Ongoing Compliance Maintenance

Maintaining Compliance between Accreditation Cycles: Who in Your Organization is Keeping an Eye on That?

In the dynamic world both inside and outside your organization, change is constant. This dynamic environment increases the risk of losing compliance status midway through your accreditation cycle. Integral Healthcare Solutions (IHS) is here to assist you in navigating these changes and staying compliant.

You've successfully achieved accreditation. Congratulations! However, don't assume it's time to relax. While your next full review might be three years away, it's crucial to understand that your reviewers will assess your compliance with accreditation standards throughout the entire accreditation cycle. Even if you've recently improved your operations and documentation before the next review, you could still be penalized for non-compliance in the earlier years of the cycle.

These lapses could jeopardize your chances of reaccreditation. How might this occur? In the ever-changing landscape of your industry, several scenarios could lead to unintentional non-compliance:

  • New personnel in key roles may unknowingly deviate from compliance procedures.

  • Expanding into new business areas or client relationships might introduce unforeseen compliance challenges.

  • Urgent business crises can divert attention away from maintaining compliance.

Furthermore, changes in the accreditation organization's requirements or variations in reviewers' strictness can impact your compliance status. This isn't merely a theoretical concern. Recent years have seen a significant increase in mid-cycle revocations, a risk that could leave your accreditation suspended for over a year—a potentially devastating situation.

Integral Healthcare Solutions' Ongoing Compliance Maintenance (OCM) Program

IHS offers a solution to safeguard against inadvertent non-compliance resulting from these changes. Our Ongoing Compliance Maintenance (OCM) Program provides a tailored approach to your specific circumstances, ensuring that no compliance-related tasks are overlooked during your accreditation cycle. We work closely with you following your accreditation achievement to determine the most suitable combination of services:

  • Regular reminders for activities mandated by the accreditation program

  • Mock monitoring on-site reviews

  • Virtual monitoring assessments

  • Training sessions

  • Access to our accreditation and compliance management system (Starfinch) for document tracking

  • Off-site and on-site staff training

  • Assistance with system implementation inquiries

  • Expert support for policy development and answering queries

  • Document audits in high-risk areas

    • Employee files

    • Quality Management Committee meeting minutes/documentation

    • Compliant files

    • Patient management files (specialty pharmacy)

  • Mid-Cycle Policy and Procedure Review

Safeguard Your Compliance Between Cycles

Don't underestimate the importance of maintaining compliance throughout your accreditation cycle. IHS' OCM Program offers a strategic solution to prevent unnecessary lapses in compliance between cycles. Let us help you navigate these challenges and ensure your continued accreditation success.