ROSEMONT, ILL. — In an effort to help health care providers make lasting improvements in quality and safety, the Joint Commission has established the Center for Transforming Healthcare to disseminate data and lessons from leading health care organizations that have successfully implemented robust process-improvement methods developed by other industries.

The Joint Commission's center, which will function separately from the accreditation process, is developing a Web-based tool and other resources to help guide organizations through process improvement.

“The aim is to deliver this to accredited organizations at no extra cost,” Dr. Mark R. Chassin said at the Joint Commission national conference on quality and patient safety.

Health care providers have expressed a desire for information from the Joint Commission on effective solutions to safety and quality problems. “What I hear from our customers is: 'Don't keep telling us only about the problems—tell us how we can get better,'” he said.

Health care providers can make major and durable improvements in patient safety and quality by adopting “robust process-improvement” tools that are widely used by high-reliability industries such as commercial aviation and nuclear energy, where adverse events are far less common than in health care, Dr. Chassin said.

The Joint Commission does not plan to require the use of these tools as a condition for accreditation. However, emerging evidence indicates that these methodologies—including the Lean, Six Sigma, Toyota Production System, and GE Change Acceleration Process models—“work just as well when applied to our very nasty safety and quality problems as they do in all of the other very successful business and administrative processes where they've been tried,” Dr. Chassin said. “I am firmly convinced that the tools of robust process improvement are an incredibly important vehicle for getting us much farther down the road.”

With that in mind, “we are collaborating with physicians, nurse leaders, and managers of hospitals and health systems where Lean and Six Sigma are already working—organizations that have already made the investment and have mastered those tools. And we are deploying teams from those institutions to solve the most difficult quality and safety problems facing all of American health care,” Dr. Chassin explained. “Our job at the Joint Commission is to build the knowledge database, compiling all of that learning across all of those organizations, and to spread it to other organizations.”

The center's first project, devoted to hand hygiene, is a collaborative effort with several institutions nationwide. Using high-reliability strategies, these organizations documented average hand-washing rates below 50% at their institutions, rates much lower than previously believed. A range of solutions tailored to specific causes of noncompliance are now being tested.

The second project, which will focus on breakdowns in handoff communications, has several different participant organizations across the country.

The third project, which will target wrong-site surgery, will be a collaboration with Rhode Island Hospital (Providence) and Newport (R.I.) Hospital on the development and testing of a universal protocol for avoiding such errors.

High-reliability industries manage risks far more effectively than do health care providers because these industries have “a set of tools and principles that allows them to look very hard at their processes and perfect them, and then a culture that wraps around those improvement tools [and] that allows those nearly perfect processes to continue at high levels of safety for long periods of time,” Dr. Chassin said.

This type of firmly embedded culture, currently absent in health care, begins with the rigorous identification of problem root causes. Health care providers generally do a good job of defining problems and measuring outcomes, but they often gloss over the critical step of identifying exactly why a process is not working, he said. In order to develop effective, durable interventions, “you have to understand the specific causes of the problem where you're trying to fix it.”

“You can have the best technical solution … but if nobody uses it and everybody hates it, it will have no impact,” Dr. Chassin said. To deal with that problem, robust process improvement incorporates explicit change-management principles and tools into the process at the very beginning.

High-reliability organizations often automate processes after they have perfected them, but automation is not always possible in health care, he noted. “What we are charged with if we're going to get improvement that is sustained is changing the behavior of the individuals that work in the health care delivery system and maintaining that changed behavior over long periods of time.”

The Joint Commission Center for Transforming Healthcare has received support from the American Hospital Association, BD, Ecolab, GE Healthcare, Johnson & Johnson, the Federation of American Hospitals, and Hospira.

For more information, go to www.centerfortransforminghealthcare.org

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'Our job at the Joint Commission is to [compile] all of that learning … and to spread it to other organizations.'

Source DR. CHASSIN

Process-Improvement Center to Share Lessons