Mark Chassin, MD, MPP, MPH, president of the Joint Commission, will deliver the keynote address at HM09 in Chicago. A board-certified internist who practiced emergency medicine for 12 years, Dr. Chassin is recognized as an expert in quality measurement and improvement.

He recently spoke to The Hospitalist about his views on the changing world of healthcare, the commission’s evolving role, and the importance of a stronger partnership between the accrediting body and hospital-based physicians.

Question: Why are you looking forward to speaking at HM09?

It’s also important for us to hear from the physicians on the front lines—and from those who have taken responsibility for oversight of quality programs in hospitals—about how our efforts are working and where we need to fill in gaps.

—Mark Chassin, MD

Answer: Hospitalists are an especially important group of physicians for [the Joint Commission] to connect with because of the close alignment between our mission and the way they practice medicine. Accreditation alone is not enough. We need active engagement of the HM practitioners in all of the quality and safety improvement initiatives the Joint Commission has set in motion. It’s also important for us to hear from the physicians on the front lines—and from those who have taken responsibility for oversight of quality programs in hospitals—about how our efforts are working and where we need to fill in gaps.

Q: Can you provide an overview of the topics you plan to talk about?

A: At the pace everything is changing, it’s hard to know exactly what I’ll want to talk about. I’ll probably say something about the major challenges we face across healthcare that are particularly magnified in hospitals. That’s where the most vulnerable patients are. That’s where the most dangerous procedures are done. That’s where the most dangerous drugs are used, and that’s where the most complicated devices are used. All these things have the potential for improving outcomes, but also increasing the potential for harm if they’re not used well.

The environment we’re in is going in one direction, and that is to demand more of all of us in healthcare with respect to the level of excellence at which care is provided and overseen. There’s a strong push on the part of public stakeholders for accountability in healthcare. I may talk about how we might respond to that demand and close the gap between what we know we could be providing in terms of safe, high-quality care, and what we are providing.

Q: You said accreditation by itself is not sufficient. What else is needed?

A: When I was exploring this job, I wanted to determine whether the Joint Commission and its board of commissioners were ready to undertake initiatives, in addition to accreditation, in order to move the delivery system more rapidly toward higher levels of safety and quality. … It became clear to me they weren’t just willing to do it, but very enthusiastic about doing it.

Q: Can you give an example of one of those new initiatives?

A: I have watched and participated in the development of applications coming out of industry in the last 10 years or so, like Six Sigma and the Toyota Production System, that are highly promising in their ability to deliver much higher levels of excellence and sustain them. We’re in the middle of a very aggressive adoption of these tools, which we’re calling our Robust Process Improvement Initiative.

Q: What are the benefits of that initiative?

A: We are doing this to enhance our capacity to do process improvement, to simplify our processes, to focus on customer service. It does not mean it’s to make these surveys easy. It means understanding where our processes are too complicated, where we have too many bells and whistles that are not related to safety and quality, and where we can reduce our costs. At the same time, we’re exploring how we can work with organizations, hospitals, and health systems who have committed to learning these tools and methods to bring them to bear on safety and quality problems—medication reconciliation, infection control breakdown, pre-op verification to get rid of wrong site/wrong side surgery—that organizations struggle with but haven’t wrestled to the ground yet.

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

Mark Leiser is a freelance writer based in New Jersey.

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