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Hospitals should no longer operate within a culture of blame, says the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL. With the addition of standards that address patient safety and medical error reduction in hospitals, the organization seeks to shift the culture to one of patient safety.
These standards are another step by the Joint Commission to focus on the issue and to have an impact on patient safety, explains spokeswoman Janet McIntyre. Previous efforts range from the sentinel event policy, in which hospitals report adverse events that seriously harm patients, to the revision of the Joint Commission’s mission statement to include patient safety.
Requirements for establishing ongoing patient safety programs in organizations accredited under the Comprehensive Accreditation Manual for Hospitals will be added in the following standards areas:
• Leadership. Hospital leaders are to create an environment that encourages error identification and remedial steps to reduce the likelihood of future, recurring errors. Such an environment includes minimization of individual blame or retribution for those involved in an error or in reporting an error. The focus is to be on establishing an actual or virtual organizationwide patient safety program that uses internal and external knowledge and experience to prevent the occurrence of errors.
"There is a need for leaders at hospitals to create an environment that encourages the reporting and the analysis of errors," McIntyre says.
• Improving organization performance. Hospitals are to implement a program for proactive assessment of high-risk activities related to patient safety and to undertake appropriate improvements. These activities are to be selected by the hospital based on available knowledge and information, including information that is provided by the Joint Commission through its study of sentinel events.
• Management of information. Hospitals are to aggregate patient safety data to identify risk to patients; apply knowledge-based information to reduce these risks; and effectively communicate among all caregivers and others involved in patient safety issues to guide and improve professional and organizational performance.
"Our root-cause analysis requirements say the most immediate cause of an error may be an individual, but it’s typically the result of a series of breakdowns. You have to get down to the root cause before you can try to reduce the risk that the same thing will happen again," McIntyre explains.
• Other functions. Hospitals are to place emphasis on patient safety in areas such as patient rights, education of patients and their families, continuity of care, and management of human resources. The standards state that the patient or the patient’s family be informed about the results of care — including unanticipated outcomes.
The Joint Commission actively sought input from the health care industry on the development of the final standards. For example, the organization consulted an expert panel that included patient safety and medical error reduction leaders, as well as representatives from government, hospitals, insurance companies, universities and advocacy groups. It also posted the standards on its Web site for public comment last summer.
In addition, a broad field evaluation was conducted among a random sample of accredited hospitals and selected professional associations, consumer groups, and government agencies. The standards also were reviewed by the Joint Commission’s Hospital Professional and Technical Advisory Committee and by the Standards and Survey Procedures Committee of the board of commissioners.
"We certainly sought comments from providers and worked closely with them on the standards," McIntyre says. These new standards enhance the nearly half of current Joint Commission standards that already relate to patient safety. These standards aren’t about creating new structures or offices within a hospital, McIntyre adds. "They are about saving lives and an integrated and coordinated approach to the process." The Joint Commission expects the standards to be implemented in July 2001.
(Editor’s note: The standards can be viewed online at www.jcaho.org.)