FAQs

Q: What is the Targeted Solutions Tool™ (TST)?

A: The Targeted Solutions Tool (TST) is a unique online application that simplifies the process for solving some of the most persistent health care quality and safety problems that exist within our health care systems. Introduced in 2010, the TST was developed by the Joint Commission Center for Transforming Healthcare to greatly enhance the efforts that Joint Commission accredited organizations are already making to tackle these difficult and pressing problems. TST is an application that guides health care organizations through a step-by-step process to measure their organization’s actual performance, identify their barriers to excellent performance, and direct them to proven solutions that are customized to address their particular barriers.

Q: How are Targeted Solutions identified?

A: Participating health care organizations use systematic process improvement methods to identify the targeted solutions. First, they measure the problems with rigor.  In many cases they learn that they are not doing as well as they thought they were. Then they identify exactly why the processes are failing, create solutions that are each targeted to the most critical contributing factors, and prove the effectiveness of those solutions. As other issues are tackled through the Center, they will be added to the TST. Work has already begun to address hand-off communications and surgical site infections.

Q: What health care problems are addressed in the Targeted Solutions Tool?

A: The TST currently provides targeted solutions for improving hand hygiene compliance and for reducing the risk of wrong site surgery. Targeted solutions for hand off communications, surgical site infections, heart failure hospitalizations, safety culture, falls and others will be incorporated into the TST as the Center completes these projects.

Q: Who can access the Targeted Solutions Tool?

A: The TST is available to all Joint Commission accredited organizations and is accessible via the Joint Commission Connect extranet – at no additional cost. The set of solutions for hand hygiene are targeted toward hospitals. The solutions for reducing wrong site surgery are targeted toward hospitals and ambulatory surgery centers.
 
Q: Is there a cost or fee associated with the Targeted Solutions Tool?

A: No. The Targeted Solutions Tool is available to all Joint Commission accredited organizations at no added charge.

Q: Is there a requirement to have RPI experience and to complete two to three projects in the first two years when conducting a project on the Targeted Solutions Tool? I read this on the Center website.

A: No, There is no requirement to have Robust Process Improvement™ (RPI) expertise or experience and there is no requirement to complete two to three projects in two years. The TST is designed so that anyone can conduct a project, regardless of process improvement or project facilitation experience. The tool walks the user through six easy steps to improve processes and see the benefits.  Participation via the TST is voluntary and self-paced. The information you read is for organizations that wish to participate in new Center projects that are being developed and tested for the TST. These organizations are referred to as “participating” organizations with the Center for Transforming Healthcare.
 
Q: Can all of The Joint Commission’s accreditation programs use the TST?

A: The TST is available to all Joint Commission accredited organizations. While the first set of solutions for improving hand hygiene was targeted toward hospitals, a pilot study confirmed that the solutions are also applicable in long term care settings. The second set of solutions for reducing wrong site surgeries is targeted toward hospitals and ambulatory surgery centers. As issues such as hand-off communications and surgical site infections are tackled through the Center, the solutions developed by the projects will be incorporated into the TST and will eventually cover more settings of care.
 

Q: How do I get access to the Targeted Solutions Tool?
A: All Joint Commission accredited organizations have an employee who is the “Joint Commission Connect” extranet security administrator. This is the person who is responsible for the accreditation activities for your organization. The security administrator can add new users and update the application’s profile of existing users to make the TST part of their application profile.

Q: How can I find out who is the security administrator at my organization?
A: Send an e-mail to tst_support@tcthc.org with your name, organization name and location. Center staff will respond to your e-mail within two business days.

Q: Do I need special training or expertise to use the Targeted Solutions Tool?
A: No. The TST is designed to be clearly understood and used by an organization’s current staff so that no new resources are required to implement it.

Q: Who has access to the information that I enter into the Targeted Solutions Tool?
A: Only individuals that your “Joint Commission Connect” extranet security administrator grants access to the TST will have access to your organization’s TST information.

Q: Will information that I enter into the Target Solutions Tool be made public?
A: No. Organization specific information will not be made public. It is confidential and is for your organization’s use only. It will not be used in the accreditation process. Aggregated de-identified compliance information may be made available.

Q: Will using or not using the Targeted Solutions Tool affect my Joint Commission accreditation?
A: No. Any information entered into the TST is kept confidential and will not be used in the accreditation process. An accreditation surveyor would have no way of knowing that an organization is using the TST unless the organization shares this voluntarily. However, if an organization chooses to use their TST work as part of their annual proactive risk assessment, then proof of use will be necessary.

Q:  What software does my computer need to use the Targeted Solutions Tool?

A:  The TST works best with the following applications and settings. You may want to consult with your company’s technical support before making changes to your PC or if you are unsure about your current settings.

Q:  How do I correct errors on screen displays in the Targeted Solutions Tool?

A:  Older Internet browsers may not display TST windows properly. Determine if your computer browser is Internet Explorer 7 or above; if it is not, contact your organization’s IT department for a browser upgrade.

Q:  Why should I use the Targeted Solutions Tool hand hygiene application?

A:  TST provides the foundation and framework for an improvement method that, if implemented well, will improve an organization’s hand hygiene compliance and contribute substantially to its efforts in reducing the frequency of health care-associated infections. Together, the leading hospitals and health care systems that developed the hand hygiene solutions have achieved and continue to show major and sustained gains in hand hygiene. At the start of the project in April 2009, they were surprised to learn that their rate of hand hygiene compliance averaged 48 percent. By June 2010 they had reached an average rate of 82 percent that had been sustained for eight months. Many other hospitals across the country – small, medium and large – collaborated with the Center to test the work of the original eight hospitals and provide guidance on the development of the TST for Hand Hygiene. These hospitals experienced the same gains as the original eight.
 

Q:  How long will a hand hygiene project take to complete?

A:  The duration of a hand hygiene project varies from organization to organization. Hand hygiene projects have generally lasted from six to 12 weeks depending on the resources and experience of the organization.

Q:  How many staff members should be on a hand hygiene project team?

A:  A core team of three to seven people is recommended.  

Q: How much staff time and commitment will a hand hygiene project require?

A:  You will need to obtain management support for your project and assemble a project team. Project teams can be expected to spend up to four hours a week collecting and entering compliance data, attending team meetings, and implementing solutions during the first 12 weeks of the project. You can expect to spend four hours each month to sustain the gains achieved by the hand hygiene improvement strategies.
 

Q:  What type of staff should be on a hand hygiene project team?

A:  The hand hygiene team should include a strong physician champion and a project leader to facilitate meetings and help gain buy-in from stakeholders. Include the manager of the pilot unit and people who work in the area, including ancillary staff, when appropriate (for example, housekeeping, lab, respiratory therapy). It is important to identify and consider the project stakeholders.

Q:  Why is hand hygiene defined as “wash in/wash out?”

A:  Observation was chosen as the method to determine baseline and post-solution hand hygiene compliance rates. However, it is nearly impossible to accurately observe hand hygiene compliance when washing occurs in a patient’s room. The Center decided to adopt the philosophy of “wash in/wash out” which directs health care personnel to wash their hands upon entry and exit from a patient’s room. This allows for accurate measurement, while still promoting the philosophy of washing before and after patient contact.

Q:  Both WHO and CDC guidelines address hand hygiene when a health care worker touches a patient or the environment and this is what our policy reflects. How do we reconcile this with "wash in, wash out?" 

A:  The concept of “wash in and wash out,” which is part of the approach and the solutions described in the Targeted Solutions Tool, describes a minimum number of times a health care worker should conduct hand hygiene when entering and exiting a patient’s room. If patient care necessitates the additional washing of hands (more than that required with “wash in, wash out”) this should be done in accordance with WHO or CDC hand hygiene guidelines.

Q:  What is a project charter?

A:  A project charter puts in writing the scope, team members, goals and completion dates of the hand hygiene pilot project. The project charter is signed by the project team members as a demonstration of their support for the project and their agreement on the project’s goals and scope.

Q: CDC and WHO guidelines indicate that health care personnel should wash their hands before and after patient contact. Why did the Center and participating hospitals decide to measure compliance upon entry to and exit from a patient’s room?

A: The collaborating organizations chose observation as the method to determine baseline and post-solution compliance rates. However, it is nearly impossible to accurately observe hand hygiene compliance when washing occurs in a patient’s room. The organizations decided to uniformly adopt the philosophy of “wash in – wash out,” whereby health care personnel are directed to wash their hands upon entry and exit from a patient’s room. This allows for accurate measurement, while still promoting the philosophy of washing before and after patient contact.

Q: Did the collaborating organizations measure and seek to improve the hand washing compliance of patients and visitors?

A: The Center’s project excluded measuring compliance of patients and visitors. CDC and WHO guidelines are directed toward health care personnel (HCP) only. The CDC definition of HCP excludes patients, family members and other visitors, but does include students, volunteers and other health care workers with direct patient contact. Studies have shown a greater risk of disease transmission from health care personnel compared to non-health care personnel such as patients and family members.

Q: Did the organizations attempt to reduce infections related to the use of medical equipment such as stethoscopes or clothing (e.g., lab coats and ties)?

A: The scope of this Center project did not include assessing the adequacy of procedures for disinfecting medical equipment or evaluating the impact of clothing of caregivers on transmissibility of infection. There are multiple factors that contribute to the effectiveness of infection prevention and control programs. Improving other aspects of infection prevention and control will be the focus of future Center projects.
 

Q: Why should I use the Targeted Solutions Tool wrong site surgery application?

A: The TST for Wrong Site Surgery was created to help organizations identify, mesure and reduce risks in key processes that can contribute to a wrong site surgery. These risks can be evaluated across the organization’s surgical system, including scheduling, pre-operative and operating room areas. Since the occurrence of wrong site surgery is rare, with most organizations going years without an occurrence, it could take a long time to monitor the incidence of wrong site surgery for a project. However, it is possible to monitor surgical cases for weaknesses that might result in a wrong site surgery, and that is exactly what the TST for Wrong Site Surgery does.

Q: How long will a wrong site surgery project take to complete?

A: The duration of a wrong site surgery project varies from organization to organization and generally lasts from 14 to 16 weeks, depending on the resources and experience of the organization. An organization can begin to see improvements in as little as eight weeks.

Q: How many staff members should be on a wrong site surgery project team?

A: On average, the project team should consist of five to seven members.

Q: What type of staff should be on a wrong site surgery project team?

A: The wrong site surgery project team should include a strong physician champion and a project leader to facilitate meetings and help gain buy-in from stakeholders. Include the operating room manager and people who work in the OR scheduling, pre-op and OR areas, It is important to identify and consider the project stakeholders.

Q: How much staff time and commitment will a wrong site surgery project require?

A: You will need to obtain management support for your project and assemble a project team. Project teams can be expected to spend up to four hours a week collecting compliance data in the first 12 weeks of the project. You can expect to spend four hours each month to sustain the gains achieved by the wrong site surgery improvement strategies.

Q: What is a project charter?

A: A project charter puts in writing the scope, team members, goals and completion dates of the wrong site surgery pilot project. The project charter is signed by the project team members as a demonstration of their support for the project and their agreement on the project’s goals and scope.

Q: Can I get a copy of the Wrong Site Surgery Targeted Solutions Tool?

A: No. The TST is not a checklist or bundle, it is a web-based application that uses a six step process to help organizations measure their performance in the areas of surgical booking, pre-op/holding, and the operating room.  This data is analyzed by the tool in a presentation-ready format which then leads the organization to solutions targeted to impact these risks.  

Q: Can an organization use the Wrong Site Surgery Targeted Solutions Tool in procedural areas?

A: Yes, it is recommended that you use the tool in the surgical areas first and then do a follow-up project in procedural areas to build on what you’ve learned, but the tool is suited to procedural areas as well.

Q: Does the Wrong Site Surgery Targeted Solutions Tool include solutions for regional blocks performed by anesthesia?

A: Yes, the pre-op/holding materials include an option to audit and improve the Time Out process for these procedures performed outside the operating room.

Q: Our organization is using a safe surgery checklist, can we use the Wrong Site Surgery Targeted Solutions Tool?

A: Yes, the Wrong Site Surgery Targeted Solutions Tool can be used to help you assess how well the checklist is being followed. It can also provide data that could be used towards building a checklist.  For instance, if the Time Out process is being initiated by the circulating nurse 99 percent of the time, then why would you want to implement a checklist where the physician initiates the Time Out?

Q: Is there any cost to use the Wrong Site Surgery Targeted Solutions Tool?

A: No, the Wrong Site Surgery Targeted Solutions Tool is provided at no additional charge to Joint Commission accredited organizations.

Q: I work in an ambulatory surgical center; can I use the Wrong Site Surgery Targeted Solutions Tool?

A: Yes, the Wrong Site Surgery Targeted Solutions Tool was tested both in hospital and ambulatory surgery centers of various sizes. The solutions contained within the tool are tailored to both settings.

Q: When will the data we’ve collected be available to present to our team?

A: The Wrong Site Surgery Targeted Solutions Tool will automatically generate your data analysis after you have input the minimum number of observations, which is 75 for both the baseline and improve phases. This analysis is provided in a PowerPoint format complete with illustrative graphs and descriptions. An advanced analysis feature generates additional custom charts based on your data.

Q: Our organization has never had a wrong site surgery. Staff are questioning the need to do a Wrong Site Surgery project with the Targeted Solutions Tool – what can I say to persuade them?

A: Many of the pilot organizations had also never had a wrong site surgery event. Like many organizations, they had established policies regarding surgical processes. But during the project it was discovered that what leadership thought was happening (i.e., following policies) and what was really happening were very different. They were pleased to find areas where they could improve and a tool that allowed them to measure success and monitor progress going forward. The Wrong Site Surgery Targeted Solutions Tool can be used to validate that your processes are consistent and effective in eliminating the risks that could lead to a wrong site surgery. 

Q:  Who do I contact with any questions about the TST?

A:  Call Joint Commission Customer Service at (630) 792-5800 or send an e-mail to tst_support@tcthc.org with your name, organization name and organization location. Center staff will respond to your e-mail within two business days.