Lynch, Daniel J. MS
Facility certification has been a topic of discussion in the health and fitness industry as far back as my industry start in 1973. In the spring of 1978, I had the opportunity to present a talk during the American College of Sports Medicine's (ACSM) Annual Meeting in Honolulu, HI. At the time, I suggested more emphasis be placed on the training of health and fitness professionals so that they would be prepared for the populations that were aging and would suddenly realize that their lifestyles were beginning to influence their personal health. In the winter of 1979, an initiative was undertaken, and a subcommittee of ACSM's Committee on Certification and Registry Boards produced what is now known as ACSM's Health/Fitness Instructor® certification.
I was honored to chair the subcommittee and work with a very talented team of experts. It had always been our hope that someday we would advance the next initiative to actually certify facilities. Since that time, two major publications have addressed this issue: ACSM's Health/Fitness Facility Standards and Guidelines, Third Edition; and the Medical Fitness Association's (MFA) The Medical Fitness Model: Facility Standards & Guidelines, Second Edition.
In February 2006, MFA started to act on its discussion of facility certification by publishing the first edition of The Medical Fitness Model: Facility Standards and Guidelines. In August 2006, the Long-Range Strategic Planning Committee of MFA met in Orlando, FL, and recommended that the study and process to move toward facility certification should begin. I was fortunate to be selected as chair for this initiative and again worked with a talented team of experts that included the following:
Facility Certification Committee
* Jinger Berry, M.Ed., executive director, Stamford Hospital, The Health & Fitness Institute, Stamford, CT
* Robert D. Boone, M.B.A./MHA, FACHE, vice president, FirstHealth of the Carolinas, Pinehurst, NC
* John Caliri, operations director, FirstHealth Centers for Health & Fitness, Pinehurst, NC
* Amanda Harris, M.Ed., vice president of Fitness & Wellness, ACAC Fitness & Wellness Centers, Charlottesville, VA
* Graham Melstrand, vice president for Operations, American Council on Exercise (ACE), San Diego, CA
* Mike Niederpruem, vice president, Certifications, American Health Information Management Association (AHIMA), Chicago, IL
* Brad A. Roy, Ph.D., FACSM, FACHE, administrator, The Summit, Kalispell Regional Medical Center, Kalispell, MT
* Gar Simers, executive director, Tilton Fitness/The Ocean Club, Stafford Twp, NJ
* Neil Sol, Ph.D., vice president for Outpatient Services & Program Development, ValleyCare Health System/LifestyleRX, Pleasanton, CA
* George Wayson, director, The Wellness Center at Meadowmont, UNC, Chapel Hill, NC
* Cary Wing, Ed.D., executive director, MFA, Richmond, VA
My thanks go to all of the above active committee members and to those members of the committee that stepped down because of other pressing commitments, for their diligence in moving the certification to the pilot stage as fast as we did.
CERTIFICATION PILOT PHASE
As of this writing (early February 2008), we are about to embark on the pilot study phase where we will evaluate the practical theories that the committee used in developing the certification tool. The resulting Facility Checklist will be used by two visiting examiners during a 2-day site visit to each facility. Facilities successful in winning a past MFA Distinguished Service Facility Award were invited to participate in a pilot study. Medical Fitness Association Distinguished Service Awards occur in three categories:
* Less than 20,000 sq ft
* Between 20,001 and 50,000 sq ft
* More than 50,001 sq ft
One facility in each category was selected to participate as a pilot facility so the certification process could be evaluated in a variety of facility sizes. After the pilot site visits, the MFA Certification Committee is to review the results and make final revisions to the process.
Before detailing the content and workings of the Facility Checklist, let's review the committee's thought process that led us to performing pilot field examinations.
A significant goal of the committee was to provide the medical fitness industry with a certification process that will provide more than a simple pass/fail score. The committee worked hard to develop a facility certification tool that is detailed and will guide each facility to self-evaluate its ability to match and meet The Medical Fitness Model: Facility Standards & Guidelines for operating a medically integrated health and fitness center. The underlining principal of the certification program is that when a facility complies with the standards and guidelines, they should be more effective in providing a safe and effective health and fitness center for the public at large. It also is the intent that through community education, public service announcements, and other public relation efforts by certified facilities and MFA, the public will become more aware of what to look for when shopping for a health and fitness center in their community. With these goals in mind, the committee embarked on a yearlong process of refining the checklist and the process to be used to achieve facility certification.
How do you know when your facility is ready to go through the certification process? The first resource you will need to evaluate your preparedness is The Medical Fitness Model: Facility Standards & Guidelines. This publication provides an in-depth review of the standards and guidelines, a checklist to determine areas of strength and weakness, and a variety of resources and examples that will assist in preparing for certification.
Many factors distinguish the medical fitness model including the following: active and regular medical oversight, qualified and credentialed staff, disease management and clinical integration of programs, use of an individual's personal health status in creating an individualized exercise prescription to reduce their overall health risk, safety, quality, and a focus on improving community health.
The following is a compiled list of frequently asked questions to clarify some of the issues associated with facility certification:
1. When will a facility be able to apply for certification?
* The application process will be open in May 2008 to all facilities that have been in operation for a minimum of 1 year. Interested facilities will request an application from MFA and will receive a packet that includes a self-study guide to assist in preparation of the application.
2. What criteria will be used to determine eligibility?
* The certification is based upon The Medical Fitness Model: Standards & Guidelines originally published by MFA in 2006 and revised in November 2007. A revised print edition will be available in spring 2008 and can be ordered through MFA.
3. Why certification?
* With a focus on medically sound prevention and rehabilitation programs, medical fitness centers play a key role in the health and wellness of all Americans. The MFA Facility Certification is an important step toward recognizing this health-care contribution and raising the bar on the quality and safety of services provided by the health and fitness industry.
4. Are there fees involved with the application?
* Yes. The fees are dependent on facility size and are broken into the following categories:
* 20,000 sq ft
* 20,001 to 50,000 sq ft
* 50,001 sq ft
* Facilities should budget between $1,500 and $2,500 to cover application fees and travel expenses for site visits. An effort will be made to select examiners within a reasonable geographic distance to the facility to reduce costs.
5. Does a facility have to be an MFA member to apply?
* No. However, facilities that are members of MFA will receive reduced application fees.
CERTIFICATION SITE VISIT
What actually happens during the facility site visit? For the pilot stage of the process, we have selected examiners who are experienced operators of MFA facilities and understand that perfection in the operations world of health and fitness is very difficult to achieve. The examiners' approach is to review the checklist and facility with objectivity while understanding that the pilot stage is a learning experience for both the facility and the examiner. During the site visit, the examiners will spend significant time reviewing the physical plant and member files, record keeping, visiting with the medical oversight team, and reviewing the staff credentials and certifications. On the second day of the field visit, the examiners will meet with the administrative team from the center to review the findings of the certification visit. During this time, both strengths and weaknesses will be discussed with the facility team. The critical importance of this review is to provide guidance to assist the center in achieving excellence and to match their operations to the standards and guidelines.
The following schedule (Table 1) provides an outline of a typical site visit and should be modified to meet facility and examiner needs:
THE FACILITY CHECKLIST
The Facility Checklist is arranged to match the Standards and Guidelines that were revised in November 2007 to include additional areas that the Facility Certification Committee felt were important parts of a facility review. A sample of the checklist is shown in Table 2.
If you follow the above sample of Section VII of the standards and guidelines and, in particular, Standard 13, there are a total of 4 items that the examiner will review in this category. The entire Facility Checklist includes 132 items that the examiners will review during a site visit. Checklist items are categorized into either "Should Have's" or "Like to Have's." Both categories carry a weight of 1 point value (PV) in the overall scoring. In summary, each category carries 1 PV for a total point value of 132 points. In the example above, the sample facility scored 3 points out of a possible 4 points in the area of accessibility and safety. A facility must achieve 80% or a score of 105 out of a possible 132 points to achieve certification. In particular, there are five areas that a facility must have in place to be awarded certification status. These five requirements are the following:
1. medical oversight
2. emergency response
3. at least one Automated Electronic Defibrillator on site
4. aquatic facilities must have a written emergency plan
5. aquatic facilities must have written policies and procedure specific to the aquatics center
Each facility that considers applying for certification status should be certain that each of the above five areas are absolute "yes" answers when they review the summary checklist. These items are considered critical factors in the safety of a medically integrated health and fitness center. These are considered pass/fail areas of importance in the certification review.
If you think your facility is ready for the challenge and you want to challenge your staff, contact the MFA office at 804-897-5701 or via email at firstname.lastname@example.org and ask for the self-study facility application forms and instructions, which will help guide your decision to achieve MFA Facility Certification. Good luck!
CONDENSED VERSION AND BOTTOM LINE
This article summarizes a history of the certification movement and the industry leaders who brought the pilot program to fruition. Readers will learn how to prepare a facility for an on-site visit by examiners and will review an overview of the facility checklist based on standards and guidelines developed by the Medical Fitness Association.