The Chief Medical Officer at a large and well-known nonprofit, multi specialty academic medical center in the mid-west became familiar with Joint Commission Resources (JCR), serving on its advisory board as he worked to integrate recommended practices and processes into that organization.
Though recently retired, he also served as the steward of elevating standards and services at another academic medical center in the south, and spoke about the process, challenges, progress — and rewards of — implementing JCR’s High Reliability Services throughout that system, as well.
Q. When did you first become familiar with JCR’s High Reliability Services?
I was introduced to the concepts of performance improvement when I had the privilege of sitting on the advisory board, and I became a big fan. When I assumed my last position, I came with a mission to drive clinical quality improvement. I knew that I needed a platform to drive it from and it was obvious to me that JCR’s High Reliability Services was the platform I wanted.
Q. What was the reception to those concepts?
Q. How did the assessments inform and drive progress at your last organization?
They helped us prioritize areas for improvement and, because they’re data-driven, there’s transparency, and that helped change a punitive culture into one that emphasized experience-driven learning opportunities.
Our first assessment identified our areas of focus, and our second showed improvement in each of the spaces. Then, we dropped back a little, but to me that proved that the process was good because it reflected reality. We were thinking about things properly and it made us reassess where we really were, rather than where we thought we were, and it created a very positive and motivating atmosphere.
We wanted to drive quality improvement here and get some systems in place, and the High Reliability Services really helped provide a structure for doing that.
Q. What is the working relationship with the team like?
I was already fairly comfortable with their advisors when I started here but having them on site helped us choose the most appropriate steps and decide when to take them. Personally, I felt strongly that I needed the support of outside assessment experts to give the initiative the gravitas it needed. Driving a program like this is about choosing the right things to address at the right point in time. We wanted to drive quality improvement here and get some systems in place, and the High Reliability Services really helped provide a structure for doing that.
Also, their experience. Knowing that whatever is observed here is something that has been seen in other places. That the facilitators have done this before and know the field and what’s going on out there.
For instance, one of our assessments determined that we were doing a lot of good things, but there still wasn’t a common approach. We had to learn to work together to build a program and that started with establishing organization-wide understanding, buy-in and accountability. We struggled with some of our performance improvement work because of some embedded cultures in place at the time, but we finally began to row in the same direction, versus rowing in opposite directions on either side of the boat and spinning in circles.
Q. What other improvements have you seen as a result of JCR’s High Reliability Services?
It’s really about the incremental steps and judging overall improvement. We were able to focus on internal data, first. Before, we had different quality scorecards, but we settled on a single one that dealt with some of the most basic things, such as hand hygiene, infections, admissions, mortality and patient experience. We were able to gather and present data in an easy-to-understand way that led to quality improvements. We were able to structure a program, identify problems and put programs in place that specifically focused on those, with some standardized programs and practices that got everyone speaking the same language.
Also, we are a safety net hospital. We have a tough population, and when we compared ourselves to national standards it helped drive understanding and realism about our goals. So, we were able to show progressive movement in the metrics internally and build trust in the data through transparency. I also think that the engagement level has improved because employee satisfaction scores have gone up over time, and it’s been easy to build physician engagement, which reinforced for me how essential that is to drive a strong program.
Something that is indicative of the cultural change that has occurred is that four years after we started we put in a Chasing Zero program. Choosing the right time to put a program like that in place was essential. Trying that right away would have been highly disruptive, so waiting helped give the initiative a lot of traction. Our scorecards are accessible on our intranet and data is updated monthly. We also selected six Never Events to track with a running clock on our intranet showing the number of days since the last significant safety event and, when there is one, the clock stops and a brief explanation is given as to why.
We also put in an office of patient experience and that significantly improved our scores in that area. Now they’re talking about an office of operational excellence. The new mantra is on maximizing value which engages hospital operations and finance in also using high reliability systems.
Q. What has it been like working with JCR? What advice would you give other organizations considering High Reliability Services?
*The use of Joint Commission Resources consultative technical or advisory services is not necessary to obtain a Joint Commission Accreditation award, nor does it influence the granting of such awards.