Recommendation Phobia

There’s a condition suffered by many CARF accredited organizations and well known to those of us who help those organizations get accredited – CARF Recommendation Phobia. It can strike even the most seasoned organization. The symptoms include:

  • An allergic-like responses to a CARF surveyor using the word “Recommendation” during a survey, typically followed by near endless arguing with the surveyor.
  • Comparing recommendations with other organizations (i.e., “how many did you guys get?”).
  • Contracts with surveyors that specify the maximum number of recommendations they can receive.

While there is no cure as of yet, there are promising treatments that are now available to all organizations! The first and most common effective treatment is a form of talk therapy where the therapist (or consultant or CARF employee) gently reminds the organization that recommendations are actually code for “opportunities for improvement”. This therapy generally works well for mild to moderate presentations of the phobia.

The “opportunities for improvement” therapy can be combined with another commonly used psycho-education treatment where the therapist (or consultant or CARF employee) educates the organization about the fact that there is only a loose correlation between the number of recommendations and the final survey outcome. Recommendations, when written, often combine multiple elements of a standard and their importance can vary dramatically in terms of how they impact survey outcomes. Put another way, you can get a lot of recommendations and still be fully three-year accredited because recommendations are – you guessed it! – opportunities for improvement.

The final treatment approach, generally reserved for more severe presentations of this heinous condition, is called “just get over it”. This treatment should be delivered carefully but firmly by a trained and trusted professional able to competently deliver the appropriate dose. Although related to the other two treatments, it is intended to address the underlying anxiety that is caused by having a neutral third party point out where the organization could do better. A common phrase used during the delivery of this treatment is “it’s just a recommendation”. Another phrase that can be used in instances where borderline or questionable recommendations are given by a survey team is “accept that both CARF and the surveyors can and will get it wrong”, preceded or followed by “get over it”.

If your organization or an organization you love is suffering from this condition, don’t hesitate to reach out to us for help! Our consultants are highly skilled at delivering all of these treatments and are available to help.