Det Norske Veritas Healthcare (DNV)
Det Norske Veritas Healthcare (DNV) is a company that has held “deemed status” approval from
the Centers for Medicare & Medicaid Services (CMS) to assess facilities for quality of care and
patient safety, and to approve or disapprove of these facilities for reimbursement since 2008. In
other words, it is one of only three organizations that can award accreditation to hospitals. The
Joint Commission (TJC), the Centers for Medicare and the Healthcare Facilities Accreditation
Program are the other two.
DNV differs from TJC in the following ways:
 DNV states that it employs “a highly collaborative survey process that encourages innovation
and does not force hospitals to accept a generic template for patient safety goals. We help you
find your highest levels of performance.” On the other hand, TJC sets the priorities for the
facility. DNV uses the ISO 9001 Quality Management System, with a focus on process
improvement.
 TJC uses The Comprehensive Accreditation Manual for Hospitals. DNV has created The
National Integrated Accreditation for Healthcare OrganizationsSM (NIAHO) Manual.
 Surveys by DNV are annual. They occur in 3-year cycles for TJC, with an annual self-review
or on-site TJC survey (the Periodic Performance Review).
 TJC is not accountable to CMS, while DNV is. The DNV’s accreditation standards are thus
fully consistent with CMS and stable, while TJC’s accreditation standards change frequently.
 Perhaps the biggest difference is that the TJC’s findings determine accreditation status, while
DNV’s findings do not.
 TJC has accredited approximately 18,000 facilities (an estimated 5000 of which are hospitals).
DNV has accredited 1200 health care facilities worldwide (an estimated 27 hospitals).
Areas of focus
DNV focuses on the following areas during surveys:
 Patient care in all settings
 Staff member activities, equipment, documentation, building structure, sounds and smells, etc
 Integration of all services
 Whether quality improvement is an organization-wide activity
 Interaction between various hospital departments
 Activity reports to assure quality management oversight
 Storage, security, and confidentiality of medical records
More about the survey
DNV uses tracer methodology and department/patient audits to include staff interviews and open
medical record review. The organization must respond with Corrective Action Plans for all
nonconformities. Once this plan is accepted and approved, a copy of the survey schedule and the
NIAHO Report and Corrective Action Response are submitted for review by the Accreditation
Committee.
The clinical surveyor(s) look at all patient care units. The generalist surveyor(s) look at the
Quality Management Program, medical staff, Human Resources Department, and ancillary areas.
The physical environment surveyor(s) look at the physical environment, life safety, and
biomedical engineering.
More about the NIAHO Manual
The standards incorporate the CMS conditions of Participation and the ISO 9001 Quality
Management System. The manual contains 25 chapters and addresses standards, among others,
for Staffing Management, Patient Rights, Medication Management, Discharge Planning,
Utilization Review, and Physical Environment.
About Dietary Services and the NIAHO Manual
According to the NIAHO Manual, facilities can carry out dietary services either internally or
through a contract with a nutrition management company. Either way, it is necessary to have
regular interaction with medical staff regarding dietetic policies that could impact patient care.
The person responsible for the management, direction, and accountability of food and nutrition
services must work full time and have training with suitable qualifications and experience. This
person must ensure that administrative and technical employees are educated and competent in
their jobs. The facility also must have a registered dietitian (RD) or registered dietitian
nutritionist (RDN) available as needed.
All menus must meet the following requirements:
 Are prescribed by a practitioner who is responsible for the patients’ care
 Meet the:
– Nutritional needs of the patients
– Standards of current recognized dietary standards
The diet manual:
 Clearly defines all therapeutic diets
 Has approval of both the RD or RDN and the medical staff
 Is located in an area available to all staff who are either directly or indirectly responsible for
ensuring that patients receive appropriate nutritional services
References and recommended readings
DNV Healthcare Inc. DNV accreditation program frequently asked questions.
http://dnvaccreditation.com/pr/dnv/document/FAQ.pdf. Published March 11, 2013. Accessed
November 14, 2013.
Managing risk. DNV Accreditation Web site. http://dnvaccreditation.com/pr/dnv/default.aspx.
Accessed November 14, 2013.
Meldi D, Rhoades F, Gippe A. NAMMS The big three: side by side matrix comparing hospital
accrediting agencies. Synergy. 2009;January/February:12-14.
http://www.namss.org/portals/0/advocacy/namss_synergy_janfeb09_accreditation_grid.pdf.
Accessed November 14, 2013.
Review Date 11/13
G-1686