Social and medico-social establishments and services: how to carry out a successful quality assessment

Do you manage or work in a social or medico-social establishment or service? You must undergo a five-year assessment based on the new quality standards drawn up by the Haute Autorité de Santé and validated by COFRAC in May 2022. This approach includes 18 so-called imperative criteria, out of a total of 157. How do you make sure you tick all the boxes? Deciphering a fastidious quality system.

In the second half of 2022, some 40,000 social and medico-social establishments and services (ESSMS) in France will have to get to grips with the new evaluation guidelines developed by the French health authority (HAS). At stake: demonstrating that the population they are dealing with (residents, people at home) benefits from quality treatment, based on relevant, objective and up-to-date criteria. An essential precaution since the scandal that rocked the world of Ehpads (former retirement homes) in the spring of 2022, when a charged book was published. Inspections carried out at 600 sites since March 2022 have led to three court referrals.

The system developed by the HAS, which is to be used every five rather than seven years, comprises three assessment methods, subject to 157 criteria, including 18 mandatory ones, based on an interview grid. AFNOR Certification, which offers this assessment as an organization referenced by the HAS on the Synaé portal, detailed them for you during a webinar on October 11, 2022, which you can listen to in replay here. For the first method, known as “accompanied-traceur”, an interview is conducted with at least three supported people chosen by the establishment or service, with different backgrounds and profiles, and then with a day-to-day support person. The goal? Record the person’s experience and satisfaction with their support, on seven themes. While this method doesn’t have to meet any of the imperative criteria, the other two methods do: “targeted tracer” and “system audit”.

Traceur-ciblé: a sensitive and paradoxical component

Subject to 7 imperative criteria (5 for professionals and 2 for the ESSMS), the “tracer-targeted” concerns fundamental rights and individual freedoms. An interview is conducted with professionals to assess the implementation of a targeted process and its control; and another with governance to measure the organization and associated resources. This part of the appraisal is a sensitive one,” warns appraiser Pierre Linden. For example, freedom of movement. Under the new guidelines, the family of the person being supported can also be consulted. But what is security and what is freedom can be paradoxical. How is this regulated and implemented on a day-to-day basis? At the very least, we need a homogeneous institutional response. This involves staff training, the induction process, the team charter, and so on. “Similarly, when it comes to freedom of opinion, the right to an image or the exercise of rights and freedoms, the assessor examines the ethics and good-treatment charters, the RGPD, the right to an image form, confidentiality rules, data hosting, the welcome booklet, and so on.

System audit: complex situations

The system audit, which assesses the way in which the establishment organizes its HR policy, quality approach and risk management, includes 11 imperative criteria. An interview is conducted with governance (8 criteria), and another with field professionals (3 criteria). An objective grid that still leaves room for interpretation: ” In the event of an undesirable event, complaint or claim, the process includes a structured procedure for reporting, handling and taking action. But when you report something, is it denunciation? And if the facility claims that there has been no abuse, it must demonstrate that any alleged abuse has been reported and verified beforehand”, illustrates Pierre Linden. The evaluator takes another example: ” The use of first names or nicknames raises questions. It can be perceived as degrading and therefore, under the law, be assimilated to a form of mistreatment.. But if the resident authorizes it, or if we can show that the support team has thought about it in the frame of reference, it changes the game, since it goes beyond personal sensitivity. “Note: consulting a regional support structure (SRA), which provides training and raises awareness, enables feedback, particularly in the event of a serious undesirable event.

Identify your strengths

If the assessor (called “intervener”) rates an imperative criterion below 4, he/she must complete an “imperative criterion sheet”, which is included in the assessment report. The ESSMS must then draw up an action plan appended to the form, and the assessment continues, rigorously and sympathetically: is governance informed of events justifying a rating of 1, 2 or 3? Has it analyzed the causes at play? Has it identified the necessary improvement measures? Are assessments or follow-up planned? ” Training, team charter, etc… The establishment needs to have as many arguments as possible for an evaluator to rate above 3. Crossing the boundary between 4 and 3 remains a tricky task for the latter, confesses Pierre Linden. One thing’s for sure: it’s in the establishment’s best interest to carry out a self-assessment beforehand, so as to familiarize itself with the reference system, be able to answer questions, and then put actions in place. For example, what exactly does freedom of movement mean for him? Answers vary widely in the absence of a framework. “Tip to remember: ask yourself about your strengths right from the start. That way, you’ll know what you want to focus on and can share best practices.