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2006 Proposed JCAHO Patient Safety Goals and Requirements

Patient Safety Quality Monthly, February 15, 2005

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Dear Colleague,

Once again the proposed JCAHO Patient Safety Goals and Requirements for the coming year have been distributed for comment from the field. There are many useful practices in the new list either as additional requirements under existing goals or as complete new goals. However, the issue I want to address is not the content. It is the arcane numbering system and confusing approach to organizing these goals and requirements.

There are different ways to build a house. One way is to build the house to your exact needs for today, and not concern yourself with what your future needs might be. If you outgrow the framework, you either add on an expensive addition that may not fit to well with the original design, or move to a different house.

The other way is to design the house with the opportunity for growth built in. You either design the floor plan to anticipate growth or build in the potential for an addition. It may take longer to plan, but it will be easier to expand and you won't have to move.

What does this have to do with patient safety? Well, unless you are the hospital's JCAHO guru, keeping track of the goals and requirements becomes a daunting task. If our goal for the patient safety movement is to be sure safety gets to the bedside, we have to keep it simple. So as the JCAHO keeps adding on to this edifice, it becomes more difficult to navigate our way through the hallway and find the bathroom.

What we need is a clear framework that doesn't change. The IOM came up with 6 aims for patient care that provided an easily remembered, timeless framework. They choose fundamental concepts under which we fit all those important tactics that make the framework useful.

Unfortunately, the patient safety goals' framework was not well thought out. When we started with six safety goals, the goals had a mixture of framework and tactics. We had "improve communication" at the same level as "infusion pump safety." And as we keep adding it becomes more difficult to separate the tactics from the goals.

So I suggest its time to move to a new house. Only let's plan the framework carefully to make sure all current valuables and furniture (the current requirements) will fit and it will accommodate future acquisitions as well. Let's use fundamental safety concepts that have been proven to be the root cause behind adverse events rather than healthcare specific issues that may only the symptom.

It's easy to point out the problem without providing a solution. So here's my idea of a framework to start the process:

• Caregiver Communication
• Attention to Detail
• Equipment and Equipment/Human Interface
• Risk Assessment and Prevention
• Safety Culture Promotion
• Patient Engagement

Next month, I will explain why I chose each category. Until then, please try it out. See if you can fit all of the current requirements under at least one category. I would greatly appreciate your thoughts and comments to include in next month's letter. I can use all the help I can get.

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

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