Benefits of Internal and External Consultants

Interviews with CARF Surveyors  –  Part 1 of a 3-part series

The January 2013 newsletter of Behavioral Health Resources, LLC features interviews Consultantswith CARF surveyors who are also internal CARF consultants in their organizations:  Pat Coleman, President & CEO of Behavioral Health Response (Admin surveyor for 5 years); and Rob Snyder, Director of Quality Assurance at Gilead Community Services (Admin surveyor for 4½ years).

Internal vs. external consultants.   “I’m not sure there is truly a big difference,” said Snyder.  “Your consultant just needs to be someone who has the interest in organizational improvement and knowledge of CARF standards and organizational practices to facilitate the self review and changes necessary to ensure conformance to CARF standards.  I think that can be accomplished whether that person is an external consultant or an internal staff member who has the desire and responsibility to fill this role.”

“That being said,” continued Snyder, “there are probably a few advantages the external consultant has including being able to see the organization with a ‘fresh set of eyes’ and see things in a way that maybe someone within the organization has become used to or might not notice.”  Coleman added, “The only difference between an internal surveyor and external consultant is that you may have to pay the external consultant a fee.”

Internal consultants understand the organization’s culture and language.  Advantages of the internal consultant include understanding the organizational culture.  Management consultants Beverly Scott and Jane Hascall report that internal consultants have an “indepth knowledge [which] makes them particularly valuable on sensitive implementation of strategic change projects or culture transformation initiatives.”

“The advantage of using an internal surveyor,” states Coleman, “is that they can conduct a mock survey before the actual one takes place” usually at no extra cost to the organization.  “Also, having that internal knowledge gives you an ‘up’ on other organizations because the internal surveyor knows exactly what to look for and can help with ‘over and above’ mentality.”   When cost is a factor as well as the need to “speak the jargon or the language of the organization and culture,” then an internal consultant may be the best choice advise Scott and Hascall.

External consultants provide objective, unbiased evaluation.  Because of involvement and relationships with numerous organizations, external consultants may be more familiar with industry “best practices” (unless the internal consultant is also a CARF surveyor).  “Depending on each organization’s internal resources,” said Snyder, “the external consultant may have a greater understanding of the CARF standards, and also a greater focus and attention on helping an organization better meet the CARF standards and prepare for a survey (since an internal consultant usually has other job responsibilities to address in addition to the CARF role).”

“Furthermore,” stated Snyder, “if an organization doesn’t really have the internal staffing resources that can provide a person with the necessary time, qualities, and skills to help the organization with the CARF standards and survey, then an external consultant is an excellent alternative.”

According to  Scott and Hascall, “The external consultant is usually viewed as having higher levels of expertise and experience and credibility, especially if he or she is published, credentialed, and well known. . . . With this broader experience, the external can provide benchmarking and best practices as well as insights into potential pitfalls learned from other clients.”  They also suggest that when the “internal does not have status, power, or authority to influence senior management or the culture,” then an external consultant would be of more benefit to the organization.

Selecting an external consultant.  According to Coleman, “When selecting an external consultant, you should make sure that they are current or have been a CARF surveyor themselves.”  In addition, “also consult with other organizations,” said Snyder.  “Talk with other organizations that used the consultant in the past to find out, not only what their CARF survey outcome was, but also what their experience was like working with the external consultant.  The external consultant should also have a very thorough understanding of the standards and have the ability to examine an organization and figure out what the best ‘fit’ is for that organization to meet each standard (since there are many different ways to meet a standard).”

Benefit of using both an internal and external CARF consultant.  Can an organization benefit from both?  “Absolutely,” replied Snyder.  “If an organization’s resources allow, then having both an internal and an external consultant would seem to provide the benefits of both worlds.  Your internal person will best understand the organization’s current policies, procedures, practices, etc. to better assess where the organization is and how best to change to meet or improve conformance to the CARF standards.  The external consultant will have that outside perspective to see things that might be more challenging for the internal person to notice, as well as a thorough knowledge from the standards themselves and know how other organizations have tackled the same challenges.”

Challenges in preparing for a CARF survey include obtaining organizational commitment at all levels.  The value of a consultant is the ability to provide candid feedback regarding areas of conformance to CARF standards as well as suggestions for improvement.  A internal consultant may be at a disadvantage when there is a need to evaluate the work of colleagues and/or senior managers.  Critical feedback may be more readily accepted from an external consultant.

Whether internal or external, the effectiveness of the consultant is dependent upon the top leadership’s support of the project, their relationship with the consultant, and the buy-in from all levels of the organization (direct-service staff to governance).  Coleman identified a basic challenge of preparing for a CARF survey as “getting all departments on board and contributing in a timely fashion.  You must have someone who can push departments heads when necessary.”

Snyder agrees.  “I think one of the biggest challenges is how to get your organization’s stakeholders interested and invested in the process. If you only have either an internal or external consultant or even just the organizational leadership involved, you’re not likely to be as successful as when you have everyone involved.  Finding innovative and creative ways to involve everyone in not only following and improving organizational policies, procedures, and practices that conform to the CARF standards, but also in preparing for the survey itself can be critical.”

Final thoughts.  “Remember that once CARF is gone and you receive your accreditation, you must have someone to stay on top of making sure that everything that was implemented is a continuous process,” advised Coleman.  Snyder ended by saying, “I know it’s stressful, but try to also have fun with this process.  Use the CARF standards and the preparation process as a great opportunity to get people involved and take another look at what your organization does and how it does it.  It is truly a way to help your organization improve and get it to where you want to go anyway.”

© 2013 Behavioral Health Resources, LLC. All rights reserved.

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