doc w/ Pen

journalist + medical student + artist

Tag: The Joint Commission

Survey Says!

family feudPicture an episode of the game show “Family Feud.” The question: One hundred health care workers were asked, “Name the first feeling you have when you hear the words ‘The Joint Commission.’ ”

Chances are, when the show’s host shouts his famous “Survey says!” line, TERROR will be the top answer on the six-item list. (Followed by fear, anxiety, dread, panic, and shock.)

The Joint Commission ( is the organization that accredits most hospitals and many other health care facilities in the United States via so-called “surveys” (a nice phrase for “inspections”). Accreditation is the key to Medicare reimbursement, as well as a generally recognized standard of patient care. So organizations desperately want to comply with The Joint Commission’s standards, for both financial and public relations reasons. Complying with these standards, though, can be a challenge, due to the sheer volume of requirements. The updated 2012 version of the CAMH (Comprehensive Accreditation Manual for Hospitals) is more than 750 pages long. No joke; I’ve got a PDF of it on my laptop. So this terror response to an impending Joint Commission survey is somewhat understandable.

But I believe in The Joint Commission, and its mission statement:

To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. 

Maybe that sounds corny, and naive (given that I am not yet in the trenches of health care work). But I am currently doing freelance editing and writing for Joint Commission Resources, the publishing arm of The Joint Commission. And the materials I have been exposed to have convinced me that overall, The Joint Commission isn’t out to punish people, it’s out to protect patients, and ensure the best possible care for them. And isn’t that what physicians, nurses, and other health care professions should strive for as well?

I am both a journalist and a scientist, and out of service to both of these roles, I will provide evidence to support my claim. Others may or may not agree with me, but I hope that this post will at least provoke some thought, and perhaps some discussion.

First of all, most of The Joint Commission standards I have seen – while complex and extensive – make sense and have a purpose. For example, organizations are required to have a formal, written “Emergency Operations Plan” (EOP) that takes what is called an “all-hazards” approach to emergencies. Basically, what this means is that a hospital (or other facility) has to be prepared for whatever may happen, along with having specific steps and procedures in place for dealing with certain types of more likely situations such as fires. The EM (Emergency Management) standards and related EPs (Elements of Performance, which are basically broken out objectives) literally comprise 20 pages of the CAMH. There are standards related to evacuation, utilities management, licensing of independent practitioners in event of a disaster, and many other scenarios and issues. That’s a lot to keep track of, obviously. But think of it this way – if you were a patient, or had an ill family member in the hospital, wouldn’t you want a hospital to have such a plan in place and ready to initiate at a moment’s notice? Without such a plan, an emergency or disaster would cause absolute mayhem. Of this I am completely convinced.

TJC bldg

One of the things I have enjoyed most (and also benefited from) with regard to my freelance work for Joint Commission Resources is reading case studies related to implementation of certain standards. For example, one of the case studies I read involved a small community hospital that faced a major hurricane. The hospital lost power, and risked losing generator capability as well, so was forced to evacuate all of its patients to surrounding facilities. Without electricity, though, such an endeavor is a feat. Consider that the hospital was several stories tall, and the elevators were out of service. So non-ambulatory patients had to be carried down the stairs on gurneys. Remember also that without electricity, photocopy machines were not working. Which meant it was impossible to copy patients’ charts prior to their transfer elsewhere. The solution to this problem was that hospital staff accompanied patients to the transfer locations, copied the charts there, and brought the original charts back to the community hospital (because both locations needed the patients’ records). While the case study (and the hospital administrators) acknowledged room for improvement, and a few hiccups in the process, for the most part this complicated evacuation went pretty smoothly. And that was because the hospital had a detailed EOP.

Second, The Joint Commission genuinely (in my opinion) tries to provide resources to help hospitals better comply with all of these standards (via Joint Commission Resources publications). Many of these resources are articles and books that specifically address complex standards. Some of them are best-practice examples from organizations that have gone above and beyond in developing a particular policy, procedural checklist, etc. I have been working with Joint Commission Resources to secure permissions for some of these best-practice examples, and have seen how Joint Commission standards can inspire organizations to improve their own workflow, procedures, and policies with the ultimate goal of providing improved patient care.

Third, I have been inspired. I know I’m not even in medical school yet, much less a practicing physician facing a Joint Commission survey. But some of the case studies, and responses to Joint Commission standards, have given me ideas on how to better provide patient care in my capacity as a Spanish medical translator, as well as ideas for patient care practices in my future as a doctor. For example, one case study I read referenced the development and use of something called a “Patient Care Notebook.” This was in response to miscommunications and accidental gaps in care, especially after a patient was discharged from the hospital and went into the outpatient setting (or vice versa). The Patient Care Notebook is just that – a notebook (rather, a three-ring binder) with dividers for different types of information, medication logs, doctor’s visit logs, space for patients to write down their own questions (and the practitioners’ answers), important contact information, discharge papers, care plans, etc. This helped organize a patient’s medical information in one place, and provided a tool for both the patient and his or her practitioners. It was something the patient could bring to every visit, hospital stay, etc., and add (or remove) information (medications, etc.) as time went on.

As I came across this, I thought to myself, “How brilliant!” I immediately e-mailed the community outreach coordinator at the clinic where I volunteer, to see whether she might be interested in incorporating this tool into the patient health literacy initiative she is working on (and I am helping with). I also realized that this type of tool is something I could develop and customize for my own patients in the future, as it is not readily commercially available. (Which does not make sense to me at all, given how beneficial it has the potential to be.)

So if I were one of the health care survey respondents, and was asked that question I posed at the beginning of this post, my answer would be different: “Gratitude.”

Getting Paid (and paid to learn)

My Facebook post Thursday afternoon was as follows:

I’d almost forgotten the great satisfaction of successfully making a deadline, and knowing that I’ll actually get *paid* for the work I’ve just completed. Key word: PAID.

In the last two years, I have worked insanely hard in school. Exams, lab reports, homework assignments … a flurry of academic activity. It was very rewarding, to be sure, to be learning new and fascinating material (and to receive stellar marks for my efforts). But there is something about the work world, about completing a task and receiving monetary compensation for it. I’m not saying that it is more rewarding, just rewarding in a different sense. While in school, your efforts lead to greater understanding and knowledge (definitely a good thing); with paid work your efforts lead to financial independence and an ability to afford what you need (and sometimes what you want).

As I said, I am not touting one over the other, just that they are different. And I am enjoying feeling the sense of satisfaction that comes from earning money. Not that I believe that money is the key to happiness. However, right now I am in some debt – not terrible, but debt nonetheless – and doing some paid work will allow me to eventually pay back that debt, which will be a fantastic and freeing feeling.

It’s been more than three years, since March of 2009, that I have had a paid job. At that time, I was a textbook editor for McGraw-Hill in downtown Chicago. Monday, March 2, 2009, more than 40 editors, including myself, were laid off. We had only hours to clean out the cubicles that we had decorated and nested in to make our homes for eight hours out of every day of the work week. It was a traumatic and terrible experience.

I went on unemployment and began looking for a job (a fruitless search). However, prior to being laid off, I had been thinking about returning to school to do a post-baccalaureate pre-medical program, and soon I decided that this would be the perfect time to do just that. So I did. And I never looked back.

Now that I have postponed my medical school application, though, I am back in the working world as a freelance writer and editor – back to my roots, so to speak. And honestly, I am enjoying it. Not that I want that as my lifetime career; I have already determined that. In fact, it is in part the content I am working with that has made this freelance work so interesting and engaging to me.

Serendipitously, I called a good friend a few weeks ago to chat. We hadn’t talked in a few weeks, and I wanted to know how she was doing. She works as a senior editor for Joint Commission Resources, which is the publishing arm of the Joint Commission. The Joint Commission is the organization that develops standards to regulate, and then accredits, hospitals and other health care facilities. Part way into our conversation, out of the blue, she asked whether I wanted to do some freelance work for Joint Commission Resources. I was just about broke at the time, scrambling to make ends meet and searching (fruitlessly again) for jobs. Of course I jumped at the chance.

Really, I did it for the money. I’ll be honest. But, serendipitously again, I have been learning a great deal through the revision work I am doing – in addition to gaining that feeling of satisfaction from doing work and getting paid for it. You can’t get much better than that, can you?