The Joint Commission on Accreditation of Healthcare Organizations would like everybody to stop trying to reinvent the wheel. If you want to run a quality shop, pay attention to the spirit and the intent of the accreditation manual. Incorporate its ideals into your organizational ethos, and you'll do fine come survey time.
That's the message that Russell Massaro, M.D., executive vice president for accreditation operations at the JCAHO's Oakbrook Terrace, Ill., headquarters will deliver in a lecture at 4 p.m. Tuesday, March 9, and 10: 30 a.m. Wednesday, March 10, at the ACHE's annual congress.
Massaro will be accompanied by Dale Brown Jr., a field surveyor for the Joint Commission, who will give the view from the trenches. They'll take questions and discuss where the organization is headed.
The Joint Commission's standards and survey processes provide a skeleton on which to hang good organizational operations, Massaro says. But he thinks organizations don't necessarily see it that way. "They construct a series of activities for the purpose of the survey and accreditation (that are) distinct from their efforts to manage their business in an effective, efficient way. That's not necessary, and it's wasteful," he says.
Massaro worked for a consulting firm that developed outcomes management systems for specific diseases across the continuum of care-such as diabetes, congestive heart failure, stroke and asthma. They created pathways to achieve maximum patient outcomes, high satisfaction and good cost control. Most healthcare organizations are following similar strategies. These approaches embody many of the Joint Commission's standards that improve quality of care and make the organization more competitive.
"So the message I'm going to try to give them is, quality is good business. Some folks perceived a need to create an artificial set of activities related to Joint Commission accreditation, when in fact much of what they do on a day-to-day basis to run the organization can be used as evidence they meet standards."
Joint Commission standards can also be used as a template when merging two organizations' cultures and procedures, Massaro says.
The survey manual covers 11 areas in 11 chapters, Massaro notes. Five are patient-care standards, and six are functional standards related to infrastructure.
Take degenerative joint disease as a typical high-volume diagnosis group. The full continuum of care for the osteoarthritis patient touches on all 11 areas. Degenerative joint disease is initially recognized and treated in an ambulatory setting. Many patients will require surgery.
So the operative questions are: How do you identify and treat people with this disease in the community? How do you decide at what point they should have surgery? How do you evaluate and prepare them for surgery? How do you admit them, operate on them and help them recover? How do you rehabilitate them and teach them to function in the home again? Do you provide home care?
If you're doing it right, your doctors and nurses have organized the patient's treatment into a cohesive care pathway, based on the best practices in that community, Massaro says. You can measure the patient's progress through the system and compile that into global outcomes statistics on complication, infection and mortality rates; length of stay in each setting; restoration of function; patient satisfaction; and cost.
By analyzing the results for large numbers of patients, clinicians can make judgments about improving the pathway over time, Massaro says.
"That whole scenario is played out for diabetes, congestive heart failure, stroke, bypass surgery, asthma, chronic lung disease and so on," he says. "Each time they construct a pathway, they're applying standards from eight or nine chapters in . . . our manual.
"Anesthesia is in our treatment chapters," he adds. "They have to transfer the patient from one level to another-that's our continuum-of-care chapter. They have to make sure the patient's data, lab tests and medical record are available to all providers-that's our information management chapter. They have to measure the outcomes-that's our performance-improvement chapter. They have to have resources and direction to do all the above-that's the leadership chapter."
Applying these principles is good management, above and beyond accreditation, Massaro says. "The accreditation is a byproduct. You shouldn't have to worry about it."