Arms Wide Open
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?
—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.
