Safety first

A new center established by the Joint Commission could lead to bigger changes for the accreditation organization and standards requirements for hospitals down the road.

The commission launched its new Center for Transforming Healthcare last week in Washington, joined by eight hospitals that have been participating in the center’s first project on hand hygiene. That announcement came fast on the heels of the accrediting organization’s latest sentinel-event alert, in which the Joint Commission directly tied leadership to medical errors, and called for more accountability among senior executives to reduce harm in hospitals.

The center, along with the commission’s tighter focus on accountability and leadership, represents a shift in the way the organization is looking at how hospitals approach safety, and how the commission measures their performance, according to Joint Commission President Mark Chassin. “We can make healthcare safer; not just a little safer, a lot safer,” said Chassin during a conference to introduce the center.

The center, which will be headed by Chassin and have its own board made up of Joint Commission officials, is expected to perform a different function than the accreditation process. Where the commission’s standards, elements of performance and National Patient Safety Goals require hospitals to establish safe processes, what’s been missing is information on the best tools to create those processes, Chassin said. “We are starting that work, to create interventions.” Over time, the interventions proven to work through the center’s projects could be folded into the accreditation process, he added. “That certainly will be part of the future.”

The Oakbrook Terrace, Ill.-based center represents the commission’s entrance into a quality arena filled with other organizations—such as the Institute for Healthcare Improvement, the Commonwealth Fund and the Agency for Healthcare Research and Quality—that have been studying various safety initiatives for some time.

The commission is creating mechanisms to deliver the center’s solutions to accredited organizations as part of accreditation at no added cost, according to Joint Commission spokesman Ken Powers. There will be Joint Commission Resources publications, educational offerings and consulting programs for those organizations that want them, Powers said in an e-mail.

The commission began putting together the center last summer, and last fall recruited hospitals for its first project on handwashing. Chassin said the commission hopes to create a $100 million endowment to maintain the center over its first five years, with the commission contributing the first $10 million toward that total. Several other sponsors—including the American Hospital Association, GE Healthcare and Johnson & Johnson—also have contributed, he said. The commission is not accepting contributions by facilities accredited through its process, Chassin said. Donors will not have a say in what’s studied, Powers said.

The goal is to transform healthcare into a highly reliable industry, much like the nuclear and aviation industries, according to Chassin, who has been advocating this position since taking over the commission nearly two years ago.

Eight hospitals began collecting data on their hand-hygiene compliance last year. They found a range of reasons that contributed to a failure of staff to wash their hands, according to data from the center. Armed with those results, the hospitals are now using a variety of techniques through the center to test solutions that will be shared with all accredited facilities.

Don Lambeth, president and chief operating officer of 795-bed North Carolina Baptist Hospital, Winston-Salem, said the hospital—part of the Wake Forest University Baptist Medical Center—is studying the use of infrared sensor technology to monitor handwashing among staff. The hospital is determining what the return of investment would be on implementing that technology.

The commission’s sentinel-event alert pointed out communication breakdowns that lead to process failures. Those are the failures that cause harm, according to the alert. High-reliability organizations operate on safety cultures, which provide an infrastructure that allows everyone to learn from errors in a blameless setting while still holding people accountable for reckless acts. That culture “is rooted in the leadership commitment,” Chassin said.

The commission’s focus on culture, leadership and sustainable improvements will get the attention of executives who have been starting to tackle these issues, hospital officials say. “CEOs are having to be more dynamic now,” said Marty Bonick, president and CEO of Jewish Hospital, Louisville, Ky.

In addition to following leadership accrediting standards and the National Patient Safety Goals, the commission recommended a series of steps in its alert that hospitals should take to create a safety culture. Some of those steps include creating a code of conduct for staff and improving communication methods, and establishing for executives evaluation measures that focus on quality and safety.

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