Quality: Not A Double Standard
The ICAVL Commitment To Continued Quality Improvement

by Cindy Weiland, RRT, RVT
ICAVL Director Of Accreditation

from the Special Edition December 2002 issue

Quality. Since the inception of the ICAVL more than a decade ago, the word quality has been the basis of the entire accreditation process. It seems only fitting that the same standard be applied to the organization itself. Having worked in an accredited laboratory and been involved in completing the application three times, it was my hope, upon eagerly accepting a position with the ICAVL, to bridge the applicant laboratory's viewpoint with the functions of the ICAVL.

The internal structure and flexibility of the ICAVL allow change to occur very quickly in the areas of logistical service to the laboratories, but require much more time and deliberation when altering or revising the Essentials and Standards, the application process or the accreditation policies.

Understanding this, I had initiated and implemented several significant changes prior to the distribution of the ICAVL Customer Survey that you received in March. Additional changes have occurred since the completion of the survey, while others are currently being examined and evaluated. In the remainder of this article, I will address some of the most frequently submitted comments and concerns voiced through the survey, and identify changes that have already occurred and those we can all look forward to in the near future.

APPLICATION COMPLETION

EXCESSIVE AND TIME CONSUMING:
(Currently being evaluated by the Board Of Directors)

• As stated in the letter from Dr. Gocke, President of the ICAVL Board of Directors, the entire accreditation process is being evaluated by the Board for potential revision of the information required, for both initial and reaccreditation submissions.

• A large majority of the customer survey respondents had not used the Electronic Application, or had used it only once. By using the application on CD-Rom to apply for reaccreditation, users will find all of the information that had been previously entered intact and they will only need to provide updates where applicable. This will provide a significant decrease in the time required to complete the application.

SUBMITTING CASE STUDIES ON CD:
(Ongoing assessment)

• In January 2002, an Information Technology committee was formed by the Board to address the issues associated with utilizing digital storage and transmission of images and case studies. The IT committee is working towards enabling the ICAVL to eventually receive case submission in digital format.

COMMUNICATION BETWEEN
THE ICAVL AND LABORATORIES

NOTIFICATION LETTERS:
(The format of the notification letters was changed in September 2001)

• The letters are now written in such a way that laboratories granted accreditation are immediately notified, and any areas delayed accreditation are identified by testing area name, with bulleted statements defining the reasons for delay and separate bullets indicating the specific information that the Board Of Directors has requested in order to correct any deviations or areas of non-compliance from the Standards.

CRITIQUE LETTERS:
(Multiple format changes throughout the past year, with major changes currently being implemented)

• The most current format includes a cover letter with the intent of better explaining the manner in which the letters have been compiled and how to best utilize the information.

• Inclusion of positive comments.

• Within the next few months, the Critique Letter will no longer exist, and will be replaced with the Application Review Findings.

APPLICATION REVIEW FINDINGS:
(To be implemented within the next month, with ongoing evaluation)

• In the spring of 2002, the ICAVL implemented the use of new electronic application review forms, and in replacement of the critique letters, the laboratory will now receive the results of the review in this electronic review format.
• The forms reflect each area of the application that was reviewed. The Application Reviewers' answers and comments are included on these forms, in anticipation that the laboratory will be able to better identify and address the exact items found to be incomplete, or those areas lacking adherence to the current Essentials and Standards.
• The forms will be sent on CD in lieu of sending twenty to sixty printed pages to the laboratory.

NOTIFICATION OF REACCREDITATION:

• Laboratories due for reaccreditation are sent a letter, addressed to both the Medical and Technical Directors, one year from the date upon which their applications are due to the ICAVL.

• A new reminder mechanism will begin in early 2003. A postcard will be sent 6 months from the date the reaccreditation application is due to the ICAVL. The goal of this additional communication is to help laboratories avoid a lapse in their accreditation status and to inform any new staff members (e.g.: a new technical director) of the expiration of the laboratory's accreditation in ample time for their completion of the application.

CALLING THE ICAVL OFFICE:

• Weekly staff meetings have been held for the past year to regularly address consistency of communication from ICAVL staff to the laboratories, as well as addressing telephone etiquette and customer service.

TIMELINESS OF NOTIFICATION

NOTIFICATION LETTERS:
(Implemented April 2002)

• Laboratories can now expect to be notified of the Board Of Directors' decisions within two weeks of that meeting; in the past year, the time in which notification letters were sent decreased by more than sixty percent when compared to previous years.

CRITIQUE LETTERS:
(Currently being addressed)

• The turnaround time for the critique letters is an ongoing issue that is being addressed. The process of improving the turnaround time is being closely examined with the implementation of the Application Review Findings. Every effort is being made to get these letters to the laboratory twelve to sixteen weeks after the successful completion of their accreditation.

REVIEW OF DELAY MATERIAL:
(Implemented November 2001)

• When additional material is requested by the Board in order to rectify application discrepancies, the material is generally reviewed within three working days of receipt, and notification letters are sent within two working days of this review.

ALL WRITTEN CORRESPONDENCE, EMAIL AND TELEPHONE CALLS:
(Implemented December 2001)

• The ICAVL staff will respond to any of the above modes of communication within two working days.

CONSISTENCY

APPLICATION REVIEWS:
(Ongoing, implemented February 2002)

• In order to enhance communication and better standardize the application review process, an electronic newsletter, regular email and my own participation in the site visits have been implemented.

• The use of new, improved application review forms began in June 2002.

• Regular, internal audits of the quality/content/consistency/accuracy of the application reviews are now conducted.

WEBSITE AND NEWSLETTER

WEBSITE (www.icavl.org):
(Upcoming 2003 changes and implemented 2002 updates)

• Updated and improved format and contents

• CME page to assist laboratory staff members in identifying conferences and courses that provide continuing medical education credits relevant to noninvasive vascular testing, as required for accreditation.

NEWSLETTER:
(Upcoming 2003 changes)

• Editions will be increased to every three months

• Updated and improved format

• More comprehensive content

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

• In light of the impending April 2003 implementation of HIPAA, the ICAVL recently revised the Accreditation Agreement to reflect the new requirements that define accreditation agencies as a "business associate". In November 2002, all laboratories that have applied for accreditation within the last three years were sent an addendum to the Accreditation Agreement that is on file with the ICAVL, for the current accreditation period. This addendum was sent with a stamped, self-addressed envelope and instructions requesting that the signed document be returned to the ICAVL.

To better serve our customers, the ICAVL has committed itself to a practice of continuous assessment and modification that reflects the constant metamorphosis experienced by the technology and health care industries. Clearly there are many enhancements already underway in improving the quality of our accreditation services; yet our efforts do not end with the survey. The insight provided through feedback from you, the members of the vascular community, is regarded as invaluable. I would encourage you to voice any comments, questions, and views by contacting me via email at weiland@intersocietal.org. Together, we can ultimately carry out the mission on which the ICAVL was founded: promoting and providing quality patient care.

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