General Questions
Q: What is the Joint Commission Center for Transforming Healthcare?
A: The Center is a unique organization that uses the most modern and effective process improvement tools and strategies to develop solutions to safety and quality problems within hospitals and health care systems—the very environments where safety process breakdowns occur. The Center’s participants—the nation’s leading hospitals and health systems—are using a systematic approach to analyze specific breakdowns in patient care and discover their underlying causes to develop targeted solutions that solve these complex problems. The Joint Commission will then share these proven-effective solutions with the more than 16,000 health care organizations it accredits and certifies.
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Q: Why did The Joint Commission decide to create the Center?
A: Historically, The Joint Commission has led the way nationally and internationally to identify the highest priority health care quality and safety problems and to address them. With National Patient Safety Goals, core measures, and state-of-the-art accreditation standards, hospitals and other health care organizations know where they should be focusing their efforts to gain the greatest improvements in safety and quality. Many already devote sizable resources to this end. Yet, major shortfalls in quality and safety persist. The Joint Commission Center for Transforming Healthcare aims to transform health care into a high reliability industry.
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Q: How will the Center address shortfalls in quality and safety?
A: The Center is working with a network of leading hospitals and health systems to develop solutions to the most pressing quality and safety problems facing health care organizations today. The Joint Commission has recruited leading organizations that have pioneered the application of Robust Process Improvement
TM (RPI) methods and tools to health care. These include Lean Six Sigma and change management process. It is likely, for example, that a number of improvement projects will follow the Six Sigma improvement framework—define, measure, analyze, improve, control (DMAIC).
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Q: Why is the Center using Robust Process Improvement(TM) to improve health care?
A: One of the important advantages of employing process improvement tools such as DMAIC (define, measure, analyze, improve, control) is that they provide a systematic approach to solving complex problems. Specifically, they guide improvement teams to examine why processes fail to achieve their desired results. It is this systematic search for causes of quality and safety problems and the assessment of the relative contribution of each cause that gives these improvement tools a great deal of their effectiveness. Experience with the application of the tools of Robust Process Improvement
TM (RPI) in health care is consistent with that of other industries including aerospace, automotive, construction, electronics and more.
The Center is using these tools to identify the most pressing problems, measure their impact, discover their causes, develop specific solutions that are targeted to each important cause, and thoroughly test the solutions in real-life situations. The Center relies on the reach of The Joint Commission to spread the use of these solutions to improve the quality and safety of patient care.
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Project Selection
Q: Why did the Center pick hand hygiene as the first project?
A: The participating hospitals selected hand hygiene as the initial project for several reasons. First, there is a direct link between hand hygiene and health care-associated infections. According to the World Health Organization, hand hygiene is the primary way to reduce health care-associated infections. Nearly 100,000 deaths occur each year in America’s hospitals due to health care-associated infections. Although the action of hand hygiene is simple, compliance among health care workers is variable throughout the world. Thus, improving compliance can greatly improve the safety and quality of care.
In addition, each hospital noted that most of their previous efforts to improve hand hygiene compliance only resulted in short-lived improvement. In fact, according to the Centers for Disease Control and Prevention, studies have found that hand hygiene—the most basic, low cost, and low technology infection prevention and control strategy—is ignored by half of health care workers. Therefore, it was believed that the application of the RPI toolkit (Lean Six Sigma and change management process principles and methodologies) would result in solutions with a greater likelihood for long-term improvement.
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Q: What project will be tackled next by the Center, and which hospitals will be working on that project?
A: Hand-off communication is the next project we are tackling to improve patient safety and quality. Launched in August 2009, the second group of hospitals include: Fairview Health Services, Intermountain Healthcare, Kaiser-Permanente, Mayo Clinic, New York Presbyterian Hospital, North Shore-Long Island Jewish Health System, Partners HealthCare Systems, and Stanford Hospital and Clinics.
A hand-off is a transfer and acceptance of patient care responsibility achieved through effective communication.
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Q: What other projects or health care-related issues are in the pipeline for the Center?
A: Medication reconciliation and central line infections are some of the other priorities based on current concerns and the participating hospitals’ choices. In addition, the Joint Commission Center for Transforming Healthcare is working with two Rhode Island hospitals affiliated with the Lifespan system—Rhode Island Hospital and Newport Hospital—on the Rhode Island Universal Protocol Project: Further Reducing the Risk of Wrong Site Surgery. Using Robust Process Improvement
TM methods, the project teams will discover specific risk points and contributing factors, and will implement interventions and controls to foster the elimination of wrong site, wrong side and wrong patient surgical procedures.
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Solution Dissemination
Q: How will The Joint Commission roll out these solutions to the nation’s hospitals?
A: Detailed information about the root causes and identified solutions are available on the Center’s Web site. In addition, in mid-2010, all Joint Commission accredited and certified organizations will have access to an application on The Joint Commission Connect extranet that will provide a set of solutions customized and targeted to the specific circumstances of individual hospitals.
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Q: Do hospitals need to adopt Lean Six Sigma, hire Black Belts or retain consultants in order to implement the solutions identified by the Center and participating hospitals?
A: No. The Joint Commission’s Robust Process Improvement™ toolkit includes a variety of methodologies. While The Joint Commission supports the use of highly effective process improvement methodologies in health care, it does not require the use of a specific methodology. The goal of translating the Center’s work is to make the solutions free of jargon and easy to use by clinicians and quality professionals already employed or on staff at health care organizations.
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Q: Will non-Joint Commission accredited hospitals be able to obtain information on the solutions developed by the Center and participating hospitals?
A: All health care organizations will have access to the root causes and identified solutions posted on the Center’s Web site.
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The Hand Hygiene Project
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 participating hospitals 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 hospitals 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.
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Q: Did the participating hospitals 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.
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Q: Did the hospitals 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 on other aspects of infection prevention and control will be the focus of future Center projects.
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Structure
Q: How were the 16 participating hospitals selected?
A: The original 16 hospitals and health care systems are known for their experience in using Robust Process Improvement
TM tools successfully in applying systematic problem-solving to clinical quality and safety issues. They are also willing to devote the resources necessary to support the project work in their hospitals and to collaborate with their peers. A number of these systems include small and medium-sized hospitals, in both urban and rural settings (e.g., Intermountain, Trinity Health and Mayo Clinic). More small, rural and mid-sized hospitals will be engaged in piloting the solutions when they are ready for dissemination.
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Q: Is there a way for more hospitals to work with the Center to develop solutions to other pressing health care issues?
A: Interested health care organizations should contact John Cullinan, director, E-Health Information Products, at
jcullinan@jointcommission.org, 630-792-5822.
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Q: Is there a mechanism for health care organizations other than hospitals to participate in Center-led projects?
A: While the early projects focus on safety issues in hospitals, most of the solutions can be applied across all health care settings. The Center’s participants have substantial, real-life expertise using RPI in the health care environment. They are using a proven systematic approach to analyze specific breakdowns in care, discover their underlying causes, and develop targeted solutions that solve these complex problems. Because RPI expertise in health care today is concentrated in hospitals and health systems, the Center is beginning its work by collaborating with a group of hospitals and systems that are expert in these methods. In the future, we will include other health care organizations as RPI expertise spreads and as additional funds become available. Meanwhile, this Web site will allow organizations to have easy access to the entire
hand hygiene project and future Center-led successes.
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Robust Process Improvement (TM)
Q: What are some of the common terms (and definitions) associated with Robust Process Improvement activities such as those utilized by the participating hospitals?
A: Robust Process Improvement
TM (RPI) – The Joint Commission’s fact-based, systematic and data-driven problem-solving methodology for improving its business processes that continuously increases their efficiency and the quality of its products and services.
Lean – a well-defined set of tools that increase customer value by eliminating waste and creating flow throughout the value stream.
Six Sigma – refers to a business philosophy of focusing on continuous improvement by understanding customers’ needs, analyzing business processes, and instituting proper measurement methods.
DMAIC – Basic Six Sigma methodology used by organizations: Define, Measure, Analyze, Improve and Control. This method is used to improve the current capabilities of an existing process.
Critical to Quality (CTQ) – a feature by which customers evaluate the quality of a product or service.
Change Management Process – a set of actions, supported by a tool set, used to prepare an organization to seek, commit to, and accept change.
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