilitation."

Toronto Rehab's Brain and SCI Rehab Program Advanced Practice Leader, Heather Flett also acknowledged the importance of finding champions to ensure the adoption of standards were implemented and carried out by the entire team.

"With the endorsement of our Clinical Director, Joanne Zee and Medical Director, Dr. Mark Bayley, our UHN Senior Leadership immediately supported utilizing SCI Standards in our Qmentum Accreditation process."

"Our Brain and Spinal Cord Rehab team was already the first in Canada to achieve the Stroke Rehabilitation Accreditation Distinction Award and, therefore, striving for the SCI Standards was a natural alignment."

Gaining valuable feedback

During the review, teams who participate also receive invaluable feedback from the survey team. This process enables teams to validate that path they are on is the right one.

"The accreditation process validated a great deal of many of the practices we already have in place."

"It gave us an opportunity to revise and revive our SCI acute and rehabilitation pathways, and gave us focus on areas where we need to grow," said Short.

Added Flett: "Acknowledgement of strong inter-professional team and focus on our new inter-professional rehab process titled "Self-Management Support for SCI" as well as our efforts to improve pressure ulcers through the SCI Knowledge Mobilization Network [was valuable feedback]."
"The surveyor also highlighted our integrated clinical-research environment and the value of having clinicians and scientists embedded in the same environment."

Advice for other sites

When asked if teams had any advice for sites that were preparing to go through the accreditation process, Flett identified "mock tracers" as a key activity that helped staff feel confident and fully prepared for the site survey. During mock tracers, clinicians would be asked one or two accreditation questions and probed to show proof (e.g. documentation, reports etc).

Mock tracers "happened at any time during the day or week and staff were then given immediate feedback and encouragement. [It] also helped us to identify areas that required further attention."

"Buy-in from all team members, physicians and management is absolutely required for success. Openness to feedback and willingness to change are also essential. It is a team process," said Thibault-Halman.

Find tools and resources to support your site visit

If your site is undergoing or planning to undergo the SCI Standards review, RHI has produced several resources including a step-by-step guide, resources to make the process easier and implementation guides for improving the most important areas of care. Access to the complete suite of tools and resources are available on RHI's clinical resource site – SCI2.

Have other questions about accreditation? Contact RHI's Accreditation Leader, Serena Bertoli-Haley at .