Just before the COVID-19 crisis began gripping the nation, I was asked to present a lecture to a group of Joint Commission accredited Federally Qualified Community Health Centers on their preparation for Primary Care Medical Home (PCMH) certification.
- environment of care
- human resources
- emergency management
- infection prevention and control
- National Patient Safety Goals
- provision of care, treatment and services
- record of care
- rights and responsibilities of the individual
- waived testing
PCMH certification recognizes various types of eligible health care organizations under the ambulatory care, hospital, and behavioral health care and human services programs. These organizations must have Joint Commission accreditation and agree to adhere to the additional PCMH principles and standards.
COVID-19 hit all of us suddenly and highlighted the exact purpose of emergency management planning. As a part of emergency management planning, organizations must identify and determine the organization’s role in various emergency situations. This role is directly dependent on the size of the organization and its role in the community’s health care delivery system. Organizations run the gamut from being the only health care delivery option to being surrounded by comprehensive access care options. The determination of primary and supportive care is critical, prior to the arrival of an emergency.
Importance of Patient-Centered Care
As a PCMH, organizations are required to involve the patient as a member of the health care delivery team. Patients are expected to advocate for themselves in conjunction with the medical staff.
Access to coordinated, comprehensive and superb care is the responsibility of the PCMH organization, as well as the use of a systems approach to the delivery of that care.
As we were hit with the early manifestations of COVID-19, all the principles of PCMH came into play. Patient-centered care supported the identification of this new challenge on the patient treatment horizon. Coordinated and comprehensive care were part of the team approach to health care delivery. The presence of the concept of teams, including the patient, resulted in a more rapid identification of the culprit. The systems’ approach to care helped to coordinate with external agencies, the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and very importantly, local and state health departments.
Some of the areas of principle focus for The Joint Commission and PCMH are presented here.
Emergency Management & Environmental Considerations
COVID-19 illustrated the need for a robust emergency management plan. Ideally, this should address:
- maintaining, expanding or contracting services
- conserving resources
- curtailing services
- evacuating or closing the organization to new services
- acquisition and control of needed equipment and supplies
Ideally, this needs to occur in these different phases:
There wasn’t much time for mitigation or even preparation. The response remains ongoing and recovery will continue throughout this year. The recovery phase will not be easy or quick as distribution of the vaccines to the waiting public is proving to be a challenge.
Human Resources Considerations
PCMH organizations often differ from larger organizations in that they have fewer staff and staff members tend to wear multiple hats.
As the pandemic wears on, the economic pain is worsening. In health care, the cancellation of elective procedures and the overwhelming volume of patients has taken a toll on the bottom line of many organizations.
Organizations may need to take the time to start having difficult conversations on:
- furloughs of staff members, some of whom may be in key positions
- reductions or increases in laboratory or pharmacy service hours, funding and staffing
- terminations based on the lack of needed financial resources
- modifications of the roles and responsibilities of some staff members to meet the organization’s needs
Infection Prevention Considerations
Infection prevention preparation for Joint Commission surveys really helped organizations the most with COVID-19. Risk identification and providing written descriptions on how to prepare for a potential influx in infected patients, standard IC 1.6.1, EP 4, became a supremely important requirement. Any organization that identified a “pandemic” as a possible emergency management scenario, certainly deserves kudos!
While preparing for survey, organizations had to consider infection control from the standpoint of:
- limiting exposure to an unknown pathogen for staff members and patients
- personal protect equipment (PPE) supplies, including sourcing, costing, acquisition, storage and dispensing
- screening and assessment of staff members and patients who entered the facility
- hand hygiene support by leadership
Last February, these exercises may have seemed arbitrary, but our Joint Commission accredited organizations with PCMH certification have indicated that their accreditation and certification preparation yielded a great deal of time and dollar savings once the pandemic hit.
While we can’t claim that Joint Commission standards can anticipate every roadblock in these strange times, we are pleased that our standards helped so much in the early days of COVID-19. We want our organizations to know that we’re there with you, every step of the way. As new challenges arise, please do not hesitate to contact your account executive with any questions or concerns.
Charles Darke, DDS, MPH, is a field representative in Joint Commission’s Ambulatory Health Care Services.