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November 2013 Archive for High Reliability Healthcare

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Observations and Lessons Learned on the Journey to High Reliability Health Care.

What hurts your patients can also hurt your staff

Nov 25, 2013 | Comments (0) | 13982 Views

By Ann Scott Blouin, R.N., Ph.D., FACHE
Executive Vice President, Customer Relations
The Joint Commission

Ann Scott BlouinI clearly recall my first needlestick as a young staff nurse. I was recapping a used needle (which was the correct procedure at that time) and accidentally missed. I remember a feeling of dread; could I have contracted something from my patient? Fortunately, I didn’t. But from that time forward, I handled all needles with extra care around my patients and myself. Later, evidence showed that recapping needles resulted in more harm than good, exposing staff to unnecessary danger.  As a result, medication management practices changed.

As we strive to reduce patients’ healthcare-acquired conditions, such as infections, and protect them from potential harm, it’s important to understand that serious safety events can harm clinical and support staff, too. There is a strong inter-relationship between keeping your patients safe and keeping your employees and physicians safe, a point made in The Joint Commission’s excellent publication “Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation.” For example, keeping the environment protected from fire and incendiary devices leads to critical life safety for patients and the staff who care for them. Disposing of hazardous waste properly can prevent transmission of infection, sharps injuries and inadvertent exposure to carcinogenic agents. Chronically fatigued staff are prone to medication and judgment errors that can potentially result not only in serious patient safety events, but they can cause physical and psychological harm to themselves and other staff. A greater number of sharps injuries, car accidents and falls happen to staff who have chronic, inadequate quality and quantity of sleep and rest.

‘Connecting the dots’ between patient and worker safety is enabled by sharing data and safety information among risk management, human resources, occupational health, security and safety, and performance improvement departments. There is a very real relationship between staff’s perception of an employer who keeps them safe and their feeling of job satisfaction (Lucian Leape Institute, National Patient Safety Foundation, “Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care,” March 2013, www.npsf.org). A key tenet of a safety culture is that staff is treated with respect. And what better way to illustrate that than by devoting attention to how to keep staff as well as patients safe?

During this holiday season, give your staff this important gift: ensure to the best of your ability that you consider staff safety and well-being in all they do for your organization, just as you do for the patients you serve.

Lead the way to a safe, efficient practice environment

Nov 20, 2013 | Comments (0) | 4554 Views

Ana Pujols McKee, M.D.By Ana Pujols McKee, M.D.
Executive Vice President and Chief Medical Officer
The Joint Commission

Every physician wants an efficient and safe environment in which to care for their patients. Unfortunately, just wishing does not make it happen.

Highly performing clinical practice environments typically evolve because leadership has made a major commitment to making safety and quality a priority. Their leaders are also committed to cultivating and driving a culture of safety which prevails throughout the organization. In essence, high performing organizations make safety and quality improvement a strategic area of focus and work hard every day towards realizing their goals and vision.

There are many features that distinguish these high performing organizations. For example, accountability and participation in efforts to improve outcomes and reduce risk is routinely accepted as everyone's responsibility. Many of these organizations also have decentralized their clinical effectiveness and quality improvement resources and developed unit-based multidisciplinary teams consisting of front line staff. The work of the quality department is no longer practiced in a silo or viewed as that "little department in the basement" whose staff is seen on the floors occasionally. Instead, unit-based clinical teams focus on improving and solving local problems that they face on a daily basis. Who better to address these challenges and develop solutions than those who know them best?

If you are not among those fortunate enough to practice in one of these high performing environments where you are actively contributing to the transformation of your organization, you can still make a difference in your local environment. Consider developing you own team, whether in your practice or unit, work on those local problems and become part of the solution. You never know, others may very well follow. Making improvements can become infectious!

Physician experience with the standards: An opportunity for understanding and improvement

Nov 06, 2013 | Comments (0) | 6532 Views

By Robert A. Wise, M.D.
Medical Advisor
The Joint Commission

Physicians know The Joint Commission for its accreditation of hospitals, but it is the Joint Commission’s standards that most impact the physician, and it is through the standards that physicians come to understand The Joint Commission.

Most questions and concerns about standards that come to The Joint Commission from physicians fall within the following four categories:

  1. Standards not related to quality and safety:  The Joint Commission has heard from physicians that certain standards do not support quality and safety of patient care.  For example, when an outpatient setting is part of a hospital (such as in hospital clinics), instead of the ambulatory standards applying, our hospital standards apply, which may not seem to be a good fit for the setting.  Any standard that is thought not to support quality and safety of care are systematically reviewed by staff to determine if the standard needs to be updated or deleted.
  2. Standards that generate ongoing debate:  In some cases, there are divergent opinions concerning the best way to create a requirement.   For example, a number of standards in the Medical Staff chapter have been vigorously debated among physicians.  These issues include which clinicians are allowed to complete the admitting history and physical and the relationship between the organized medical staff and the medical executive committee.  We often find that issues that elicit ongoing passionate debate tend to be based less on data and instead are influenced by strong opinions.  While it is impossible to satisfy all stakeholders, The Joint Commission attempts to elicit all major points of view and create a clear rationale for the final requirement.
  3. Relationship of Joint Commission standards to CMS’ Conditions of Participation:  A number of standards originate as Center for Medicare and Medicaid Services (CMS) Conditions of Participation (CoP). Per our agreement with CMS, all CoPs must be included in Joint Commission standards, even ones that do not directly support the quality and safety of care. An example is the requirement that all medical record entries must be dated and timed. While we are required to include the CoPs in our accreditation standards, The Joint Commission works closely with CMS to remove or modify any requirement that has little direct impact to patient care.
  4. Misinterpretation of requirements within a standard:  On occasion, the intent of a standard is misunderstood.  For example, the privileging standards associated with physician privileging and re-privileging. These processes use a combination of the Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE). These two processes are used for different phases of the privileging process and are quite different. The most common misinterpretation is the level of complexity required in these two evaluations. Not infrequently, we find interpretations of these requirements that go significantly beyond the intent. The Joint Commission is reviewing different methods to clarify this type of misunderstanding.

The Joint Commission strives to include physicians in the standard-setting process. Making sure that physicians understand the reason for relevant standards and that they have a clear understanding of the meaning of the standards is a goal of a number of efforts being undertaken by The Joint Commission. These efforts include engaging physicians around their experience with the standards in order to inform staff when changes are needed.

The Joint Commission provides a Standards Online Submission Form as one of the means of soliciting questions about the standards. I invite physicians to take advantage of the form and send us your thoughts about the standards.