Partnership for Survey Success

Enhancing patient safety and finding real value in clinical compliance

Are you ready for survey?

The three-year mark is fast approaching since your last triennial survey. While keeping compliant with accreditation standards is a foundational goal for your organization, and ever-present in the back of your staff’s minds, the reality is that it’s near impossible to come away unmarked. The pressure of patient care often takes precedence over check-box activities. It’s a challenging balancing act, but one that offers real value with the right survey program in place – for you and for your organization’s patients.

We know that the best way – perhaps the only way – to implement sustainable solutions to regulatory challenges is to focus on the big issues. We help healthcare organizations focus on underlying root causes so they can eliminate the most important survey vulnerabilities once and for all.

We can help

Greeley’s Partnership for Survey Success is a cyclical survey readiness program that minimizes risk and enhances patient safety. Compliance is never “done;” it requires continuous monitoring over your three-year accreditation cycle to ensure that you are managing the risks that matter most – those that will make you vulnerable to a survey citation or worse, and those that could impact patient safety. This is particularly important as accrediting organizations are intensifying their focus on high-risk processes and resolution of past deficiencies.

At Greeley, we recommend focusing only on true, underlying process issues. The approach to fixing these issues is to make the process easier to understand and implement. The easy thing to do should be the right thing to do.

Partnership for Survey Success Methodology

At the completion of each phase, we will provide a written report of findings with recommendations for improvements and corrective actions

PHASE 1

Initial Assessment
(immediately following survey)

  • Conduct pre-survey document review to identify and sort prior survey high-risk/high-impact findings
  • Collaborate on developing implementable corrective action plans for submission to accrediting organization
  • Evaluate level of success in achieving sustainable improvements related to prior corrective actions
  • Conduct exit conference with executive leadership and designees to present findings and recommendations for improvement

PHASE 2

Touch-Point
(mid-point in triennial survey cycle)

  • Evaluate level of completion of hospital’s corrective action plan
  • Provide synopsis of areas of noncompliance or lack of progress along with recommendations for achieving intended goals

PHASE 3

Survey Rehearsal
(in anticipation of survey)

  • Review high-risk vulnerabilities commonly existing in the environment of care (EOC); identify areas requiring immediate action
  • Consult with staff on how to demonstrate that prior deficiencies are corrected
  • Conduct readiness survey rehearsal with staff to prepare for survey
  • Evaluate current state of survey readiness, provide recommendations for enhancing staff survey response

The Greeley Difference

Clinical compliance and survey preparation must evolve – just-in-time mock surveys may not provide the value healthcare organizations need. We partner with our clients over the course of their accreditation cycle to sort through survey findings, focus on resolving the high-risk underlying root causes, and simplify processes to enhance long-term success. We leverage our decades of experience, proven methodology, access to regulatory insights, and library of model documents to partner with our clients.

The value? Fewer citations, better documentation. But more importantly, the value of this approach can be found in the patient outcomes. Fewer falls. Fewer infections. Fewer mistakes. Higher satisfaction.

Want to know more about Greeley’s Partnership for Survey Success?

Fast Facts

  • There are approximately 30 requirements for improvement on the typical Joint Commission survey report.
  • The Joint Commission classifies findings in two tiers of importance – findings assigned to the higher level of importance, about 25% of all findings on an average report, are key contributors to Condition-level findings.
  • Findings related to the Environment of Care and Life Safety Code account for most citations on a typical report.
  • Findings of higher significance are dominated by infection prevention and the identification and protection of potentially suicidal patients.

Our Featured Leaders

Meg Hartwell

Meg Hartwell

Vice President, Client Services
Meg is a seasoned healthcare consultant who brings more than 25 years of experience to her role as Vice President Client Services. She plays an instrumental role in driving the company’s mission to help healthcare organizations solve complex challenges, improve efficiency, comply with regulations and standards, achieve practitioner engagement and alignment, and excel in delivering high-quality, cost-effective patient care.

Lisa Eddy

Lisa Eddy, MSN, MHA, RN, CPHQ

Vice President, Clinical Compliance & High Reliability
Lisa has more than 25 years of experience in CMS certification and accrediting agency regulatory compliance. First-hand knowledge at the executive nursing level, hospital operations, quality and risk management and critical care nursing are all embedded in the guidance she provides to organizations to help them achieve and maintain regulatory approval.

Bud Pate

Bud Pate, REHS

Vice President of Content Learning, Clinical Compliance & High Reliability
With more than four decades of experience, Bud is a nationally recognized expert in CMS and Joint Commission compliance, process simplification, clinical quality and patient safety. He works with healthcare organizations across the country to achieve sustainable, common sense solutions that promote efficiency, protect patients and comply with external regulatory requirements.

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