Joint Commission surveys take on friendlier tone
Joint Commission surveys take on friendlier tone
Orion Project fosters partnership
A new initiative by the Joint Commission on Accreditation of Healthcare Organizations that aims to make the review process for hospitals more meaningful is receiving high marks from access managers who has been part of it.
An increased emphasis on education and on partnership between the Joint Commission, based in Oakbrook Terrace, IL, and the health care organizations it surveys characterizes the pilot initiative, known as the Orion Project, says Karen McKinley, CHAM, manager of hospital admission and utilization services at Penn State’s Milton Hershey (PA) Medical Center. The Orion Project is under way at selected hospitals in Pennsylvania and Arizona. (For a project synopsis, see story, at right.)
"The Joint Commission’s mission is to educate," she says, encouraging those with upcoming surveys to make use of them as a learning experience. "Don’t be afraid to ask lots of questions." This is in contrast to surveys of the past, where the tendency was for reviewees to "cringe and hide in the corner," McKinley notes.
Her facility’s October 1995 Joint Commission survey under the auspices of the Orion Project sparked some enhancements of her operation and underscored the effectiveness of several procedures already under way, she explains. The final report, received just three weeks after the team’s visit, resulted in the medical center’s most successful survey to date, McKinley says.
She shares the following highlights from the experience:
• Confidentiality. "The reception areas were a big issue how we greeted the patients and protected their confidentiality," McKinley says. "When we needed to ask questions to clarify [sensitive matters], it was stressed that it should be done in a private environment." As a result of the feedback, she adjusted staff placement, but no physical modifications were needed.
Surveyors also were interested in what staff did when they called a patient and got an answering machine. McKinley worked with the staff on scripting an appropriate message that doesn’t compromise the patient’s right to privacy. She notes, however, that such technological advancements as Caller ID and the blocking of anonymous calls underscore the fact that eventually this type of patient contact will need to be handled at the physician’s office.
• Patient rights. The Joint Commission also applauded the transfer of patient rights counseling from the registration staff to the physicians’ office staff. That idea was sold to the physicians’ staffs by emphasizing that it would improve the patient’s convenience and well-being. To facilitate a smooth relationship with the physicians’ staffs, McKinley’s employees take turns visiting them to discuss any complaints or problems.
She suggests documenting any efforts along this line such as the development of a handbook for office staffs for the survey team’s perusal.
• Bulletin boards. The surveyors were particularly pleased with six bulletin boards used to announce meetings, post minutes, and pose questions for staff. A year ago, she hung a large bulletin board over the department copy machine that staff and supervisors use to post newsletters, thank-you notes, and information about new programs, among other things.
The bulletin boards were a big hit with the Joint Commission team, McKinley says, because they address how information is communicated from the administration to the departmental employees and vice versa. "It’s part of the quality piece," she adds. "If [staff] don’t know what’s going on, how can they impact what’s going on?"
• Education. Making sure staff is familiar with the fine points involved in patient interviews is another area of interest to surveyors, McKinley notes. With help from the Orion Project representative, she developed a self-study program on age-related development and interventions that aids staff in assessing every patient they interview and in managing interviews appropriately.
"It helps guide people in how you talk to a teenager vs. a 90-year-old vs. parents with a sick child," she says. "It’s helpful to understand what goes through people’s minds at different ages: Adults like to be addressed as "Mr." and "Mrs."; teen-agers like to be spoken to and not at; you learn how to distract a child so you can work with the parents."
Both McKinley and Betty Bamonte, CHAM, whose organization underwent a regular Joint Commission review two years ago, emphasize the uncertainty regarding the subject matter that will be addressed.
"Each review team is unique and comes from a unique background," McKinley says. "They may focus questions in an area they are most comfortable with and enjoy."
Although her facility processes some 200 prisoners a day, Joint Commission surveyors didn’t ask one question about them, says Bamonte, admissions manager for the Louisiana State University (LSU) Medical Center in Shreveport. A colleague at another hospital, however, reported being asked detailed questions about how other patients’ safety was ensured when prisoners were on-site and how the prisoners’ confidentiality was protected, she says.
Like McKinley, Bamonte says she was struck by the educational tone of the Joint Commission visit, even though her survey team was not part of the Orion Project. Her surveyor was interested in a meeting she had with the hospital’s ethics committee concerning how patients were informed of their rights. The surveyor used that as the starting point for a conversation about the hospital’s responsibility to the patient and the patient’s responsibility to the hospital.
Other issues covered during her hospital’s survey included:
• How patients’ complaints were handled. LSU Medical Center has a patient relations department that addresses such complaints. Patients may speak to a representative of that department in person or may fill out a complaint form available to patients in the admissions area.
• Registration procedures. Bamonte had to provide a flowchart of the registration process. The surveyor observed an employee registering an outpatient and quizzed staff about how they protected patients’ privacy and about the signing of consent forms.
• Pastoral care. Regarding this new Joint Commission category, the surveyor asked whether admitters asked patients their religious preferences, and where this was documented. In her hospital’s case, patients are asked about religion, and the information is entered into the computer and printed on a form that goes to the pastoral care department. Bamonte also was asked to explain the procedure followed when patients ask for a chaplain.
Although Bamonte’s hospital scored in the 90s on its Joint Commission survey, surveyors pointed out one oversight, she says. "We did not have a policy for a consent for treatment for minors." The problem was corrected on the spot by adding a line to the existing consent form.
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