Category: Clinical Perspective
May 13 2016
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The Joint Commission accredits and certifies more than 21,000 health care organizations and programs in the United States, providing the tools and resources needed to deliver safe, high-quality patient care. We spoke with Dr. Ana McKee, executive vice president and chief medical officer of The Joint Commission, about the organization’s commitment to improving care for all patients and what it means to be a high reliability organization.

What is The Joint Commission’s role in health care?

The Joint Commission is an independent, nonprofit organization with a mission to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

We have experience and expertise in the full spectrum of health care, including hospitals, home care, hospice, medical equipment, long-term care and ambulatory. Having this breath of expertise makes The Joint Commission a unique organization in health care.

For some of the organizations we work with, Joint Commission accreditation fulfils their requirements for Medicare and/or Medicaid payments, because we have been approved by the Centers for Medicare & Medicaid Services (CMS) as having standards and a survey process that meets or exceeds Medicare requirements. In many cases, our accredited organizations will seek one of our certifications, which demonstrates they have met a specific set of requirements related to one particular area of care. We offer certifications for specific diseases, such as heart failure and hypertension, as well as for health care delivery such as our Integrated Care Certification and Community-Based Palliative Care Certification. All of our certifications help maintain consistent, high-quality care.

What do physicians need to know about accreditation?

Physicians play an important role in the accreditation process and should be actively engaged in it every step of the way. Accreditation involves creating structure and processes that reduce the variation of care, and physician input is critical to developing this framework. Physicians are in a unique position to influence change and help their health care organizations meet and exceed their patient safety and performance improvement goals.

What tools does The Joint Commission provide to help organizations meet quality standards?

We have a full complement of tools to assist accredited organizations in meeting and maintaining quality stands. One of the primary tools we offer free to all accredited organizations is the Targeted Solutions Tool® (TST®), which has been developed by our Center of Transforming Healthcare. The TST® helps organizations through a step-by-step process to accurately measure their performance, identify their barriers to excellent performance, and direct them to proven solutions that are customized to address their particular barriers. We currently offer a TST® for hand hygiene, prevention of patient falls, reduction of surgery site infection and improved hand-off communications. We are already seeing results, such as a 55 percent reduction in patient fall injuries through the use of the Preventing Falls TST®.

What is a high reliability health care organization?

A high reliability organization (HRO) is an organization that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity. The Joint Commission has spent years studying HROs outside of health care, in industries like defense (Department of Defense), aviation and nuclear power. These studies taught us there are certain principles that an organization needs to focus on. The three pillars of high reliability are leadership commitment to zero harm, a culture of safety and Robust Process Improvement® (RPI®) – performance improvement methods that are evidence based. Not many organizations like to commit to zero harm because they don’t think it is possible. Health care organizations that do commit make significant improvements in the care they provide to their patients. The Joint Commission wants to continue educating organizations and to help them begin to adopt these principles of high reliability.

Can you explain how Robust Process Improvement® (RPI®) works?

RPI® is the combination of three key concepts:

  • Lean – Identifying where non-value is in a process to eliminate waste
  • Six Sigma – quality improvement outcomes
  • Change Management – how to manage changes that people have to make to sustain outcome improvements

We encourage organizations to invest in training so they have the right tools to make sustainable improvements. Using a process and analyzing the data can produce the best outcomes.

The greatest opportunity for health care to improve is leadership taking a greater role and being more accountable for preventable errors and adverse events in their organization. If we move the needle in having more leaders make a commitment to reaching zero harm, I think the advancement in safety improvements will be remarkable.

Dr. Ana McKee presented with Dr. Alan Weiss, MD, chief medical information officer, Memorial Hermann Health System, at Cerner Ambulatory Summit on the tools and resources available from The Joint Commission to reduce patient harm, including Memorial Hermann’s success in hand hygiene improvements.