Why AAAHC's CEO is focused on the 1,095 days between surveys

In 2017, Noel Adachi took over as the president and CEO of the Accreditation Association for Ambulatory Care, the largest accreditor of ASCs in the nation. 

Through taking on the role, Ms. Adachi became the first and only female leader of an accrediting organization for ambulatory care. 

Ms. Adachi spoke with Becker's about what it has been like to step into the role as a female leader and what AAAHC has planned for 2024 and beyond. 

Question: What about your role drives you the most? 

Noel Adachi: I have the opportunity to work with such tremendous people. Dedicated, passionate, caring and funny people. We like to infuse humor into what we do because we are making some tough decisions and going through a lot of work. Infusion of a little humor helps things be that much smoother and easier. It's not humor like, I'm going to tell you a joke, it's laughing with each other about everyday life. It's also our way of getting to know people, and that's so important. What drives me is I have an amazing team. Secondly, the space we're in, ambulatory care, is so important. It's what really attracted me to this role. This is the space I live in and that most people live in. As I get older, I am living in it more. It's a growing space because we're all living longer, and with more, so there's more to take care of. I like working in the space to impact the space for me, the people I love, my colleagues, the people I care about. That's a real motivator. Also, I've always been driven to build. My focus throughout my career has been on going into a role and finding the opportunities for growth, change and improvement. It is always about what can I do to move something forward. We've done a lot of changes here at AAAHC and it's been fun. Doing that change together, it's not easy but it's fun. 

Q: How is a continual shift from inpatient to outpatient care changing your role? 

NA: Obviously it opens up new opportunities. With cardiology going more into the outpatient space, more procedures are on the CMS outpatient list so they're willing to reimburse in the cardiology and orthopedic space. The introduction of telehealth that we thought would just be a COVID-19 thing has stuck. It provides more access to care, particularly for underserved and rural communities. All of that is important, and we're looking at ways to ensure our facilities have access in providing quality care and are meeting requirements no matter who they are taking care of. That is so important. Also as private equity gets into the space, making sure organizations, while they're trying to be cost effective, aren't cutting corners on quality. That is so critical. Having been in the lab space for most of my healthcare career, my philosophy is if something is wrong, even if it's just one vial that is expired, it's as important as if there were 10 vials. And the same in the ambulatory space because I don't want it to be someone I care about or me getting that expired vial. Or that one time you show up and they don't have something you need on the crash cart. It's important because you don't want to be the person or the parent of a person who goes in and something happens. So much of the fast pace of what's happening in the space is about being prepared. The other interesting aspect about this job is COVID-19 changed the way we do business. The learning over the past six years has been phenomenal. I wish I didn't have to learn those things, but I'd never written an employee vaccination policy before. I don't think I'm unique in that. All of a sudden, we had to figure out, what does that mean for our workforce, our surveyors, our facilities. Different facilities had different requirements depending on their organization's philosophy on different things. That was a major shift. And managing a workforce that was remote was a major shift. Our facilities that are accredited, the shortage of healthcare workers was just bad and continues to be. I don't know where they all went, but a lot of workers walked out of the healthcare space. People in those facilities that were less experienced are being promoted into more senior levels and they need help. And that's where we come in and where accreditation can make a difference. We give you the bumpers. We say get your procedures down, get your processes down, train your staff, have checks and balances in place. Make sure your governing body is actively engaged. So I see it also that accreditation is helping establish a new norm with the new workforce. It gives that structure. 

Q: What role is an increase in private equity having on ASCs? 

NA: I can't say I am an expert on that, but we do know that when private equity comes in, they're looking for opportunities to improve the efficiency and operation of an organization. To trim. That could have a negative impact on patient care. And I'm very cautious in saying that because not all private equity negatively impacts quality, but we have seen healthcare is about humans. It's not the balance sheet. What I would like private equity to see is that having accreditation in place actually can make an organization more efficient. It can ensure quality, reduce liability and risks, it can ensure that there are mechanisms and checks and balances to ensure that the right people with the right training and qualifications are taking care of patients appropriately. Private equity has entered into a lot of different industries, and they're not necessarily in it for the long haul. I'd like to partner with organizations to say put your accreditation policies and bumpers in place and you will be more efficient. The likelihood of error occuring will be less. Error is costly, risk is high, prepare for the unexpected. With AAAHC we don't want to be an unnecessary burden. When I think about the things we provide feedback on to CMS and other organizations, don't put more burden on healthcare workers unless it brings value. Having facilities, especially in the ambulatory space that don't have resources of a hospital, to make them report constantly without seeing whether it benefits anything, that's concerning. 

Q: What was it like stepping into this role as the first female leader of an ASC accrediting organization? How has that impacted/inspired your work day to day?

NA: I didn't want this job because I'd be the first female. I wanted this job because it's a tremendous growth opportunity. I have the pleasure of working with a talented team that is predominantly female. Our chair is a female. What I've really focused on is promoting individuals who are passionate about learning, demonstrate performance, are inquisitive and curious, who want to make a difference and are willing to invest the time and the learning to improve their skills, improve their impact. Thinking about being the first female made me start thinking about other accrediting organizations in my past. They were all run by males. I feel strongly that people ought to be looked at for what they bring and supported based on that. That's what I've tried to do with my team, is really ensure that they're learning. That they have opportunities for growth and that they're having fun doing it. In healthcare in general, especially in the nonprofit space, women tend to be more prevalent. I've had the privilege of having several female mentors over my career. 

Q: What initiatives are you most proud of since starting your tenure with AAAHC? 

NA: One isn't quite done yet, but it's been a labor of love — the development of the new accreditation management system. What the whole philosophy around the development of our accreditation management system is driven and inspired and influenced by is 1095 Strong. 1095 Strong was super important to me when I first started here and we seemed to be so focused on the survey that happens once every three years. The reality is, what you and I care about is when I go to the doctor, are they performing good quality medicine? When I go to the ophthalmologist, are they doing what they're supposed to be doing? Not when the surveyor shows up, but when I as a patient shows up. That's what matters to me. Not just the day of the survey. The philosophy was, how do we drive participation with our accredited organizations and hold them accountable throughout all three years of the accreditation term? And how do we use that to drive what we do, what our surveys do, what our clients do, so we're all accountable to the same concept? We have targeted a launch [of the program] for next year. That's a huge not-yet-finished accomplishment. There's been a lot of other accomplishments along the way. We have totally redesigned our governance structure. We used to be a pay for play, meaning organizations would pay to sit on our board. The problem is, they were all representing their whole specialty instead of representing accreditation in the ASC space. We changed our governance structure and have a much more focused and strategic board. We've heightened our focus on education, but we have a lot more to do. Those are just some examples, but the biggest part is to have thrived during COVID. And held it together. It's the people who work here, our surveyors, our clients — we held it together and continued to deliver. That was tough, and we didn't stop doing surveys, and that is a testimonial to some amazing surveyors who saw the importance and kept doing it. And my staff, who I am in awe of. 

Q: Is there anything else you would like to elaborate on? 

NA: I continue to be in awe of healthcare providers in general. Right now, we're going through an era where there's a shortage of people, a shortage of pharmaceuticals impacting ASCs. They have to constantly be adapting. You have patients coming in and you're not sure what you're dealing with. Emergency drills now have to include violence in the workplace. These drills add more and more and more stress on an already stressed out workforce. Working at AAAHC has given me more appreciation when I go to see my physicians. I am in awe of what they continue to do every day; therefore, I want to do what I can to help their roles so they can continue to do what they need to do. 

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