You wouldn’t send a carpenter to build a bookcase without nails and a tape measure. You wouldn’t ask an artist to paint a portrait without brushes and paints. And, The Joint Commission would not expect an accredited ambulatory care organization to evaluate its systems and processes and continuously improve its patient care without providing the right tools to succeed.
Thanks to the rollout of the Standards Improvement Initiative and the introduction of a new tool—the E-dition (see related article)—we have simplified and customized the standards to meet the needs of our varied ambulatory customers. Complying with the standards is the first step toward achieving high quality care on a consistent basis.
In recent years, we’ve developed other tools to help accredited ambulatory organizations improve care including the tracer methodology (which focuses the on-site survey directly on patient care), National Patient Safety Goals, and Sentinel Event Alerts, which share lessons learned from serious adverse events.
We recognize that you have a choice when it comes to accreditation. And we value your continued relationship with The Joint Commission. Our goal is to achieve consistent excellence and efficiency, and, thereby, greatly enhance the value we provide to you. Contact me at mkulczycki@jointcommission.org, or (630) 792-5290.
Michael Kulczycki, MBA, CAE
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Ambulatory care organizations and office-based surgery practices will see customized improvements in the new E-dition (electronic manual) and print manuals for 2009. The E-dition allows organizations to pull up service-specific standards and elements of performance. For example, using the filter feature on the E-dition, an imaging center will see only the standards and elements of performance for that service. Approximately 74 percent (or 795) of the 1,082 ambulatory care EPs are applicable to imaging centers.
Here’s what ambulatory care customers who participated in the field testing like best about the E-dition:
- It is easy to navigate after just a little exploration
- The organization of the standards makes them easier to comprehend
- Quick access to information
All accredited ambulatory care organizations and office-based surgery practices will receive a complimentary, single-user license. Larger organizations with multiple sites may be interested in purchasing additional user licenses or a site license.
The redesigned print manual also was heavily influenced by customer input. Key features include:
- Links from certain EPs to associated requirements in other chapters
- Icons that alert readers to certain requirements, such as when documentation is required to demonstrate compliance
- Tabs that distinguish standards and requirements from accreditation policies and procedures
All accredited ambulatory care organizations will receive a complimentary copy of the 2009 print manual in a portable binder format. Customized spiral-bound standards books are available for ambulatory surgery centers, diagnostic imaging services, medical/dental services, and office-based surgery practices. In addition, the complete set of ambulatory care standards is available for purchase in two additional print formats—a larger size binder and a spiral-bound standards book. Visit the JCR website: http://www.jcrinc.com/ or call (877) 223-6866.
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Read what Joint Commission OBS surveyors Jay Afrow, D.M.D., M.H.A., and Jim Bersot, M.D., say about accreditation for office-based surgery practices.
What have OBS practices told you are the benefits of being accredited?
Afrow: Accreditation gives them a framework to build their practice around.
Bersot: Practices appreciate the information shared by The Joint Commission concerning safe, quality patient care and performance improvement approaches.
What is one myth you hear about Joint Commission OBS accreditation?
Afrow: "The Joint Commission says I have to do X.” Often, physicians may think our standards are prescriptive. Actually, The Joint Commission usually says you have to develop a process or system that is appropriate for your practice. In most cases what we’re asking for is process development.
Can you give an example of how OBS accreditation is often easier to achieve than some may think?
Bersot: If the practice understands the process and necessary time commitment, and uses the appropriate preparation tools, it usually achieves accreditation. Also, if the practice takes advantage of the Periodic Performance Review tool—even though it is not required for OBS practices—it usually does well and continues to be accredited at the time of resurvey.
What do you see as the biggest difference between an accredited OBS practice and one that isn’t accredited?
Afrow: In general, accredited practices see the big picture and develop a long-range perspective based on refined structure. Unaccredited practices tend to focus more on the day-to-day issues because there is less structure in place.
In your opinion, how can OBS accreditation be used as a business tool by OBS practices?
Bersot: Joint Commission OBS accreditation is a way for practices to distinguish themselves from their competition—with respect to marketing, business operations, risk management, staffing and recruitment, and of course, cost-effective, high quality clinical care.
Name one reason why OBS practices should choose The Joint Commission.
Afrow: The Joint Commission surveyors who conduct OBS surveys may also conduct ambulatory surveys—giving them a wide range of experiences which may be of help to the OBS practice. Surveyors can relay concepts and practices they have seen at larger organizations to the OBS practice and help the staff tailor these concepts to their specific need.
For more information regarding OBS accreditation, visit The Joint Commission website.
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The law that took effect in January requires most New York State physician practices that perform office-based surgical procedures to achieve accreditation—by July 14, 2009. To ensure receipt of your accreditation certificate by July 14, submit your application to The Joint Commission no later than January 30, 2009. FAQs about NY OBS requirement
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Accreditation has an impact on quality-related activities at federally supported health centers according to a recent study in the Journal of Ambulatory Care Management, 2008, October-December; 31(4):303-18. The findings of the study, “Quality-Related Activities in Federally Supported Health Centers: Do They Differ by Organizational Characteristics,” indicate that, in general, the frequency and type of most quality-related activities did not vary greatly by size and location, but do differ by accreditation status. Accreditation confers a greater likelihood that health centers have integrated specific QI activities into their daily operations, thus supporting the value of the investment in accreditation.
“This study helps illuminate the many quality-related activities—quality improvement, staff training, competency verification, infection control, environment of care, and risk management—that distinguish accredited health centers from those that aren’t yet accredited,” says Lon Berkeley, project director, Community Health Center Accreditation, at The Joint Commission.
Staff from The Joint Commission, the University of Illinois at Champaign’s Survey Research Laboratory, the Agency for Healthcare Research and Quality’s Center for Outcomes and Evidence, and the Health Resources and Services Administration’s Bureau of Primary Health Care collaborated on the study that included a questionnaire with 44 items. Almost 300 health centers completed the questionnaire.
The authors of the study are Barbara Braun, Ph.D.; Linda Owens, Ph.D.; Barbara Bartman, M.D., M.P.H.; Lon Berkeley, MS.; Nicole Wineman, M.A., M.P.H., M.B.A.; and Charles Daly, M.H.A. See the abstract at www.ambulatorycaremanagement.com.
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Q: Do you have any suggestions for refrigerator temperature monitoring for ambulatory centers that close over the weekend? Is the back-up generator enough with all refrigeration in red plugs?
According to Jerry Gervais, CHFM, CHSP, an engineer in The Joint Commission’s Standards Interpretation Group, “There are freestanding thermometers with high and low set points that can be purchased from several national supply houses. It’s possible to set both parameters, and there are two additional indicating needles which will ‘set’ at the highest and lowest temperature registered. These needles will remain fixed on these points unless the ranges are reset. The cost for these thermometers is relatively inexpensive—about $30-35 dollars each. There are also continuous recording thermometers that use a circular graph with a recording stylus. These thermometers continuously monitor the temperature and maintain a record. However, they are considerably more expensive and run several hundred dollars each. The charts on these thermometers need to be changed daily or weekly.
“With respect to the second question, it is considered best practice to plug refrigerators into the red outlets (emergency powered) with the thermometers discussed above. If the refrigerators are plugged into red outlets, they should have power within 10 seconds of a failure of the utility power. However, if the generators didn’t start for some reason, you would have no way of knowing what temperatures the drugs or other items were exposed to during the power outage. The Joint Commission would expect the organization to conduct a risk assessment to determine what level of protection is appropriate, based on what the refrigerators are used for.”
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The Joint Commission’s ambulatory care team is hosting a free meeting for New York-based office-based surgeons considering Joint Commission accreditation from 6 to 8 p.m. Wednesday, Jan. 21, at the Marriott New York East Side To register, visit www.jointcommission.org/NYOBS.
Ambulatory Care: A Primer for Beginners
Monday, Feb. 23, Oakbrook Terrace, Ill.
Ambulatory Care Accreditation Essentials
Tuesday and Wednesday, Feb. 24-25, Oakbrook Terrace, Ill.
To register, contact JCR Customer Service at (877) 223-6866, or visit the JCR website, www.jcrinc.com.
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A recent Joint Commission Sentinel Event Alert warns that rude language and hostile behavior among health care professionals goes beyond being unpleasant and poses a serious threat to patient safety and the overall quality of care. To see the Alert, visit the website.
The Joint Commission and the Centers for Disease Control and Prevention (CDC) are engaged in a cooperative agreement to evaluate how rapid tests for influenza are used in outpatient medical settings by surveying community health centers, solo and group practice physician offices and hospital emergency departments. Interested individuals are invited to access the Wiki webpage that has been created for this project. To participate in the online collaborative forum, register on the home page, http://wikihealthcare.jointcommission.org/twiki/bin/view/Perform/RapidTestingForInfluenza. For more information, contact Erica Galvez, associate project director, Division of Quality, Measurement and Research, at egalvez@jointcommission.org.
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For an in-depth look at a systematic approach to preventing MRI accidents, don’t miss “Enhancing Magnetic Resonance Imaging Safety,” featured in the August 2008 issue of JCR’s Environment of Care News. To subscribe or to download and purchase a single issue of the newsletter, visit the JCR website, http://www.jcrinc.com/Periodicals/ENVIRONMENT-OF-CARE-NEWS/844/.
- American Academy of Cosmetic Surgery, Phoenix, Ariz., Jan. 15-17
- ASC 100/Imaging 100, San Diego, Calif., March 22-24
- Midwest Podiatry, Chicago, Ill., April 2-5
- American Society of Cataract and Refractive Surgery/American Society of Ophthalmic Administrators, San Francisco, Calif., April 4-8
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Michael Kulczycki, executive director
(630) 792-5290
Mike Dye, senior associate director
(630) 792-5259
Darrell Anderson, business development specialist
(630) 792-5292
Account representative
(630) 792-3007
Standards Interpretation Group
(630) 792-5900
JCR Customer Service
(877) 223-6866
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