JCAHO pushing new age of patient empowerment

'Speak up' changes, new patient safety goal

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is emphasizing that knowledge is power when it comes to patients. Recent Joint Commission initiatives indicate a growing trend toward patient education and empowerment to enhance a culture of safety and prevent infections.

"It is very clear that issues of infection are rising high on the agenda, "says Robert Wise, MD, vice president of the division of standards and survey methods at JCAHO. "This issue of patients taking greater responsibility for themselves is clearly a push, not only for patient safety, but also the expectation that health care workers understand that they are going to be meeting more and more informed consumers. That is something that should be embraced as a positive thing."

In the effort, the Joint Commission joins myriad cultural forces that are driving a transformation in the way the patient is viewed in the health care system. The patient safety movement has given rise to consumer advocacy groups that are demanding more transparency in health care. As a result, there is an increasing pressure to bring patients into the process and educate them about preventing infections and other adverse outcomes. Indeed, there is the perception that patients — with growing knowledge about the risk of infections and patient safety hazards, such as medication errors — could become health care's much-needed new partners in prevention.

But what about liability concerns? Does informing and educating patients somehow make hospitals more liable if treatment fails, for whatever reason? "There is that added awareness of the risk, which could lead to some additional litigation by the mere fact that there is an increased [knowledge]," says Julie Savoy, BSN, RN, JD, an attorney at Gachassin Law Firm in Lafayette, LA.

"But the trade-off is very beneficial in that if it gets more people to wash their hands, that's a good thing. The more the consumer knows, the better partner they are going to be in their own health care and the better advocate they are going to be for themselves and the better outcomes they will have."

Time to 'Speak Up'

Indeed, the Joint Commission is urging patients to "Speak Up" in a campaign that emphasizes the importance of taking care of your own health and avoiding transmission of infections to others. The brochure highlights four easy things everyone can do to prevent infection and help avoid contagious diseases such as the common cold, strep throat, and the flu.

"One [emphasis] is keeping yourself healthy and the other one is making sure other people are healthy," Wise says. "So it's making sure you don't get sick but also not spreading it. It's respectful of family members, colleagues; so that if there is an infectious illness, there is a greater chance of containing it."

Moving from public health to hospitals, the brochure was recently updated to include a recommendation that patients "gently remind" health care workers to clean their hands and wear gloves. The Speak Up brochure states: "Doctors, nurses, dentists and other health care providers come into contact with lots of bacteria and viruses. So before they treat you, ask them if they've cleaned their hands. Health care providers should wear clean gloves when they perform tasks such as taking throat cultures, pulling teeth, taking blood, touching wounds or body fluids, and examining your private parts. Don't be afraid to gently remind them to wear gloves."

In issuing such warnings, the Joint Commission wants to alert patients without alarming them, Wise explains.

"Patients need to be involved with their care, but it is not a statement that hospitals are unsafe," he explains. "Hospitals are extremely busy places and we know that a health care worker can forget something. It can have something to do with infection control, like washing hands, moving quickly, and [the health care worker] not realizing they should be putting gloves on. As the informed consumer, these are two important things that a patient can take responsibility for; it could have a significant impact on their health getting better."

The Joint Commission reports that heath care organizations are printing out the Speak Up materials for patient rooms, sponsoring local public service announcements using their own physicians and nurses, and including the brochure content in patient information materials, web sites, and community newsletters.

New goal calls for 'active involvement'

Moreover, the Joint Commission has announced a major change for its 2007 Patient Safety Goals. A new goal for hospitals is a requirement that accredited organizations encourage patients' active involvement in their own care as a patient safety strategy. The requirement — first applied to the home care, laboratory, assisted living, and disease-specific care programs in 2006 — will apply to all hospitals in 2007. The complete goal reads: "Encourage patients' active involvement in their own care as a patient safety strategy. Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so."

The accompanying rationale reads: "Communication with patients and families about all aspects of their care, treatment or services is an important characteristic of a culture of safety. When patients know what to expect, they are more aware of possible errors and choices. Patients can be an important source of information about potential adverse events and hazardous conditions." The implementation expectation for the goal is that "Patients and families are educated on methods available to report concerns related to care, treatment, services, and patient safety issues."

That development follows publication this year of the book, You: The Smart Patient, which calls for consumers to become informed about infections and other risks they face in the hospitals. The Joint Commission is listed as a co-authoring agency on the book, which urges that patients demand that health care workers wash their hands. "The importance of hand washing to prevent infection is such a big deal that the Joint Commission came up with buttons for nurses, doctors, and other health care staff to wear that read 'Ask Me If I've Washed My Hands,'" the book states. "So, if you see those on your health caregivers' lab coats (or even if you don't), ask away. Don't be shy about it."1

The Joint Commission is not acting unilaterally here, but joins a variety of organizations urging similar measures. For example, the Association for Professionals in Infection Control and Epidemio-logy (APIC) has launched a web site designed as an educational source for consumers and health care professionals (www.preventinfection.org). APIC bills the web site as a one-stop educational source that provides information on infectious diseases and prevention measures from leading experts in the field. "When it comes to infection, the old adage, 'An ounce of prevention is worth a pound of cure' is more appropriate now than ever," says Kathleen Meehan Arias, MS, CIC, 2006 APIC president "This site is designed to convert consumers to informed patients."

(Editor's note: All materials for Speak Up initiatives do not require reprint permission and are available on the Joint Commission web site at www.jointcommission.org.)


1. Roizen MF, Oz MC, with the Joint Commission and Joint Commission Resources. You: The Smart Patient. New York City: Free Press; 2006.