New standards address patient communications

ED setting presents special challenges

In July 2011, Joint Commission (JC) surveyors will begin holding hospitals accountable for some of the elements of performance (EP) contained in new patient-centered communication standards that were first unveiled last summer. The new accreditation standards, which are currently in the pilot phase of implementation, are designed to ensure that hospitals take all necessary steps to make sure that patients get the information and support necessary to make appropriate decisions about their own care.

While the JC has had standards for patient-centered communications for years, Christina Cordero, PhD, MPH, associate project director, department of standards and survey methods, division of healthcare quality evaluation, the Joint Commission, explains that years of involvement with an initiative focused on hospital language and culture led the JC to conclude that new standards were needed. "One of the interesting things we found was that most of the organizations we worked with as part of that initiative had some type of language interpreting services," she says. "But when we interviewed the front-line staff, we found that many of the staff weren't using the services that were provided, for several reasons."

For example, many staff members would complain that the telephone interpreting services their hospitals offered tended to be cumbersome or difficult to use; in other cases, passwords would be required to use these services, but staff didn't have ready access to these passwords, says Cordero. "Many times, we also found that the telephones were locked in drawers or closets, and people didn't have keys in order to access these tools to their full potential," she adds.

Problems like these prompted the JC to develop new accreditation standards and to develop a guidance monograph to help hospitals most effectively meet these standards. That document, "Advancing Effective Communication, Cultural Competence, and Patient and Family-centered Care: A Roadmap for Hospitals," is available for download at www.jointcommission.org/Advancing_Effective_Communication.

Alleviate stress and fear

The first of these new accreditation standards to be fully implemented are EP 29, which states that hospitals are to prohibit discrimination "based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression," and EP 28, which states that the hospital will "allow a family member, friend, or other individual to be present with the patient for emotional support during the course of stay."

Hospitals will be held accountable to these accreditation standards beginning in July 2011, says Cordero. "The intent behind [EP 28] is to just make sure patients can identify an individual who they want to be with them in the hospital, and that the hospital will allow this person to be there. The policy is not intended to dictate visitation policies or to call for open visitation," she stresses. "It is really about alleviating fear and stress for patients when they are alone in the hospital. There was a lot of concern that the presence of individuals would put stress on the patient, when the reality is that the opposite is true. It really does help patients feel better about being in the hospital."

For compliance with EP 28 and EP 29, JC surveyors may review a hospital's written policies, mission statement, staff training procedures, and they may gauge staff awareness and understanding of these standards, says Cordero. "We also put a note with this element of performance that the hospital would allow the presence of this individual, unless it infringed on the rights or safety of other patients or it is contraindicated by treatment, so there is some flexibility to determine whether or not it is appropriate to allow the presence of some people," adds Cordero.

Determine patient needs

Hospitals will have at least until January 2012 before JC surveyors will include two other new patient-centered communications standards in their hospital reviews. The first of these, EP 1, directs hospitals to identify a "patient's oral and written communication needs, including the patient's preferred language for discussing health care." The second provision, EP 2, directs hospitals to then communicate with patients "in a manner that meets the patient's oral and written needs."

To be in compliance with these provisions, hospitals need to try to determine what written materials patients understand, or if they have health literacy needs, and what kind of materials they need, explains Cordero. "In addition, communications needs can be personal devices that people have brought with them to the hospital such as eyeglasses or hearing aids," she says. "Sometimes throughout the care continuum, people are separated from those devices, so it is a matter of bringing patients back their glasses or hearing aids to facilitate communication between patients and providers."

Surveyors are likely to review what policies and procedures are in place to ensure patient communications are effective; they may also conduct patient interviews, review staff training procedures, look at what resources are in place to help with communications, and find out how these resources can be accessed, explains Cordero.