The goal of The Joint Commission is to drive the health care delivery system to achieve major, sustainable improvements. A little better just isn’t good enough. For years, ambulatory providers have been grappling with how to do this.
Enter Robust Process Improvement, a systematic approach to problem-solving proven in many other industries. We at The Joint Commission are busy deploying tools such as Lean, Six Sigma, Change Acceleration Process and Workout to help improve internal systems and processes that will benefit our customers. Five essential steps of Robust Process Improvement (similar to the DMAIC strategy—define, measure, analyze, improve, control) are:
- Specify the improvement target
- Measure the size of the problem
- Identify specific causes
- Target interventions to most important, modifiable causes
- Embed the intervention into routine work
Moving forward, The Joint Commission will use Robust Process Improvement to aggressively improve the standards and survey process, and increase confidence that complying with standards will improve health outcomes.
Our vision is to lead the transformation of health care into a high-reliability industry, with rates of adverse events and safety process breakdowns comparable to air travel. If your ambulatory care organization is already using any of the tools mentioned above, I’d love to hear from you. Contact me at mkulczycki@jointcommission.org, or (630) 792-5290.
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The Joint Commission and the Urgent Care Association of America are partnering to provide quality oversight for the nation’s urgent care clinics. The collaboration will include quality standards specific to urgent care, targeted for development in 2009-2010. Also, the UCAOA has discontinued its accreditation program to focus its efforts on the partnership and on services available under The Joint Commission’s ambulatory care accreditation program. Beginning in 2008, the UCAOA joined The Joint Commission’s Ambulatory Professional and Technical Advisory Committee to provide input on standards and other issues. Below is an interview with Lou Ellen Horwitz, executive director, UCAOA, and Michael Kulczycki, executive director, The Joint Commission’s Ambulatory Health Care Accreditation Program.
Why did the Urgent Care Association of America choose The Joint Commission over other accreditors?
LH: We chose The Joint Commission for two reasons: they are the established leader in accreditation, and they were the most flexible and interested in providing urgent care a ‘seat at the table.’
Why is achieving accreditation important for urgent care centers?
LH: Accreditation offers urgent care centers an additional perspective on their internal processes and interactions with patients, and provides outside recognition for their organizational excellence. This sends an important message to their community and to other stakeholders such as employers, referring physicians, payers and legislators.
How will this agreement benefit your member organizations?
LH: Through this collaboration, the field can offer practical information to assist in the standards development process. This, in turn, will benefit our members by increasing the applicability and ultimate value of accreditation.
What is the goal of this partnership between UCAOA and The Joint Commission?
LH: The primary goal is to provide an opportunity for urgent care centers to strengthen their position in the health care delivery system. The partnership will help provide an ambulatory accreditation product that is not only recognized as the gold seal of approval in health care, but also has significant input from the urgent care community.
MK: For The Joint Commission, the goal is to leverage the influence of the association in educating the urgent care field to the value of accreditation, and to smooth the way for urgent care professionals to focus on continuous compliance with state-of-the-art standards.
Why does this partnership make sense?
LH: There has never been more interest in urgent care. Urgent care centers are an essential part of the health care system and with more than 8,000 centers in the country—almost double the number of emergency rooms—their numbers are significant. UCAOA continues to seek projects that elevate the field and helps to fulfill our mission of providing leadership, education and resources for the successful practice of urgent care.
MK: UCAOA leadership understands the valuable concept of delivering on core competencies. Their leadership determined that other organizations, like The Joint Commission, could deliver the competencies desired by their members. And in turn, their membership could contribute their industry content knowledge to our standards development and survey process development.
How will you determine whether or not this agreement is successful?
LH: The industry will determine that for us. Our role as an association is to facilitate opportunity and provide the leadership and resources. The urgent care centers themselves will need to take the next steps to embrace the opportunity and take advantage of the resources.
MK: Customer satisfaction, as measured by whether urgent care organizations find our survey process and evaluation standards relevant, achievable and contribute to their efforts to improve patient safety in their setting, will be a key factor in determining success.
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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 until January 1, 2009. During that time, the new standards and scoring methodology will be loaded onto the site. Therefore, the due dates for completing the PPR are being changed:
- Organizations with PPR due dates from October 1, 2008 through December 31, 2008 are not required to submit a 2008 PPR.
- Organizations that wish to document Plans of Action for requirements for improvement (Full PPR or post-survey Option 2 PPR) must submit the 2008 PPR by Sunday, November 30, 2008 at 11:59 p.m. Central Time.
When the PPR is re-activated on January 1, 2009, ambulatory care organizations will need to repopulate the Open PPR. (Note: The PPR is optional for OBS practices.) 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 not be activated in the Open PPR during the fourth quarter of 2008; it will become available on January 1, 2009. For more information, contact your account representative.
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The Joint Commission’s Standards Interpretation Group has received several questions from ambulatory customers about applying National Patient Safety Goal 08.04.01: In settings where medications are used minimally, or prescribed for a short duration, modified medication reconciliation processes are performed.
Ginny McCollum, associate director, Standards Interpretation Group, offers this helpful advice:
- The rationale for NPSG.08.04.01lists settings tha include office-based surgery and ambulatory care, but does not specifically mention ambulatory surgery centers. Please note that this Goal does apply to ambulatory surgery centers as well. The list was intended to provide examples of settings and not be all-inclusive.
- The terms ‘minimally’ or ‘short duration’ can be unclear. In this case, we are referring to something like a short term antibiotic. However, the organization should define what it means by used minimally or prescribed for a short duration.
- With respect to the last statement of the rationale, while it’s true that we do not require ambulatory organizations, ambulatory surgery centers and OBS practices to obtain information on the dose, route and frequency of a patient’s original, known and current medications, there are times when it is important. For example, it is important to check with the patient’s primary care doctor if requested to do so.
- When only short term medications are prescribed and no changes are made to the patient’s current medication list, the patient and/or family only needs a list of the short term medications. If there is a change in the long term medications, or if a new medication is added, the patient would need a complete updated list.
For more information on the 2009 NPSGs, contact the Standard Interpretation Group, (630) 792-5900, option 6, or use the online question form.
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For the first time, a complimentary, single-user license electronic manual, or E-dition, will be available for all accredited ambulatory care organizations and office-based surgery practices. The E-ditions will be available in November, and interested individuals can purchase additional user licenses and site licenses at that time. For other interested parties or organizations that wish to purchase an additional license, the special introductory price for a single user license for the ambulatory and OBS electronic manual is $297. This offer is good through April. For details, visit the JCR website, or call (877) 223-6866.
A study in the September issue of The Joint Commission Journal on Quality and Patient Safety looks at quality outcomes in accredited and non-accredited ambulatory surgical centers. To subscribe or to download and purchase a single issue of the Journal, visit the JCR web site.
- Medical Group Management Association, San Diego, Calif., Oct. 19-21, booth 616
- Becker's ASC Conference, Chicago, Ill., Oct. 23-24, booth 315
- American Society for Plastic Surgery, Chicago, Ill., Nov. 2-4, booth 234
- Radiologic Society of North America, Chicago, Ill., Nov. 30-Dec. 4, booth 9520
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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