The Basics

This standard outlines the requirements for the quality management program.  The required components of the QM program description include approval by the board of directors or other governing panel, the "scope, objectives, activities, and structure" of the program, annual review by the QM committee (the roles and responsibilities of which must be described), and the identification of a single member of senior staff who oversees the QM functions while serving on the QM committee.

Management Tips

As described in a previous page, the Quality Management Program description should be able to support most of the documentary requirements for this standard.  In fact, it could be said that this provides you with an outline for that program description.  

In addition to preparing a suitable QM program description, the other essential management function behind this standard is getting the required approvals of the oversight authority (e.g., a board of directors or executive committee) and the Quality Management Committee.

URAC Accreditation Tips

Each of the elements of this standard is weighted either 2 or 3.

The URAC Program Guide says that all you need do at the Application stage is submit a "Program description and plan or P&Ps addressing QM oversight of the program," and your documentation worries are over.

And, for some reviewers, that may be so. However, you can save yourself the risk of a dispute over the adequacy of that documentation, and take some of the work out of the onsite review process, if you go a bit farther in demonstrating compliance with the elements requiring approval by the "oversight authority" and annual review and approval by the Quality Management Committee.  At some point in the process, either during the desktop review or the onsite review, the reviewer will need to see documentation independent of the QM Program Description that the governing body has approved the QM Program Description and that the QM Committee, within the past year, has reviewed and approved it. 

I recommend that you do this up front, at the Application stage of the process. This should be easy -- submit committee minutes demonstrating such committee approval by both of these panels or submit signed, dated attestations from the chairs of these to bodies indicating that their committees have, as required, approved the program document, and when each committee did so.

While I usually think the Program Guide provides the best idea of what documentation will suffice for a particular standard, this is one situation in which I think it's best to go a bit farther.