Social and Medical-Social Facilities and Services: How to Succeed in Your Quality Assessment

Do you manage or work at a social or medical-social facility or service (ESSMS)? You are required to undergo a five-year assessment based on the new quality framework developed by the Haute Autorité de Santé and validated in May 2022 by COFRAC. This process includes 18 so-called mandatory criteria out of a total of 157. How can you be sure to meet all the requirements? An in-depth look at a rigorous quality framework.

Residential care facilities for the elderly (Ehpad), home care services, specialized care homes, SAMU Social, shelters for young workers, educational support centers and shelters… In the second half of 2022, some 40,000 social and medico-social establishments and services (ESSMS) in France will need to adapt to the new evaluation framework developed by the High Authority for Health (HAS). At stake: demonstrating that the population they serve (residents, people at home) receives quality care, based on relevant, objective, and up-to-date criteria. This has become an essential precaution since the scandal that rocked the world of nursing homes (formerly retirement homes) in the spring of 2022, following the release of an exposé. Inspections conducted in 600 facilities since March 2022 have, in fact, led to three referrals to the courts.

The system developed by the HAS, which is now conducted every five years rather than every seven, comprises three evaluation methods, based on a 157-criteria checklist—18 of which are mandatory—using an interview grid.  For the first method, known as the “accompanied-tracer” approach, an interview is conducted with at least three individuals receiving support—selected by the facility or service—who have different backgrounds and profiles, followed by an interview with a daily caregiver. The goal? To assess the individual’s experience and satisfaction with their support across seven themes. While this method is not required to meet any of the mandatory criteria, this is not the case for the other two: “targeted-tracer” and “system audit.”

Targeted tracking: a sensitive and paradoxical issue

Subject to seven mandatory criteria (five for professionals and two for ESSMS), the “targeted assessment” focuses on fundamental rights and individual freedoms. An interview is conducted with professionals to evaluate the implementation and management of a targeted process; and another with management to assess the organization and associated resources. “This aspect of the evaluation is sensitive,” warns Pierre Linden, an evaluator. “For example, regarding the freedom to come and go.” According to the new framework, the family of the person receiving care may also be consulted. Yet issues of security and freedom can be paradoxical. How is this regulated and implemented in daily practice? At the very least, a consistent institutional response is required. This involves staff training, the integration process, the team charter, etc. "Similarly, regarding freedom of opinion, image rights, or the exercise of rights and freedoms, the evaluator reviews the ethics and well-treatment charters, the GDPR, the image rights form, confidentiality rules, data storage, the welcome booklet, etc."

System audit: complex situations

The system audit, which assesses how the institution organizes its HR policy, quality management, and risk management, consists of 11 mandatory criteria. One interview is conducted with the governing body (8 criteria), and another with frontline staff (3 criteria). An objective framework that nevertheless leaves some room for interpretation: 

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The evaluator gives another example: “Using informal terms of address with the people being supported, or using nicknames, raises questions. This can be perceived as degrading and, consequently, under the regulations, be considered a form of abuse. But if the resident gives permission or if it can be demonstrated that the care team has considered this within the framework of best practices, that changes the situation, since it goes beyond mere personal sensitivity.” Note: Consulting a regional support structure (SRA) that provides training and raises awareness allows for feedback, particularly in the event of a serious adverse incident.

Identify your strengths

If the evaluator (referred to as the “assessor”) rates a mandatory criterion below 4, they must complete a “mandatory criterion form,” which is included in the evaluation report. The ESSMS must then develop an action plan attached to the form, and the evaluation continues with rigor and fairness: Is the leadership aware of the events justifying a rating of 1, 2, or 3? Has it analyzed the underlying causes? Has it identified the necessary improvement measures? Are further evaluations or follow-ups planned? Training, team guidelines, etc. The institution must present as many strong points as possible to ensure that an evaluator rates it above a 3. Crossing the line between a 4 and a 3 remains a delicate matter for the evaluator, admits Pierre Linden. One thing is certain: it is in the institution’s best interest to conduct a self-assessment beforehand to familiarize itself with the standards, be able to answer questions, and then implement measures. For example, how exactly does the freedom to come and go play out in its setting? Answers vary widely in the absence of a clear framework. Tip to remember: Ask yourself what your strengths are right from the start. That way, you’ll know what to highlight and can share best practices.

Become an evaluator

With its 9 thematic areas and 157 criteria—including 18 mandatory ones—and its 4 specific tools (accompanied assessor, targeted assessor, system audit, and a specific checklist for the social life committee), the new quality assessment framework for ESSMS requires a thorough and detailed review. All assessment bodies must be re-accredited by COFRAC in accordance with the EN ISO/IEC 17020 standard . Evaluators, whether external or internal (school principals, administrators, and other professionals in the ESSMS sector), therefore have every reason to undergo training. Since the multi-year planning decrees for the period from July 1, 2023, to December 31, 2027, have already been issued, now is the time to get started! AFNOR Compétences offers several modules for you to explore, accompanied by explanations from instructor Cathy Barret-Beaumard.

The 9 themes of the framework

1. Ethical Care
2. Rights of the person receiving care
3. Self-expression and participation of the person receiving support
4. Collaborative development and customization of the support plan
5. Health Support
6. Support for Independence
7. Continuity and fluidity of the pathways
8. Human Resources Policy
9. Quality Approach and Risk Management