Twenty years ago, The Joint Commission proudly launched its accreditation program for the home care field. Since that time a lot has changed, but our commitment to driving improvement has not.
Under the leadership of our new president, Mark R. Chassin, M.D., The Joint Commission has embraced Robust Process ImprovementTM, a systematic approach to problem-solving proven in many other industries. We are busy deploying tools such as Lean Six Sigma, Change Acceleration Process and Work-Out to help improve internal systems and processes that will benefit our customers.
Moving forward, The Joint Commission will use Robust Process ImprovementTM to aggressively improve the standards and survey processes, and increase confidence that complying with standards will improve health outcomes.
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.
Happy Holidays to all, and best wishes for a safe and healthy New Year.
Debra Zak, Ph.D., R.N.
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What is your role as the home care representative on The Joint Commission's Board?
I bring to the Board the perspective of a health care environment that is not rooted in bricks and mortar. Our issues are different than a facility-based service. In addition, home care is not a physician-based medical model. It is a direct hands-on care model that brings with it quality and safety concerns that are not a part of a hospital or acute care setting. I'm also the ‘little engine that could’ that keeps reminding the Board that home care is different, and that the traditional accreditation standards, methods and models don't always apply. I'm the one who has been heard repeating, "But don't forget home care!" I’ve even suggested that hospitals might be able to learn something from how home care does things!
What have you learned since joining the Board this year?
I have a much better understanding of the complexity of the accreditation process. Although I've experienced it from the other side, I am now certain that The Joint Commission is truly interested and committed to addressing the needs of home care. I can't tell you how motivating that is for me, not only as a Board member, but also as a CEO of an accredited home care organization.
What are you hoping to accomplish during your time in this position?
If I can facilitate an active effort on The Joint Commission’s part to put aside the current standards and safety goals to take a fresh look from home care's perspective, I will feel I've achieved a little. If that effort turns into truly relevant home care standards and safety goals, I will be extremely satisfied.
Your organization was the first freestanding home care agency accredited by The Joint Commission. How has the home care field and accreditation changed since 1988?
Home care has progressed from a fairly low-tech service to a fast paced, high-tech 24/7 operation. The care we provide is much more acute and uses not only advanced health care technology, but also more communication and mobile technology than any other health care setting. We have also become much more outcomes-based and quality/safety conscious. Accreditation has also changed over the last 20 years. It has moved from focusing on the ‘papers,’ such as policy/procedure and documentation, to actual provision and coordination of care.
What do you remember about that first home care survey?
Mostly, as the quality coordinator for VNA, I remember being scared to death! I also remember spending all my time writing and reviewing policies and procedures and making sure our notebooks were in order.
Why is accreditation important for the home care field?
It sets the standard for achievement and holds us accountable for what we do. I believe a large part of the health care future will depend on community-based services. That is a tremendous opportunity for home care, but it is also a recipe for disaster if we don’t ensure that we provide quality and safety to our patients. Accreditation should be the benchmark that we achieve and are encouraged to exceed.
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As part of The Joint Commission’s Standards Improvement Initiative, the Periodic Performance Review process and availability of the on-line PPR will be affected. The PPR will be off-line from December 1, 2008 through January 1, 2009. During this time, the new standards and scoring methodology are being loaded onto the site. Therefore, the due dates for completing the PPR have been changed. Organizations with PPR due dates from October 1, 2008 through December 31, 2008 are not required to submit a 2008 PPR.
When the PPR is re-activated on January 1, 2009, home care organizations will need to repopulate the Open PPR. The Open PPR will include a link to a data table (available throughout 2009) that provides copies of all of the organization’s data that was saved on the Open PPR. Organizations can print a variety of reports to help repopulate the PPR and they will be given ample time to do so. Automatic submission due date extensions will be granted: PPR due dates in January 2009 will be extended 90 days and PPR due dates in February and March 2009 will be extended 60 days. In addition, for organizations with PPR due dates in January, February, or March 2009, the “Begin Submission” link will become available on January 1, 2009. For more information, contact your account representative.
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The Joint Commission’s Home Care Accreditation Program turned 20 this year. Hear from Joanne Rodgers, a surveyor who was one of the first to be trained for home care in 1988 and who is still surveying for The Joint Commission.
What was it like being one of the first Joint Commission home care surveyors?
It was a whirlwind time. Many of the national companies wanted to be ‘finished’ first, especially the infusion companies, so there was never a lack of surveys to be completed. I spent many early years on national system surveys crossing the states. Office to office the word was out whether you liked coffee or a soft drink and, of course, what you had scored at the last offices you had surveyed. It was a challenge keeping one step ahead.
Do you remember anything from your first survey?
Yes. My first survey was in Belfast, Maine. It was one day. The agency was small, hospital-based and occupied one room—formerly a patient room—in the hospital.
What keeps you surveying for The Joint Commission?
I enjoy the staff I meet in rural, suburban and urban cities that really care about their patients, and the patients I meet who understand that they probably couldn’t stay home if it weren’t for the visiting staff.
Most memorable survey?
I don’t have one most memorable, just snippets from many. I remember a ride to a buffalo farm in Iraan, Texas, after a severe rain storm. You wouldn’t believe just how many different pickup trucks, delivery vans and types of cars I have had the pleasure to ride in on the way to home visits. And, of course, I have more than enough material for a very funny book!
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To make it easier to determine eligibility for home care organizations providing clinical respiratory services, a team of Joint Commission employees have developed a decision tree to provide direction and improve clarity. If you can answer yes to all of the following questions, your home care organization is eligible for clinical respiratory services accreditation.
- Is a licensed health care professional or respiratory therapist providing services to patients of the organization?
- Are services provided in the patient’s place of residence?
- Does the organization provide services in conjunction with equipment?
- Does the licensed professional (respiratory care practitioner, respiratory therapist or nurse) provide “respiratory care” as defined by the State Scope of Practice under the care of a physician/licensed independent practitioner? Examples of respiratory care service include both observing and monitoring the same patient; teaching disease process (not equipment use); and evaluating a patient to determine if he or she can use an oxygen conserving device.
- Have these services been provided to at least 10 patients over the past 12 months?
With respect to pulse oximetry, a physician/licensed independent practitioner’s order is not needed unless required by state law/practice act. Currently, there are no federal regulations that require an appropriately licensed professional to have an order. Also, the occasional or one-time use of a pulse oximeter does not mean the patient is receiving clinical respiratory services. For more information, contact your account representative. Look for details coming soon to The Joint Commission Web site.
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A warm thank you and best wishes to Bob Floro, R.R.T., who recently left The Joint Commission after 11 years of service. Bob had worked as both a surveyor and in The Joint Commission’s Central Office.
The Joint Commission is revising its 2009 NPSGs, and input from the home care field is essential. To comment, click here. Comments will be gathered through December 24.
All providers of durable medical equipment who wish to participate in the Medicare Program must meet Quality Standards by January 2010. Check out what The Joint Commission has to offer.
The Joint Commission’s first ever Accreditation Summit will be held April 28-29, in Rosemont, Ill. at the Donald E. Stephens Convention Center. The Summit will offer a comprehensive curriculum and customized accreditation tracks to meet the needs of all accredited organizations, including home care service segments. Faculty for these programs will include surveyors, members of the Standards Interpretation Group, and others.
The Joint Commission’s home care team will exhibit at the following conferences:
- Home Care 100, February 1-3, North San Diego, Calif.
- National Private Duty Association, March 18-19, Chicago, Ill.
- Medtrade Spring, March 25-26, Las Vegas, Nev., booth 421
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- Debra Zak, Ph.D., R.N., executive director
(630) 792-5742 or dzak@jointcommission.org
- Margherita Labson, R.N., associate director
(630) 792-5284 or mlabson@jointcommission.org
- Account representative
(630) 792-3007
- Standards Interpretation Group
(630) 792-5900
- JCR Customer Service
(877) 223-6866
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