by Dianne M. Cearlock, PhD and CEO and Mark Spence, Volunteer Services Manager

The year 2020 brought a number of “first time ever” events to NAACLS. The COVID-19 pandemic really intensified in March in the United States. Schools at all levels closed their doors to in-person education and either suspended education entirely or shifted to online formats for delivery. NAACLS accredited and approved programs, whether sponsored by educational or medical institutions, experienced waves of changes similar to K-12 schools and healthcare clinics and services. Drastic actions were taken to support the health of communities. All the while the need for new and competent graduates in the clinical laboratory sciences and other healthcare services exploded. Clearly, it was in the best interest of communities nationwide to keep NAACLS programs turning out clinical laboratory professionals to staff clinical laboratories, perform testing, and help stressed healthcare systems answer the pandemic challenges.

NAACLS fielded hundreds of calls and emails from program officials, deans, laboratory directors, and others asking about NAACLS’ policies regarding converting to online learning, simulating laboratory exercises, abbreviating courses or clinical experiences, and many other factors. One decision made by NAACLS was quick and firm: NAACLS standards would not be lowered – even temporarily – in response to the pandemic and programs were required to continue to meet the standards. Another guiding principle was taken from the standards. The standards were designed to give programs the flexibility to innovate and that included curricular design, modes of education delivery, and creative partnerships that best serve a program’s local community and stakeholders – as long as NAACLS’ standards were met. The answers that NAACLS provided to the questions pouring in from programs had a similar theme – if the standards are met, most of the decisions regarding program structure, curricular adaptations, innovative solutions to aborted clinical experiences, and other topics were within the purview of the programs and the sponsoring institutions. These policies were articulated and posted on the NAACLS website to give guidance to programs as they searched for solutions. And the programs innovated.

Internally, NAACLS had to deal with an unprecedented interruption of its program review cycle. Sixty (60) NAACLS programs were scheduled for site visits in the spring of 2020. These programs had developed and submitted self studies, responded to self study reviews, and prepared for the hosting of site visits. Of those 60 programs, 25 (MLS-17; MLT-8) were concluded while all the rest had to be cancelled because of the pandemic. That left 35 (MLS-23, MLT-9, HT/HTL/DMS/CG-3) programs that had progressed far into the cyclical review process then been stopped short by circumstances beyond their control. Most were ready and eager to get on to the next step in the review process and NAACLS was determined to accommodate them if it was possible to do so. For the first time in NAACLS’ history, the feasibility and desirability of conducting virtual site visits was addressed.

The first step in exploring virtual site visits was to form a task force. Members with substantial site visit experience were drawn from the Board of Directors, the Review Committee on Accredited Programs (RCAP), and the Program Approval Review Committee (PARC). The task force’s charge was:

1. Explore 100% virtual site visits conducted by NAACLS. Include:
   • Requirements for eligibility for a virtual site visit
   • Critical components of the site visit
   • Identify site visit components that “verify” documents or other components that are already covered with the self study/report
   • Use innovative thinking to suggest how on-site site visit functions could be handled in a virtual manner.
2. Identify significant processes or operations that need to be addressed should NAACLS conduct virtual site visits.
3. Submit a written report of the VSV task force to the Board of Directors for inclusion at the April 2020 Board meeting.

This fast-working task force discussed many issues and concerns and mapped out essential procedures for conducting virtual site visits. Members developed criteria for programs to be considered eligible for a virtual site visit (if the Board of Directors approved such visits). These criteria were:

1. The program’s previous award must have no citations.
2. The virtual site visit is voluntary.
3. The program must be up to date with all applicable NAACLS responses and administrative issues (review materials, annual fees, survey, etc).
4. The previous three years of outcomes must meet all benchmarks.
5. Programs inactive during any part of their previous award are ineligible.
6. Initial Site Visits are not eligible.

In addition to virtual site visit eligibility for programs, the task force established special requirements for the site visitors participating in this pilot program. To serve as a virtual site visitor, a volunteer must have previous site visit experience. Since NAACLS relies on mentorship to train new site visitors, the task force chose to relieve that responsibility for virtual site visits, allowing for the site visit team to focus exclusively on the content of the visit.

The task force also focused on preserving the privacy of the visit, as well as the organization and efficiency of reviewing documentation in a virtual setting. For NAACLS to ensure the site visit’s confidentiality, the task force recommended that NAACLS invest in a video conferencing platform (Zoom), which would host all virtual visits. The task force also recommended a cloud file sharing service (Box) to be used as a central site for programs to submit all documents that would need to be reviewed by the site visit team. NAACLS followed through with both those suggestions.

The procedures and criteria were presented to the Board of Directors in April 2020. The Board approved moving ahead with virtual site visits (as delineated by the task force) during the summer of 2020 as a temporary, exploratory foray into this type of review process. By allowing virtual site visits, NAACLS could help clear the backlog of cancelled site visits. Also, the virtual site visits were to be evaluated for strengths, weaknesses, and useful tips in the event that NAACLS continues to conduct such visits.

Following the Board of Directors approval, all eligible programs that were waiting for site visits were contacted to see if the programs wished to and were able to go forward with a virtual site visit in the summer of 2020. When the response was affirmative, NAACLS began recruiting the site visitors. The potential site visitors were asked, among other questions, if they thought a quality review was possible virtually and if they would feel comfortable conducting virtual site visits. Responses from both eligible programs and potential site visitors were remarkably positive.

NAACLS was able to schedule 27 total virtual site visits (of the 35 cancelled site visits) during the summer of 2020. It should be noted, as yet another NAACLS’ “first-time-ever” event, that NAACLS had never conducted summer site visits before this season. Prior to getting the summer site visits rolling, NAACLS had to provide guidance on the practical application of a site visit in a virtual medium. For example, while traditional site visits have the visitors on site and able to work through the day, virtual site visits may be conducted by visitors from very different locations and therefore the scheduling process requires an extra layer of care. Also, both program officials and site visitors needed to be comfortable with the technology utilized during virtual meetings. To this end, NAACLS conducted training exercises, provided virtual site visit tips and suggestions through a “Virtual Site Visit Guide,” and hosted a Q&A session for programs and site visitors to address any questions and concerns before the majority of visits took place.

Once the task force completed its charge of developing a pilot virtual site visit process, NAACLS set about determining the remaining review schedule. Due to the virtual visits’ timing, the programs going through a virtual site visit were unable to remain on the summer and fall 2020 RCAP and Board of Directors’ agendas, respectively. After reviewing the NAACLS Policy and Procedure Manual and considering the size of the fall 2020 site visit schedule, the NAACLS staff recommended adding a committee meeting, a Quality Assurance period, and a Board of Directors meeting to the already existing schedule. The post virtual site visit schedule is as follows:

• October 30th – RCAP Teleconference (Recommendations only – no additional discussion items)
• November 6th – Quality Assurance Committee review begins
• December 4^th – Programs are notified of the review committee recommendations
• January 4^th – Reconsideration request period over
• January 11^th – NAACLS Board of Directors meeting

As of this writing, NAACLS’ virtual site visits for the summer are ongoing. With each one, NAACLS learns a little something new about what works and what does not. Impressions, tips, and strategies are being catalogued for possible future use. At the September 2020 meeting of the Board of Directors, a summary report will be shared. Conclusions have not yet been formed but it is interesting and heartening how openly and with good will and humor the NAACLS community has approached these “first-time-ever” events.