Highly reliable patient care requires well-designed systems and professional accountability that support teamwork, trust and respect. Healthcare team members are well positioned to observe disrespectful and unsafe conduct – behaviors known to undermine team functions.
A new study in the January 2023 issue of The Joint Commission Journal on Quality and Patient Safety evaluated the feasibility and fidelity of implementing the Co-Worker Observation System (CORS), a tool and process to address disrespectful behavior through feedback from trained peer messengers, for staff nurses. CORS has been shown to decrease instances of unprofessional behaviors among physicians and advanced practice providers (APPs).
Researchers implemented CORS at three academic medical centers (Keck Medicine of the University of Southern California, University of Iowa Health Care and Vanderbilt University Medical Center) using a project bundle with 10 essential implementation elements. Reports of unprofessional behavior among staff nurses that were submitted through the institution’s electronic reporting system were screened through natural language processing software – coded by trained CORS coders using the Martinez taxonomy – and referred to a trained peer messenger to share the observations with the nurse.
A total of 590 reports from the three sites were identified from September 2019 through August 2021. Most reports included more than one unprofessional behavior – a total of 1,367 unprofessional behaviors were successfully mapped to an existing CORS category:
- Clear and respectful communication – 48.8%
- Responsibility – 33.3%
- Appropriate medical care – 6.8%
- Professional integrity – 5.9%
- Report of concern/possibly egregious – 5.2%
Of the peer messages, 76.5% successfully completed a debriefing survey. The researchers believe the study supports that CORS can be successfully implemented with staff nurses when nursing infrastructure is adequate.
“As the largest group, by number, of healthcare professionals, nurses must be included in programs that promote professional accountability,” said Cynthia Baldwin, MS, RN, CPHRM, lead study author and senior associate, Department of Pediatrics and School of Nursing, Vanderbilt University Medical Center. “Prior research shows that unprofessional behaviors in healthcare settings lead to unhappy, less motivated workers and poorer outcomes for patients. We thought this was a unique opportunity to provide nurses with the capability to self-regulate as shared governance models highly support this concept. Creating a vision for respect and inclusion for all team members aligns with organizations’ values and nursing code of ethics.”
The January issue is available in special open access through the end of the year. Also featured in the issue:
- A Multicenter Collaborative Effort to Reduce Preventable Patient Harm Due to Retained Surgical Items (Ascension)
- Retained Surgical Items: How Do We Get to Zero? (editorial)
- Factors That Affect Opioid Quality Improvement Initiatives in Primary Care: Insights from Ten Health Systems (data from 10 U.S. healthcare systems)
- Impact of Adherence to a Standardized Oxytocin Induction Protocol on Obstetric and Neonatal Outcomes (HCA Healthcare)
- Determination of Unnecessary Blood Transfusion by Comprehensive 15-Hospital Record Review (observational analysis of 15 U.S. hospitals)
- Engineering a Clinical Microsystem to Decrease Workplace Violence for Medically and Psychiatrically Concurrently Decompensated Patients (University of Texas Southwestern Medical School, Dallas)
Access the Journal.
The Joint Commission and Joint Commission Resources (JCR) have been named as an Ambassador to the Occupational Safety and Health Administration’s (OSHA) Alliance Program.
The Alliance Program partners with organizations and other agencies “to share information about OSHA’s initiatives and compliance assistance resources with workers and employers, and educate workers and employers about their rights and responsibilities,” according to the OSHA website.
The Joint Commission and JCR have been part of the Alliance Program since 2004. To continue to support the Alliance Program’s mission, The Joint Commission will share information with its stakeholders and encourage them to participate regarding:
- OSHA’s national initiatives and rulemaking processes.
- Safety and health laws and standards, including the rights and responsibilities of workers and employers.
- Building relationships with OSHA’s national, regional and area offices to address health and safety issues.
- Personnel and industry safety and health professionals regarding good practices or effective approaches through training programs, workshops, seminars, and lectures.
Learn more about the Alliance Program.
Register now for two free Pioneers in Quality Expert to Expert webinars scheduled for January. The webinars are on the 2023 annual updates. The series provides a deep dive into measure intent, logic, and other clinical/technical aspects of electronic clinical quality measures (eCQMs) to assist hospitals to improve data use for quality improvement.
The webinar series incorporates content from The Joint Commission, Centers for Medicare & Medicaid Services, Mathematica, and other measure stewards. The sessions will include a live Q&A segment and recordings and presentation slides will be available through the webinar platform. Continuing Education (CE) credit is available, but only for those participating during the live broadcasts.
The webinars are on:
- Jan. 10 — Venous thromboembolism (VTE) eCQMs VTE-1 and VTE-2
- Jan. 24 — Hyperglycemia and hypoglycemia eCQMs
The sessions’ learning objectives are to:
- Navigate the eCQI Resource Center website to locate measure specifications, value sets, measure flow diagrams and technical release notes.
- Apply concepts learned about the logic and intent for the eCQMs.
- Prepare to implement the eCQMs for the 2023 eCQM reporting period.
- Identify common issues and questions regarding the eCQMs.
To earn 1 CE credit, participants must:
- Individually register for a webinar.
- Attend the entire live broadcast.
- Complete a post-program evaluation/attestation. A survey link will be sent to the participant’s registered email after the webinar.
The Joint Commission, in collaboration with the Georgia Department of Public Health (DPH), announced that Northside Hospital, Atlanta, is the first in the country to receive Maternal Levels of Care (MLC) Verification. Northside Hospital also is the first in the state to receive a Level IV Maternal Center Designation from DPH.
The U.S. has a higher maternal mortality rate than many other developed countries. Georgia is taking action to help improve care for women and newborns. It is one of a handful of states to review risk-appropriate care and the first to collaborate on a program with an accreditation organization.
“The Joint Commission congratulates Northside Hospital on this outstanding achievement, as well as the state of Georgia for its efforts to standardize, implement and improve regionalized systems of care,” said Brian Enochs, JD, Executive Vice President for Business Development and Marketing, The Joint Commission. “Georgia is leading the way in establishing levels of maternal care designations for hospitals, and we expect more states to follow as the nation’s overall maternal mortality rates remain high. Through the MLC program, we look forward to working closely with hospitals to identify areas where they may need to strengthen risk-appropriate care to match their population – helping to make care safer for mothers and their babies.”
In 2022, DPH announced a partnership with The Joint Commission, recognizing its MLC Verification program. The program, offered in collaboration with the American College of Obstetricians and Gynecologists (ACOG), is a verification process that involves an on-site comprehensive review of a hospital’s maternal capabilities and policies, as well as a level of maternal care determination.
Through the partnership, hospitals may seek the optional Maternal Center Designation with The Joint Commission’s MLC Verification program. Details on the designation process are available at https://dph.georgia.gov/maternal-and-neonatal-center.
“Early in our history a pivotal decision was made to provide the best care for mothers and newborns in Georgia at Northside Hospital,” said Melissa Sisson, who is retiring as Northside Hospital's longtime Director of Women’s Services and led the hospital’s certification process. “Our strategy began in earnest with the establishment of a maternal-fetal medicine program, alongside a team of highly qualified obstetricians, certified midwives, nurses and staff. The designation of Northside Hospital Atlanta as the first Level IV Maternal Center in Georgia is an achievement that validates our ability to care for the most critically-ill mothers and newborns in Georgia.”
More babies are born at Atlanta’s Northside Hospital each year than at any other single hospital in the U.S. This position offers Northside a unique opportunity to develop exceptional expertise in the care of women and newborns with high-risk conditions complicating their pregnancies.
“The Georgia Department of Public Health commends Northside Hospital for its commitment to high levels of care, and for their partnership with DPH to improve the health of mothers and babies in Georgia,” said Kathleen E. Toomey, MD, MPH, Commissioner, Georgia Department of Public Health.