(upbeat ambient music)
-: Hello and welcome to today's podcast,
"Spotlight on Success: Settlement Health."
I'm John (indistinct) with the Joint Commission
and I'll be your host.
Today we'll be talking with Dr. Warria Esmond.
Dr. Esmond is an OB-GYN
and the Chief Medical Officer at Settlement Health,
a community health clinic located in East Harlem, New York
that offers a full range
of primary care family medicine services.
Dr. Esmond will be sharing her organization's story
about achieving Joint Commission accreditation.
Dr. Esmond, thanks for joining us today.
-: It's a pleasure to join you, thank you.
-: Now to start, can you tell us a little bit about
Settlement Health and Alliance of Chicago,
as well as what your roles are in those organizations?
-: Certainly.
So at Settlement Health,
I've served as a Chief Medical Officer since 2004.
And in that capacity, in addition to supervising
all the clinical care that happens at the health center,
I've been involved in work around practice transformation,
achieving accreditation, such as Joint Commission,
patient centered medical home.
Initially I was involved in EMR implementation
and continue to work to improve the quality
and efficacy of the health center
and in the care for patients in East Harlem.
And my role at Alliance Chicago, which I joined in 2019,
I serve as Chief Clinical Officer,
and Alliance Chicago is a health center control network
that receives funding from HERSA to support health centers
in their use of electronic health records.
When Alliance was founded,
its initial function was to support the implementation
and hosting of electronic health records
for federally qualified health centers around the country.
In its recent roles,
we're looking to diversify our offerings of EHR platforms
to support in a vendor agnostic way,
health centers and their use of data, their access to data
and their processes to improve practice quality
and achieve the transformation necessary
to be successful in current day times.
-: Dr. Esmond,
what led you to decide to work with the Joint Commission?
-: So when I joined Settlement in 2004,
our CEO at the time handed me a list of requirements
to achieve as Chief Medical Officer,
and the top of his list
was achieving Joint Commission accreditation.
In his mind, and I think we all learned that subsequently,
the notion of looking deeply inside of your organization
and systems and processes that promotes patient safety
as importantly put that seal of approval
of the Joint Commission on your organization was his goal.
And so accepting the job meant I was accepting
getting us Joint Commission accredited.
-: Now, prior to this position
did you know anything about the Joint Commission?
-: Actually I did.
My prior role was within a health network,
a large hospital system on Long Island
and of course it was Joint Commission accredited.
So I'd had that experience of every three years or so
having the Joint Commission survey the hospital,
sometimes get involved in the ambulatory care,
really looking at how the organization was functioning.
So at a very high level I did understand
what the Joint Commission was accomplishing
and what we as a healthcare provider
in the hospital setting were required to be compliant with.
-: What can you tell us about your experience
with the Joint Commission survey?
How did you prepare
and maybe what was your experience like with the surveyors?
-: So our initial survey was actually the week
after we went live on our electronic health record.
So it was a very hectic time,
but we really took as an organization
a very team-based approach to preparation.
We pulled together all of the necessary team members
from operations to human resources to clinical services
and facilities to come together initially to become familiar
with the standards of the Joint Commission
and began to evaluate
our capacity to be successful on an initial survey.
We were fortunate at the time,
HERSA was really supporting Health Center's quest
to achieve Joint Commission recognition.
So there was a lot of technical assistance
and consulting services available to us.
And it took us about two years to really get everyone
up to speed on the expectations of the standards.
And we were ready for survey
and had our initial survey in March of 2008.
And it was actually an excellent process.
We had a surveyor
who was very familiar with community health center,
she was a Chief Medical Officer, as the clinical surveyor,
she was the Chief Medical Officer of a health center.
And we had a team that was very collaborative
in terms of their approach to the survey process.
It was a three day survey and we did amazingly well,
in fact, we got a phone call from our health center liaison
at the Joint Commission who was Lawn Berkeley at the time
and he commended us for being
one of the first health centers to have
so few findings on an initial survey,
I think we had three findings on our initial survey.
So of course we were very proud
and what we agreed was the work that we had invested in,
in our initial survey we needed to support and maintain
so that we could continue
to be successful in our recognition process.
-: And while you were going through the survey process,
did you notice any differences
between the Joint Commission survey and say a state survey?
-: Oh yes.
So when I arrived at Settlement,
we had her first New York State survey,
which in New York we call Article 28.
And it was one of the most invasive processes
that I had ever been through
in my years as a healthcare provider.
They pulled out rulers, they measured how far our boxes
were from the ceiling in our storage area.
It was very brusque and was not very thoughtful about
what challenges the organization might be facing.
And then the response process was not dissimilar
from the Joint Commission survey process,
but I think the timeline may have been shorter
and the responses had to meet a standard
that the state required
and you risk the potential that they might come back
and check on your improvements.
When we first got recognized by the Joint Commission,
one, we had this very best practices approach
to our survey process,
so our surveyors were very collaborative
and very focused in on making sure that they left us
with some opportunities for improvement
and some tools to use to be successful
even in areas where there were no findings.
We learned later that in New York State,
there is an exemption from your state survey
if you are Joint Commission recognized.
And we were very quick to submit that documentation
to New York State 'cause we were so comfortable
with our Joint Commission process that we decided
we would avoid a state survey at all costs.
-: Dr. Esmond, what value or outcomes
or maybe even improvements
have come from working with the Joint Commission?
-: Well, I would say that first,
we have our leadership and management teams
keenly aware of all of the important standards
that relate to our patient safety,
to maintaining our building
in this comprehensive fashion
that I believe before our efforts to achieve accreditation
weren't always so clear across every team.
It's allowed us to come together as a leadership team
to speak a common language about the organization
and the work that we're doing.
It's really a positive thing
that a lot of the Joint Commission standards
align with our HERSA standards.
So to have that reinforcement
as we're proceeding through each year,
thinking through the standards really
as they're aligned makes it so much easier.
And it also helps us keep an eye
on systems in our organization
and make sure that we're providing the safest care possible,
the safest environment possible,
and with a team that's all on board.
We've also seen our staff really become very knowledgeable
about what it means to be Joint Commission accredited
and recognizing that that seal of approval for our staff
and for our patients is a critical one to communicate
and we make sure that that's on our website
and available for anyone who is looking
at Settlement Health from a web-based perspective.
-: Dr. Esmond, were there any challenges
obtaining Joint Commission accreditation?
And if so, how did your team overcome that?
-: I think the biggest challenge,
and it continues as standards evolve,
is the interpretation of standards.
So in the beginning
when we were preparing for our initial survey,
it took time to really go through the standard,
explain what that meant operationally
or clinically for the organization
and then to evaluate our systems and processes to assure
that they were meeting that standard.
So that was a big educational process
for those of us who were involved in the survey.
And at the time, I was probably only one
somewhat familiar with Joint Commission standards.
Again, our technical assistance
that was made available by the Bureau of Primary Healthcare
was very supportive of that.
And in fact, we dug in so deeply to understand
and participate in any of the seminars
that were available to us
that we all walked out on the other side
feeling like we had made a huge dent
in the knowledge gap that we started with.
In fact, one of our consultants came to visit us pre-survey,
it was like a mock survey
and she was just so touched by the preparation of our team.
I think that challenge is just really spending time
and educating staff and as we get new managers
and roles at the organization, we continue that education.
So in fact, we're currently preparing
for an upcoming survey in the first quarter of 2023.
We meet every two weeks,
we discuss the standards again in detail
with a close eye on what is changing
or what might change before the next survey,
and making sure that we have the documentation
that everyone is clear on what the standard is.
And then we do some mock surveys ourselves internally,
we walk around and look at the environment of care,
we train our staff to make sure that they understand
those standards that are pertinent to them,
particularly those related to national patient safety goals.
So again, the time commitment is not insignificant,
but I do believe the benefit of the process
and the constant review of standards
allows us to be sure that we are running a high quality,
safe organization.
-: As we wrap up, is there any advice
that you'd offer to a community health center
or a federally qualified health center
that's considering the Joint Commission for accreditation?
-: My first piece of advice
would be it feels like it's more work,
but it really is complimentary work
to those requirements we're already meeting
between State Health Department requirements
and Bureau of Primary Healthcare requirements
and I would propose that it's just another lens
with which to apply to your organization
to assure that you have the best systems
in place that you possibly can,
and helps you monitor areas of risk
and know what they are so that you're able to address them
and not put patients and staff at risk.
-: Dr. Esmond, thank you so much
for coming on the show today
and for sharing Settlement Health's
accreditation journey with us.
-: It's been my pleasure, thank you for having me.
-: Thanks for listening.
And watch out for upcoming episodes from this podcast
on the Joint Commissions website at www.jointcommission.org.