As announced earlier this month, Mark R. Chassin, M.D., M.P.P., M.P.H., has been appointed to lead The Joint Commission as its next president, succeeding Dr. Dennis S. O’Leary, M.D. Dr. Chassin’s appointment is effective January 1, 2008. Dr. Chassin is the Edmond A. Guggenheim Professor of Health Policy and Chairman of the Department of Health Policy at Mount Sinai School of Medicine, New York, and Executive Vice President for Excellence in Patient Care at The Mount Sinai Medical Center.
What follows is an insightful question-and-answer session with Dr. Chassin conducted by The Joint Commission Perspectives, the official newsletter of The Joint Commission. Dr. Chassin shares his thoughts with Joint Commission-accredited organizations and other interested stakeholders as he prepares for his new position.
Why did you choose to accept the position of president of The Joint Commission?
I wasn’t looking for a job. I’ve been very enthusiastic and content in my work at Mount Sinai. A lot of job opportunities do come across my desk, but this was one of the very few that I took seriously. It is undeniable that The Joint Commission is the most prominent quality and safety organization in American health care, from the standpoint of importance and level of influence. Also, this opportunity came at the right time, for quality and safety have never been higher on the agenda of all stakeholders. I believe we are poised to make major and substantial improvements in health care, and I want to be a part of that national effort.
What do you see as some of the major opportunities and challenges facing The Joint Commission and you as president?
The biggest challenge and opportunity are to build on the momentum of demands for major improvements to bring about real and durable change that improves health outcomes for patients. It is a challenge to get beyond measurement and measures to help accredited organizations make the substantial and quantifiable improvements that we all—not just The Joint Commission— want to see. Accreditation is vital to improvement, but it is not sufficient by itself. I would like to go beyond measurement and accreditation to facilitate that kind of improvement in quality and safety in accredited organizations.
How has your career up to now prepared you for this position?
I’ve been fortunate to have been able to play a variety of different roles, and all have been important in contributing to how I approach quality. I practiced emergency medicine for 12 years, and that was in real practice, not just supervising residents, in medium to medium-large community hospitals. I’ve been a state and federal regulator, I am a researcher, and, more recently, I took on the additional responsibility of overseeing all the quality, safety, and risk management activity of a very large hospital.
Quality measurement has been a particular interest of yours. As health commissioner in New York, you led some pioneering work in measuring performance using risk-adjusted outcomes. Do you see The Joint Commission developing new metrics for quality and safety?
The short answer is “yes.” We need more and better measures of quality, ones that address a wider spectrum of health care. In that development process, however, we must never lose sight of the absolute necessity to be as sure as we can that improvement on those measures will translate directly into improved outcomes for patients. Now, with respect to New York, we started with clinically and scientifically sound measurement, but we didn’t stop with measurement. We took the data on risk-adjusted mortality following coronary artery bypass surgery to the hospitals. But the part that I am most proud of is that we helped the hospitals figure out which clinical and administrative processes they needed to improve in order to achieve better outcomes. And when they improved those processes, outcomes did in fact get better.
Through its standards, National Patient Safety Goals, white papers, and other activities, The Joint Commission has taken a leadership role in spearheading efforts to improve safety and quality. Do you plan to continue on this path, and are there any new areas on which you would like to focus?
Well, I’m still learning about the organization and would not claim to be an expert on Joint Commission standards and procedures. It’s too early for me to be able to recommend any changes. But I do believe that the innovations in standards and accreditation surveys that Dennis O’Leary has introduced, particularly in the last five or six years, are really responsible for The Joint Commission’s leadership position in quality and safety. However, I would like to emphasize the need to understand the specific needs of accredited organizations as they initiate improvements and to then respond with high-quality products and services from The Joint Commission and Joint Commission Resources. I want us to take part in the process of creating, in a careful and rigorous way, the necessary tools and metrics and then disseminating them to organizations. We should be able to provide organizations with generalizable lessons so that they save time and resources from developing tools on their own and move more rapidly toward improvement. For example, if you want to reduce the frequency of long delays in getting laboratory tests back to clinicians, what specific causes of that problem have other hospitals, similar to yours, found when they tackled that problem? How exactly did they successfully manage the underlying causes of the problem? How do you embed improvements into routine work, so that they are sustained once the specific team that invented them has disbanded—we’ve done some work in this area at Mount Sinai.
Concern has been voiced that organizations are often asked to take on quality and safety interventions for which there may not be the evidence of effectiveness, as there might be for clinical or drug interventions. Where do you come down on the issue of the evidence?
A careful consideration of available evidence is vital to developing sound targets for quality improvement. We must have a high level of confidence that the actions that we are asking organizations to take improve patient outcomes. We will be careful to focus on the actions, then, that have the greatest effect on outcomes, and that have a beneficial long-term impact on organizations. We must also be mindful of the “opportunity costs” in undertaking a given improvement activity, for it takes the organization’s resources away from other improvement activities in which it might otherwise be engaged. There is a need to “prune this garden” to ensure that scarce resources are deployed in the most beneficial interventions.
How can The Joint Commission help providers address the proposed CMS rules about not paying for preventable adverse events?
I plan on exploring the CMS rules in greater detail. I would then involve the provider community in helping define The Joint Commission’s role in determining how to address them. I hope that CMS would be open to discussion about how to best achieve its quality and safety goals. Usually, it is very difficult to develop financial incentives for quality based on the administrative data available to Medicare. They are often a blunt instrument, and relying on them alone can produce unintended consequences.
As you know, this interview will be published in The Joint Commission Perspectives, the official newsletter of The Joint Commission. What key messages do you have for Joint Commission–accredited health care organizations that read this newsletter?
First and foremost, I want to continue with the kind of innovations that The Joint Commission has made to even further increase the value of Joint Commission accreditation and other programs, and I look forward to working with—and learning from—accredited organizations to achieve this goal. Second, as I have indicated, I also want to go beyond measurement and accreditation to help accredited organizations achieve real and major improvements in quality and safety.