Quality Indicators for Professional Service Programs in Audiology and Speech-Language Pathology

A. Administration

The structure and function of program administration assure effective and efficient program operation.

• The program has established policies and procedures that reflect the program's purpose and scope of services, which are communicated to program personnel and followed.

  How are policies and procedures established to reflect the program's purpose and scope of services?

  Policies and procedures are written by administrators and/or a committee of knowledgeable individuals in the organization. Ideally, professional staff members are included in the development process. Care is taken to reflect the purpose and scope of services in the policies and procedures. All policies and procedures are reviewed and updated on a regular basis.

  How are policies and procedures communicated to the program's personnel and how does the program determine if the policies and procedures are applied consistently?

  The program's policies and procedures are published in a resource manual and disseminated to all personnel or, at the least, located in an area that is accessible to all. Personnel are informed of revisions to the manual, and methods exist to determine if the policies and procedures are followed.

• Administrative structures indicate clear lines of authority and responsibility.

  What are the program's lines of authority and responsibility?

  Organizational charts can clearly represent the lines of authority in a program. Job descriptions outline the levels of authority and responsibility and are available to staff.

• The knowledge and skills of program administrators are consistent with job responsibilities and level of decision-making authority.

  How does the program determine that the knowledge and skills of the program administrator(s) are consistent with the responsibilities of the job and the level of authority to make decisions?

  Qualifications, responsibilities, and authority of the designated professional are shown in a written job description. If the program director is not an audiologist or speech-language pathologist, it is recommended that a credentialed professional is designated to represent the professional staff when decisions regarding clinical services are being made.

• Administrators lead staff in formulating attainable program goals and measurable objectives.

  How does the leadership of the program work with the staff to formulate attainable program goals and measurable objectives?

  Program goals and objectives are developed in collaboration with qualified and credentialed professional staff representing the clinical services offered. Staff members and/or leadership typically review goals and objectives regularly, modifying and updating as needed.

• Program operations are in compliance with applicable legal mandates and regulations.

  What are the legal mandates and regulations the program is required to follow, and where are the reference materials located?

  Administrators and professional staff members are knowledgeable about all applicable legal mandates and regulations at the federal, state, corporate, and facility levels. Copies of these mandates/regulations are easily accessible for review. Written policies and procedures describe how the program will comply with the applicable legal mandates and regulations.

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B. Human Resources

The program has the human resources necessary to fulfill its purpose and scope of services and to achieve its goals.

• Professional staff providing clinical services has appropriate qualifications and valid credentials to provide those services.

  What qualifications and credentials are required for audiologists and/or speech-language pathologists working within the program?

  Minimal criteria for speech-language pathologists and audiologists are specified by a number of groups, including professional orgnizations, departments of education, and licensure boards. Program policies indicate the education, experience, skills, and other credentials needed for staff that independently provide clinical services, taking into account the current requirements of all appropriate groups. Programs can refer to the ASHA policy documents for information regarding clinical certification requirements and to government regulatory agencies for guidance.

  How does the program monitor the currency of the credentials of professional staff members once they are employed by the program?

  Programs typically maintain a personnel file for each employee, which includes copies of credentials such as ASHA certification, state license, registration, specialty certifications, and continuing education records. Professional staff members submit documentation of the currency of their credentials on an annual basis.

  How does the program make certain that nonlicensed and noncertified staff providing clinical services (including students) are appropriately supervised?

  The amount and type of supervision needed for nonlicensed and noncertified staff are designated by program policies and are consistent with legal mandates, accreditation and certification standards, and other pertinent directives. Typically, programs maintain logs that document the amount and type of supervision. In addition, programs provide periodic performance assessments of such staff and students.

• All program personnel are in compliance with applicable legal mandates and regulations pertinent to the performance of their job responsibilities.

  What are the program's policies and procedures for making certain that staff meet legal mandates and regulations?

  Some legal mandates and regulations (e.g., licensure, certification, or registration) apply only to specified staff. Other legal and regulatory directives (e.g., privacy, health precautions, or corporate compliance issues) apply to all staff. Programs provide staff with information needed to meet legal requirements. Usually, programs monitor staff compliance through training and assessment programs and by documenting credentials.

• Assignments are made in accord with staff members' professional qualifications and specific competencies.

  How does the assignment of caseload take into account each professional's qualifications and specific competencies?

  The knowledge and skills required of clinical staff are considered foremost when making assignments; these may include, but are not limited to, specialized skills in working with persons across the age span, expertise with specific communication disorders and differences, and procedural competencies. The clinician's qualifications and areas of expertise are consistent with clinical assignments.

• For each of the areas of clinical practice represented in the program's scope of services, someone on the staff maintains competence. There is a mechanism in place to make certain that these competencies are established and maintained.

  How are the skills and competencies needed by clinical staff established?

  Programs have processes for determining the skills and competencies needed across staff to provide their scope of services. Clinical practice statements and ASHA guidelines are good resources for identifying needed skills and competencies. This information is reviewed periodically and is available to all staff.

  How are the skills and competencies needed by clinical staff maintained?

  Maintenance of skills and competencies can be addressed in a number of ways, such as continuing education, mentoring, in-services, and providing a minimum number of services or procedures. It is important that programs provide ways for staff to maintain skills and competencies as well as to develop new ones when needed.

• The program assumes responsibility for providing opportunities for continued professional growth and development for staff at all levels of the organization.

  How does the program provide for continued professional growth and development of staff?

  Providing high quality clinical services requires continued professional learning. Programs can support continued learning by providing financial support, release time, on-site training, mentoring or sharing of clinical expertise, journal clubs, client staffings, in-services, and other activities and materials that result in the acquisition or refinement of knowledge and skills. A variety of educational resources and learning opportunities are available for staff, taking into account individual learning styles and needs. Programs usually maintain annual records of staff continuing education activities.

• Written personnel policies and records are maintained and updated on a periodic basis.

  How are the program's personnel policies established?

  Programs that are part of a larger organization typically have personnel policies and procedures that have been developed by the institution, while independent programs develop policies and procedures appropriate to their setting and needs. In both cases, personnel policies address issues including, but not limited to, position descriptions, vacation and sick time, benefits, personnel records, grievances, and leaves of absence. Personnel records include evidence of current licensure, continuing education, certification, or other requirements. Policies provide for periodic staff performance appraisals.

  What procedures are in place for maintaining and updating personnel records?

  The content of personnel records and the individual's access to the records are specified by personnel policies. Each employee's personnel file may include items such as hiring documents (e.g., curriculum vita, contract, position description), copies of credentials (e.g., ASHA certification, state license, and continuing education records), salary information, individual staff member goals, and documentation and results of periodic reviews. The personnel file includes records of changes or updates for these items.

• Individual staff workloads are adjusted to achieve a balance between program needs and available staffing without compromising the quality of service delivery.

  What are the procedures to make certain that each staff member has adequate time for fulfilling all job responsibilities noted in the position description?

  Staff schedules reflect that each staff member has sufficient time for planning, record keeping, supervision, follow up, equipment maintenance, and other job-related activities. Staffing policies and procedures discriminate between workload and caseload, and they ensure that quality service delivery is not compromised by workload fluctuations.

  How does the program manage client caseload and other program activities relative to available staff?

  Programs have policies and procedures for managing fluctuations in caseload and other work activities. These policies may include staffing needs (both professional and support staff), waiting list policies, initiation and termination of service criteria, staff recruitment, and staff productivity and absences.

• Program support services are adequate for the volume and scope of program activities.

  How does the program address the need for adequate support services?

  Inadequate support services may impact the quality and viability of clinical services. Programs assess their needs for support services, including clerical and administrative assistance, technical support, access to office machines and technology, business staff, and professional assistants. Support services must be adequate for the volume and scope of program services. Resources allocated for support services (e.g., salaries, space, and equipment) are consistent with the need.

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C. Financial Resources and Management

The program's financial resources and their management are appropriate for program operations.

• The program has financial resources that are sufficient to provide appropriate services with a reasonable expectation of continuity.

  How does the program determine if the financial resources are sufficient to support the operations of the program?

  Resources provide adequate financial support for personnel, space, equipment, materials, and supplies to provide services continually across the designated scope of service. Staff member requests are considered when developing the budget.

• The program's financial management is conducted in accordance with established policies and procedures, including those related to determining fees, using acceptable accounting procedures, budgeting, and maintaining accountability to relevant groups.

  How does the program manage its finances in accordance with the policies and procedures established?

  The program has an identifiable process for budget development that shows expenses and revenues consistent with the program's goals and scope of services. There are written procedures for monitoring the program's expenditures, billing, collection of fees for services and/or products, and donations received.

• The program's financial management complies with legal mandates and regulations.

  How does the program document that its financial management complies with legal mandates and regulations?

  The program maintains written documents that specify policies and procedures addressing the applicable laws and regulations regarding all financial matters of operation. These mandates and regulations may include, but are not limited to, those of third-party payers and the state and federal governments.

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D. Physical Facilities, Equipment, and Program Environment

The program has a physical plant and suitable environment to conduct program activities and to provide for the safety and welfare of persons served.

The equipment, materials, and supplies of the program are current and adequate to meet program needs.

• The program's physical facilities are adequate for conducting activities that meet the program's purpose and scope of services and comply with applicable building and safety codes.

  How does the program's physical plant support its purpose and meet the needs of persons served?

  Programs have facilities that are clean, of adequate size and design, and treated to achieve noise abatement. The facility's climate control system is maintained regularly to make certain that all work and storage areas are appropriately ventilated, heated, and cooled.

  How does the program monitor its compliance with safety codes?

  There is evidence that safety inspections are conducted regularly and that the facility meets applicable local, state, and federal safety codes for fire protection, mechanical lifts, lighting, and electrical systems. An emergency evacuation plan exists, and regular evacuation drills are conducted in accordance with the appropriate authority's regulations for safety.

• The program's physical facilities and services are accessible to persons with activity limitations in compliance with applicable legal mandates and regulations.

  How does the program safeguard that the physical facility is accessible to all persons served, including its personnel?

  Standards established by the Americans with Disabilities Act (1990 and all updates) provide guidance for programs to develop and implement procedures for ensuring accessibility. Information contained in Section 4.0 of Part 36 (“Nondiscrimination on the basis of disability by public access and commercial facilities”) specifies standards for accessible design.

  How does the program make certain that its compliance with applicable mandates and regulations is current?

  Plans are made to conduct routine inspections of the facility, to check currency of compliance, and to take any action necessary for addressing inconsistencies.

• The program's physical facilities and service environment are designed to minimize communication barriers for persons served.

  How has the program considered the communication limitations of persons served in the design of their physical facilities and service environments?

  Programs may use signs and emergency signaling systems that accommodate individuals with all types of communication limitations. Administrators and professional and support staff are instructed on how to communicate with persons who have a range of disorders (e.g., hearing loss, aphasia, laryngectomy) and communication differences (English language learners). The program's services are adapted to meet the preferences and needs of persons served, with sensitivity to the persons' culture.

• The program establishes and maintains an environment that protects the health and safety of persons served and program personnel by implementing policies that address universal precautions, infection control, risk management, radiation exposure, and emergency preparedness.

  How does the program protect the health and safety of all persons served?

  Written policies and procedures that focus on risk management address those circumstances that potentially endanger health and safety. These include, but are not restricted to, infection control, medical emergencies, equipment safety, radiation exposure, weather emergencies, natural disasters, and physical plant catastrophes (power failure, radiation leaks, evacuations, etc.).

  How does the program implement its health and safety procedures?

  Contingency plans are necessary for managing events that may endanger the health and safety of persons served. When a risk management program is conducted, it is necessary to post universal precautions for implementing infection control measures in areas that are at risk for health and safety violations. Signage that illustrates proper hand washing is situated throughout the facility. Training is regularly provided to staff regarding health and safety procedures.

  How does the program prepare its facility to implement its health and safety precautions?

  Administrators and professional and support staffs are trained to recognize and respond to emergency situations. These may include, but are not restricted to, CPR training, incident reporting procedures, and evacuation procedures. Structural barriers are eliminated and all areas of the program's facilities are easily accessible by all persons. Policies and procedures for maintaining a safe and healthy environment are reviewed at least annually for currency.

• Non-facility-based services are delivered in environments that are suitable for conducting program activities and that minimize risk to the persons served.

  What criteria does the program apply to determine that non-facility-based environments are safe and appropriate for persons served, including personnel?

  When services are delivered in non-facility-based environments, the program develops and applies guidelines for determining the suitability of such sites. Criteria may include accessibility (such as lack of barriers), safety, structural stability, compliance with prevailing building codes, proximity, availability of equipment, materials and supplies, standards of clinical practice, support personnel, and security for all persons served, including the individuals who provide services. Programs approve non-facility-based sites according to the criteria prior to the delivery of services.

• Equipment, materials, and supplies available are consistent with state of the art practices and reflect preferred practice patterns, best available empirical data, and professional consensus.

  How does the program select and implement equipment, materials, and supplies that will be used in diagnostic and treatment activities?

  Using a range of criteria, the program's administrators and professional staff select materials, equipment, and supplies to meet the needs of persons served. These criteria may include validity and reliability of particular test instruments, treatment materials or protocols, theoretical bases underlying their development and use, robustness of the results from empirical studies, practicality, usefulness, cost, format, availability, product reviews in professional and trade journals, and applicability to the communication disorders served by the program.

  How are materials, equipment, and supplies monitored?

  An inventory of materials is maintained and updated at least annually; materials, equipment, and supplies that are outdated, broken, or unsuitable are removed from the inventory and discarded.

• All equipment is maintained in safe and effective working order.

  What steps does the program take to make certain that equipment, materials, and supplies are maintained appropriately and that they are up-to-date, safe, and in working order?

  Policies and procedures exist that cite the care and maintenance of the program's equipment, materials, and supplies. They also specify the frequency, schedules, and persons responsible for carrying out routine safety and maintenance. Routine maintenance is documented and reviewed regularly. When equipment does not meet safety standards or is not in working order, it is repaired or removed from inventory.

• Equipment that requires periodic calibration is maintained and checked in accordance with current industry standards and benchmarks.

  How does the program meet industry standards and benchmarks for calibration of equipment?

  Calibration is conducted using guidelines from the American National Standards Institute (ANSI) and equipment manufacturers. Calibration procedures (including electrical, acoustical, and mechanical) are established at the time of equipment installation, and regularly scheduled calibration checks are conducted and documented. Daily biologic checks are performed and all calibration activities are logged, documented, and reviewed on a regular basis. Policies and procedures specify what happens when equipment is out of calibration.

• Hearing testing services are offered in a sound-treated test environment that meets the standards of ANSI and that is of sufficient size to accommodate procedures appropriate to the services offered.

  How does the program show evidence that its test environment meets ANSI standards and that it is an adequate size to meet the needs of persons served?

  Records of calibration of audiometric equipment provide evidence of compliance with universal standards for noise levels. The amount of ambient noise in sound-treated test environments is documented through frequent and systematic measures that are conducted according to ANSI guidelines. Sound-treated rooms/suites comply with industry standards related to electromagnetic, acoustic, and fire suppression qualities.

  What is “sufficient” size?

  The size of the test environment depends on: 1) the nature of the services provided; 2) the size and type of equipment, furnishings, and materials; and, 3) the mobility status of the persons served.