Q: Why is it so difficult?
A: In the last year, I’ve been challenging healthcare organizations with respect to exactly that question. I believe everyone—and I put the Joint Commission side by side with organizations that deliver the care—can’t settle for anything less than aiming to transform healthcare into a high-reliability industry. That means rates of adverse events and breakdowns and quality problems that are as low as the best high-reliability organizations in the world, like commercial air travel, nuclear power, and other organizations, that deal with risk and hazards every bit as difficult and dangerous as healthcare but do it a heck of a lot better than we do.
Q: What are the barriers that keep that from happening?
A: First, there’s no role model. There’s no example in healthcare of an organization of any size that is at that level of high reliability. We’re not really in a position to hand out a playbook or a set of blueprints and say, “If you follow these step-by-step set of processes, you’ll get there.”
Another issue is the imperfect creation of a uniform safety culture. One of the hallmarks of a true safety culture is every individual who works in a healthcare organization should be alert to the smallest deviation from safe practice and safe circumstance, and they should be expected and encouraged to report those problems. Is somebody not observing safe sterile techniques in the operating room? Is somebody giving an order for medication that is ambiguous or inaccurate? Just like the junior navigator in an airplane cockpit, everyone must feel his or her obligation to point out what he or she thinks the captain is doing wrong and bring that discrepancy to the surface.
Q: What are your thoughts on the tremendous growth of HM, as well as what the future holds for the field?
A: The growth provides challenges and opportunities. The biggest challenge is the risk the movement toward the delivery of more hospital care by hospitalists provides a discontinuity between the care that’s provided in the community on the front end and hospital care, and then a discontinuity on the back end when the patient goes back into the community. It puts a much larger burden on hospitalists and organizations to make sure they work together to develop really effective ways on both the front and back ends to minimize the unintended consequences of those potential discontinuities.
That said, the opportunity of having a group of physicians who are focused primarily on what happens in hospitals gives those of us who are in quality-oversight positions a natural constituency to work with on perfecting our safety and quality programs in hospitals. That’s an important opportunity, given how complicated it has become to deliver high-quality hospital care.
Q: When hospitalists head home from Chicago, what would you like them to know about the Joint Commission and its mission?
A: The legacy of what the Joint Commission used to be sometimes gets caricatured as a bunch of silly rules and hoops people have to jump through that have nothing to do with patient care. That caricature really is a thing of the past. The current programs we have—both in accreditation and some of these newer initiatives—really have the promise of delivering the capability of helping hospitals and other health organizations achieve the high reliability I know they want. And we need to work shoulder to shoulder on problems. That comes back to how we really need unvarnished feedback about our current programs, whether they’re working well and where we should be deploying more resources. TH