Monday, July 18, 2016

Surveyors Who Interpret Standards

You read the headline and thought to yourself, "A surveyor would never interpret the standards would they?"  The federal and state standards are clearly written, state exactly what they mean, and really should have no room for interpretation right?  You would think that it would be clear and cut, but unfortunately that is not always the case.  

Imagine you have been faced with an issue and had to take some action either as the QIDP or the Administrator.  It really does not matter what the issue is, we can just assume it is any issue that could be considered a minor or major issue depending on how you look at it.  You read the standards and it clearly says "If this happens, then you should do this."  You look at the guidelines and decide what your organization is going to put in place to fix the problem.  Done right?  Well, maybe....

Two weeks later your annual survey shows up so naturally the action you have taken to correct a problem comes into the surveyor's sight.  They ask the routine questions such as "What happened," "What action did you take?" "What was the result?" "Did notify XYZ?"  You're able to answer all the surveyor's questions in order and with a reasonable answer....then it happens....out of the wild blue yonder the surveyor says, "Well did you do this?"  You answer honestly and say, "Well no, I did not consider that and did not do that."  .....Bam, the next thing you know the surveyor makes that statement, "Well, you know this is deficient practice and I'm going to have to cite this....."

If that has never happened to you, then congratulations!  If on the other hand, you have faced the human surveyors, many who have been QIDPs before with their own ideas of what is right and what is wrong to do, then you have likely been subject to that area you did not consider.   Whatever the case may be, many of us have found ourselves sitting there and thinking, "Well that's not in the tags...."

So, how can you handle these situations?  I have on a few occasions been faced with this difficult situation.  Now, do not misunderstand me, I completely understand where the surveyor is coming from and often agree that the question makes sense and it is something that the organization should have or might have considered doing, but ultimately it simply is not part of the standards.  I have found it best to handle these situations in a couple of ways.

The first way I have handled them is to confront the surveyor directly.  I might say, "Well, I see what you are saying, but we did not consider that because it was not in the standards and we did not feel we need to exceed standard requirements on this issue."  That goes over well sometimes, and sometimes it goes over like a lead weight.  If it does the later, then I usually indicate that I would like to talk to the program manager about the issue and do that.

The second way to handle these issues is to simply express your disagreement, or not, and wait for the tags to arrive.  You can then assess the tags, discuss possible responses to the tags, and even consider arguing the tags through your state's dispute.  Remember, in most cases the surveyors understand if you decide to follow your state's dispute route - that's what it's there for - disputes. 

The final thing to consider is that after you've talked with the surveyor and expressed your views simply drop it.  It's entirely possible that the surveyor will go back to the office, reconsider, or even be told by supervisors that they should not cite the particular situation.  In those cases, and I have seen some, you will receive deficiencies that never mention the item the surveyor brought up.  When this happens, it just confirms my faith that the surveyors are just as human and subject to errors as we are in the field.