(soft upbeat music)
-: Welcome in.
I'm pleased to be joined by Dr. Joel Roos,
vice president of international Accreditation,
quality improvement and safety
for Joint Commission International.
Prior to that, he spent 30 years in the U.S Navy
and the veterans health administration.
Dr. Roos, I believe it's been just about
over a year since you joined JCI,
what's it been like being on the other side?
-: Well, it's been an interesting experience
and yeah, it's about almost a year and a half.
It's not been entirely at the other side of the table
given my variety of experiences and background,
but it's a lot of different observations
of certainly seeing people get ready for a survey
and the analysis of the survey
rather than being on the receiving end of the survey.
-: Now, Dr. Roos, what have you learned from your career
that you might be able to use here in your position at JCI?
-: Well, one of the advantages of spending 30 years
in the Navy is a wide variety of opportunities
to do different things.
And I have trained as undersea medical officer,
I'm an emergency physician,
I've worked in emergency departments
in a variety of locations,
I've been an academic chair,
I've had leadership opportunities,
I've been the chief executive officer, a commanding officer
in military parlance of our largest healthcare facility
which was an integrated healthcare facility
with the 11 associated clinics,
and I've served internationally as a fleet surgeon,
working with countries around the world
and living in Japan and experiencing a lot
in the Indo-Pacific area with my colleagues and like.
So I've seen different levels of care,
I've been on the receiving end
of many joint commission survey.
I've prepared for joint commission surveys
as a senior executive.
I've had many leadership opportunities
and lots of different interactions as a clinician
all which feeds into what you can bring into an organization
regarding quality and patient safety.
Probably one of the foundational ones
which people don't think about is we talk about zero harm
and high reliability.
There's been a lot of discussion
in the last 10 or 20 years regarding that.
And they always point to the nuclear power industry,
they point to aircraft carriers
as the epitome of high reliability.
Well, those aren't it.
I actually served in what I would consider that role.
I rode nuclear powered submarines for six years.
That's a 300 foot metal tube that is intentionally flooded
with water that contains a nuclear reactor
operated by 20 year olds.
And that is a highly reliable organization.
And there's nothing that tops that,
but yet it's an organization that doesn't look
at itself as a high reliability organization.
It is the normal way of doing business.
It is a culture of safety
where most junior person says stop we can't do this
because it's dangerous for whatever reason.
So that's something I clearly bring
and it's a cultural shift for medicine,
but I've also had the leadership opportunities
to help implement some of those.
And then when I went to the VA as a deputy under secretary
for health, quality, safety and value,
had the opportunity to assist in their initial rollout
of high reliability
among all of their healthcare facilities.
So clearly, a number of things in my background
that hopefully translate well into leading us
into the future for quality and patient safety.
-: Now, many people are familiar with the joint commission
but they may not be as familiar
with Joint Commission International.
So can you tell us a little bit about JCI?
-: Well, I think we're known similar
as the joint commission as an accreditor.
Well, what does that mean?
And that really is just part of what we do.
I view us as a quality and patient safety organization.
We help organizations improve.
Part of that is through accreditation
which gives organizations the tools to set
a culture of safety, to look at process improvement
in systematic way and to attack problems
in their organizations that need improvement.
And we assist in that process.
Our surveyors are an unbelievable resource in the heart
and soul of what we do and their ability
to look at a hospital in addition to identify issues
but also give ideas on how to improve it.
And that is essentially what we do.
There's other products we have in terms of self-assessment
or educational resources, but at the end of the day
it's about looking at hospitals and helping them improve.
-: Now it's been over two years since the pandemic started
and I find it hard to find anything or anyone
that hasn't been affected by COVID-19.
I'm curious, how did the coronavirus impact
JCI's quality and patient safety initiatives?
-: Well, I think just in general
as you look at the healthcare spectrum,
it's affected everybody's quality and safety initiatives
because frankly people were too tied up
to focus on new projects, new procedures.
It was all hands on deck, keeping heads above water
in terms of delivering care at facilities.
And so if facilities are so focused on delivering care
and meeting an unbelievable demand,
it's really hard to focus on initiatives.
And so we had to sort of take a step back
and offer advice and support when asked
but internally we couldn't project further than we'd like.
We were able to adapt our survey processes
which clearly helped as there were organizations
that clearly didn't want to pursue accreditation
and put on hold.
And rightfully so, they were worried about,
overflowing hospitals, lack of ventilators,
no valid medical treatments initially,
but there were organizations that were determined
as things settled out on conducting surveys
and because they were focused on process improvement.
And so we adapted some of our survey methodology
to be able to do remote video surveys
or hybrid with single person on site.
So that's probably where we adapted the most
which was how we actually physically conducted a survey.
-: Now, some assume that JCI services are best suited
for highly advanced and mature healthcare systems,
but do you only work with major hospitals
and academic medical centers
or can JCI accreditation be achieved
by smaller or newer systems?
-: So there's two parts to that question
or two different answers.
So on one hand, yes, we worked with at the moment,
fairly advanced organizations
because in order to achieve accreditation,
you have to have a certain level of quality improvement
and patient safety in place.
And that requires some element of infrastructure dedication.
So in that regard, it is a certain subset of a market
or cross section of hospitals or healthcare organizations.
But in terms of actual types of healthcare organizations
there's a wide spectrum.
On one end, you have the academic medical centers
on the hospitals, on the other you may have
home health services, emergency medical transport,
ambulatory clinics, surgical clinics, and things like that.
So it is a wide spectrum, but within that spectrum,
there is a certain subset organizations
that are truly aimed at the moment for accreditation.
However, I'm not about accreditation.
Accreditation is a tool and a means to an end
and that's really towards setting the groundwork
for high reliability and zero harm.
That's sort of the peak end of the spectrum
but where we also need to commit and move our resources
and some of our projects going forward
is how do we prepare organizations
to even begin that process?
Because it is a long journey
and we need to do a better job in that arena
-: Dr. Roos, what kind of advice would you give organizations
that are considering pursuing accreditation?
-: Well, one, they have to really think about it seriously.
It's a commitment of time and money.
I think the ends are worthwhile,
but we have some products that can help them.
Our navigator is an assessment tool to really allow
an organization to conduct a self-assessment
of where they sit in terms of patient safety and quality,
whether they're truly ready for accreditation right now,
or it identifies areas of what they need
to work on to get there.
And so I think that would be one of my first piece of advice
is conduct a self-assessment using the navigator
-: Joint Commission International accreditation
and the gold seal of approval symbolize
a culture of quality.
When you speak with organizations
that are considering JCI services,
what are some of the key points you stress
on how they can develop that culture of quality and safety?
-: So it's a culture of safety
and it is a leadership initiative.
And until leadership commits,
the rest of the organization will not follow.
And it's more than a commitment
of financial resources there.
There's obviously, you have to build an infrastructure
but it's the dedication and commitment
that you as a healthcare organization
are going to improve the care.
For everyone that walks in the door,
it'll continue to get better.
You wanna know where your problems are,
you want to fix them.
And it's essentially don't shoot the messenger
when they come with you that we're not doing this well,
we're not doing this well, we've had a bad outcome.
It's what do we learn from it?
How do we make it better?
And it's a tone and a culture that has to take place first,
or all efforts will fail.
-: Now earlier, you had mentioned that it's not
just about accreditation for you
and obviously quality and safety are huge points of pride
for the joint commission enterprise,
what are some of the initiatives
in quality and safety that JCI's undertaken?
-: In terms of initiatives, I think probably the biggest one
that we're really touching on now
is shifting the conversation.
We've been very focused on accreditation as an endpoint
and I view accreditation as a tool towards zero harm.
And zero harm is really about preventing any sort of harm
coming both to a patient and to a staff.
There are there incidents where staff members
get hurt as well.
So really that's the big initiative,
is how you leverage the aspects of accreditation
and the other things we offer to approaching zero harm
in any healthcare institution.
And that's the goal of everybody.
Nobody comes to work in a healthcare institution
trying to harm patients
or putting their staff in position to get hurt.
They're there to make people better,
but unfortunately it's not a perfect process.
And we all know of things that occur
in healthcare facilities
that are less than desired of outcomes,
what can we do to help them improve that?
-: You had mentioned that surveyors
are the heart and soul of JCI.
What in your mind sets them apart?
-: Well, the survey process is really based
on evaluating a hospital against a set of standards.
The standards are really our intellectual property.
However, they come to life with the surveyors
and the surveyors come from a variety of backgrounds.
We have nurses, physicians, healthcare administrators,
very seasoned people who are dedicated to teaching,
dedicated to improving quality and patient safety
and have been doing this for a very long time.
They're not junior people, they're very experienced
and they're very passionate about what they do.
And they bring that passion to every facility
that they look at with the idea of improving them
day in and day out.
-: Doctor Roos, thank you for your time.
This has been a very fun conversation.
-: It's been my pleasure.
(soft upbeat music)