As results of its annual report indicate that hospitals still are not performing adequately in certain performance measurements, the Joint Commission has stepped in with targeted action recommendations for designing the hospital of the future.
Despite gains on process measurements, barriers to safety persist, according to the annual report. A lack of robust process measures and a splintered safety culture continue to stand in the way of real improvement, according to Mark Chassin, the commissions president. Healthcare organizations have not uniformly adopted a true safety culture, said Chassin, speaking to an audience of 300 at the commissions Annual Conference on Quality and Safety last week in Chicago.
Hospitals are more consistently providing evidence-based treatments to heart attack, heart failure, pneumonia and surgical patients, according to the report, Improving Americas Hospitals: The Joint Commissions Annual Report on Quality and Safety 2008. However, they are still failing to improve on quality measures such as discharge instructions for heart-failure patients and pneumococcal screening for pneumonia patients. About 72% of hospitals failed to achieve 90% compliance in discharge instructions, and 61.4% of hospitals failed to achieve 90% compliance with the screening, according to the commission report.
The annual report and the white-paper recommendations come as the accreditation organization continues to expand the ways in which it advises the healthcare industry. At the conference last week, the commission highlighted patient-safety initiatives that emphasized culture; disseminating best practices in key areas such as technology adoption; medication reconciliation and infection control; leadership; and medical staff, family and patient engagement. In the white paper on hospital design also released last week, the commission focused on several of the same areas, suggesting that the accreditation organization wants to sharpen its focus on targeted issues within healthcare.
The commission suggested a redesign of business and care processes in step with healthcare information technology adoption; promoting the use of health IT to support patient-centered care outside of the hospital; and sustainable funding for the support of widespread healthcare IT adoption.
But some of the actions in the white paper have been suggested elsewhere. For instance, the paper suggests using bundled payments to reduce variation in costs and encourage joint accountability. This is a concept that will be tested through a CMS demonstration in January 2009. While the initiatives in the white paper are not new concepts, putting them together in one comprehensive report confirms the value they have in the industry, said Herbert Pardes, a physician who is president and chief executive officer of New York-Presbyterian Hospital and its healthcare system. We were really trying to collate the best of what people have to say.
The commissions white paper shows there isnt one magic bullet to improve care, according to Kathryn Correia, president of 142-bed Appleton (Wis.) Medical Center and 168-bed Theda Clark Medical Center, Neenah, Wis., and senior vice president of the ThedaCare health system. It has embarked on its own three-year renovation and redesign plan to create the hospital of the future. Like the actions in the commissions report, ThedaCarewhich is using Lean methodology to institute changesearched extensively for the best practices, said Correia, who praised the commissions report. We took a lot from a lot of places and pulled it together in a way that made sense for the system, she said, adding that she would have liked to have seen the commission come out with its report three years ago.
Responding to the hospital building boom fueled by a need to update obsolete facilities, the commission said it put together the principles to guide organizations in hospital design. Without principles and guidelines, healthcare organizations run the risk of falling into old practices and following the status quo, according to the commission.
Hospitals face daunting challenges in transforming their culture, practices and design, Chassin said during a news conference. An expert panel consisting of 45 representatives from a broad range of healthcare stakeholders analyzed what effect current social, economic and healthcare trends will have on hospitals in the future to realize the recommendations laid out in the white paper.
As the commission continues to provide improvement help to the field, the organization is looking at ways to improve internally as well. The commission will not add new requirements in its National Patient Safety Goals for 2010, but instead it will focus on the current goals and conducting a review of the program, said Peter Angood who is vice president and chief patient-safety officer of the organization.
The Oakbrook Terrace, Ill.-based organization is pushing its internal changes and external efforts as its annual Form 990 shows the organization had a lower net income of $3.9 million in 2007, down 28% from $5.4 million in 2006, on higher total revenue of $113.9 million. Program services accounted for $85.8 million in 2007, down 12% from $98 million in 2006.
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