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The One that Got Away

Patient Safety Quality Monthly, July 15, 2006

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Dear Colleague,

Last month I wrote about the importance of the new JCAHO 2007 Patient Safety goal to increase involvement of patients in their own care. This month I would like to talk about a goal that really surprised me when it didn't make the list.

Every year when the candidate goals and requirements are sent out for comment, more are proposed than will be adopted. While the JCAHO spends a great deal of effort to explain the adopted ones, we don't seem to hear the reason why goals that had excellent rationales did not get approved. While the generic reason is that the field can only handle a few things at a time, it would be helpful to know if something didn't make the list for effectiveness reasons (i.e. we aren't sure it will make a difference), technical reasons (i.e. we don't know how to implement it), or political reasons (i.e. the field doesn't believe it can "afford" it and the JCAHO won't make them do it).

Why is this important to know? Because organizations that are seeking to create a true safety culture should be looking beyond what required and implement what is good and useful. Of course, if an idea isn't effective, we should waste our time and resources trying to figure how to implement it. If an idea is effective but technically difficult, we have the option to determine if we want to be pioneers to determine how to make it work or wait and benchmark from others who have. But if we know something works and we know how to do it, should the reason that the healthcare field can't afford it be adequate?

Every organization makes choices on how it spends it resources, both time and money. When the hospital field says it can't afford to do something, it is saying it has other priorities. While often time those priorities are be correct, I question the decision for one particular proposed goal this year: Improve recognition and response to changes inpatients' condition.

The driving force behind this goal is the IHI Rapid Response Teams initiative, part of the 100,000 lives campaign which the JCAHO pledged to support. The proposed requirement was that organizations adopt processes that empower healthcare staff members to directly request assistance from a designated response team when a patient's condition appears to be worsening. Without using the term, that sure sounds like a Rapid Response Team to me.

When this requirement appeared on the candidate list this year, I thought it was a "no brainer" for approval. So what happen? Let's hold up this goal to the three criteria I described earlier to figure it out.
Is it effective? Both research and the experience of hospitals across the country have shown that Rapid Response Teams reduce the number of codes and improves patient outcomes. Do we know how to implement it? Hundreds of hospitals already have Rapid Response Teams in place and there are ample seminars and literature available to those who haven't.

So that leaves the reason that the field believes it can't afford it and the JCAHO won't make them. That is a shame. Is there a resource implication to putting this in place? Of course. Is it exorbitant? Absolutely not.

Of course, just because the JCAHO didn't push the field on this requirement doesn't mean it won't be implemented.  Many organizations do not need something to be a requirement before they do it.  For those organizations that have already implemented Rapid Response Teams, you are telling you patients and society that you have your priorities straight. For those who haven't created a Rapid Response Team, start today to figure when and how.

The good news is that, as I wrote 18 months ago, I believe this eventually will be a standard for all hospitals. The sad news is that as a field we will allow it to be another year or two go by where patient care could have been safer at hospitals that must wait for a requirement. And for the JCAHO, the sad news is that it missed an opportunity to exert the leadership it promised when 18 months ago it sat on the podium at the IHI pledging support to save lives through this and other initiatives.

Regards,

Bob Marder, MD
Practice Director, Quality and Patient Safety
The Greeley Company

For more information on our Patient Safety and Quality consulting services, click here or contact Christine Beringer by e-mail, cberinger@greeley.com, or by phone at 888/749-3054, ext. 3174.

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