TJC launches 'solution exchange' to addresses core measures

High performers will be able to share keys to success

Believing that facilities that have significantly improved their performance in core measures will be able to help others improve by sharing their experiences and knowledge, The Joint Commission has launched what it calls 'The Joint Commission's Core Measure Solution Exchange' to facilitate this process through the establishment of a website where hospitals can both post and search for information.

"We've had these measures for quite some time, and we're pleased that overall there has been significant improvement in performance across the board in the last six years, but we also know there are some hospitals that lag behind," says Scott Williams, PsyD, associate director of The Joint Commission's Division of Healthcare Quality Evaluation.

Williams says this approach is something new for The Joint Commission. "We decided to experiment a little with whether we could link those hospitals that have already improved to those that need to," he says, adding that at this point use of the site is totally voluntary. "We haven't specifically targeted lower-performing hospitals," Williams says. "There may be some point in the future when we could tell a hospital we've noticed they're struggling with a measure, and this is a way they can improve."

Some "mentors" chosen

As it stands right now, any accredited hospital that has access to the Solution Exchange can describe a PI project that has worked, Williams says, "but we also wanted to make sure that when we put new measures out we had solutions for people to look for." So, he explains, in October 2010, a pilot test was conducted around surgical care measures. Williams says The Joint Commission "primed the pump" to generate site content; it invited postings from organizations whose core measure data showed that they had improved.

"These were not necessarily stellar performers from the get-go," Williams says. "We looked for facilities that had started lower, and then had statistically significantly improved performance to where they met or exceeded the national target and sustained improvement over a minimum of six months." These facilities, he continues, received an invitation to post their experience on the site; during that pilot test, 73 solutions were posted that ran the gamut of surgical care measures.

"In May, we added the rest of the measures and sent out invitations to a cohort of 200 solutions that cover a wide range — but not yet all — of the core measures," says Williams. "But even if you've not been invited to post, any accredited organization that visits the site can describe what they've done if they think it's useful to share." (For an example of one of the facilities invited to post, see related story, below.)

Solutions that are posted are set up according to a template provided by The Joint Commission, "but the hospital defines the problem in its own words," says Williams. Then, he adds, the hospital discusses how it analyzed the problem; what causes it discovered; what solutions it implemented in order to improve; any other types of measures it used to evaluate progress; challenges and barriers and how they overcame them; and how they sustained their progress. "You can also attach articles, links, order sets, PowerPoints, and so on," Williams notes.

The information is posted directly; The Joint Commission does not review the content. "This is a departure for us," says Williams. "We're basically providing a community of users with a forum, but not vetting content. We are giving users the ability to rate the value of solutions, to post comments, and so on."

Several search options

Users have several options for searching for solutions of interest to them. "For example, those who post solutions can identify primary and secondary measures that apply, and those who wish to view it may see a number of different things they can use," says Williams. "They also have the ability to add keywords."

In addition, he continues, if users wish, they can drill down farther for more targeted information. "You can, for example, identify the measure," Williams says. "You can include a whole bunch of demographic hospital care statistics. So, for example, if you want to, you can search surgical care infection prevention measures submitted by hospitals with fewer than 50 beds in a rural setting; if you put that in, the site will give you all hospitals that meet those criteria."

You can also further specify information based on all keywords, and can then filter that by measures, he notes. "For example, you can search surgical care measure solutions that involve 'assignment of responsibility,'" Williams explains. "You can also search for the highest rated solutions, or the newest solutions." Finally, he says, users can subscribe to "notification," and will then be notified via e-mail any time something they're interest in is posted.

But will it work?

Having examples to follow is all well and good, but has Williams found evidence that this strategy will result in improvement on the part of those hospitals that are not currently high performers? "Not as such, although if you look at the diffusion research literature, what we know is that before an organization or an individual can adopt a new innovation, one of the things they want to know is whether their peers have done anything with this approach," he says. "We're kind of building on this — if a hospital wants to know something's worth improving but they're gun-shy, can we show them something that will work for them? This will expand their network of peers — not just to the hospital across the street but to the accredited hospital community."

On the other hand, Williams' optimism is tinged with a note of caution. "High-performing healthcare systems do have a lot to teach, but the learning process and transformation are not simple," he says. "If knowledge were enough, we'd all be there already."

While it may be too early to judge the program's effectiveness, Williams says a survey was conducted following the pilot program, "and the feedback we got was very positive," he reports. "The biggest criticism was that they wanted more measures included."

[For more information, contact: Judie Speer, RN, MSN, Chief Quality Officer, Hartselle Medical Center, 201 Pine Street, NW, Hartselle, AL 35640. Phone: (256) 751-3000.]

One of the "chosen" tells us how they did it

One of the facilities invited to post its experiences on The Joint Commission's Core Measure Solution Exchange is Hartselle (AL) Medical Center, which was recognized for "Adult Smoking Cessation Advice Counseling." Judie Speer, RN, MSN, chief quality officer, explains what the measure requires and the kind of information visitors to the site will be able to find.

"You have to have documentation within your medical records that you have offered smoking cessation advice counseling," she says. "We have concurrent reviewers who go out on the unit, review performance, and see if we're actually documenting and giving out information." If not, she leaves the doctors and nurses notes to do it.

How did this program come about? "My quality team decided what we needed to do," says Speer. It works like this: Whenever a patient comes to the facility and is being admitted, the staff immediately hand out information about smoking cessation — whether or not the patient or family member smokes.

"Then, when they are put on a nursing unit, the nurse does an assessment — lung sounds, heart sounds and so on, and finds out if they smoke," says Speer. "Again they are offered educational material, and it's documented in the chart."

The materials actually reside in the facility's AS 400 computer system. "The system is also in the ED, so education material about medications or cessation can be given there as well," Speer adds.

The facility also uses standardized order sets for smoking cessation, which cover treatments such as nicotine patches. "If they need therapy, our respiratory therapist reinforces education on cessation of smoking and documents it," Speer says.

It's easy to document your performance, Speer says. "CMS audits our records, so when we extract them we put them in our computer. They send us a note back saying they need us to send five random records to audit and they give you a grade, or a validation score," she explains. "You have to make 75% or above to be considered as passing validation, and we're usually at 95%; we've basically nailed it."

Speer also has advice to share about what happens if you don't "nail" it. "If we keep having a problem with one of the core measures, we do an action plan on how to correct it," she says.

That seems unlikely to happen with this smoking cessation initiative. "This year, we also went to a non-smoking campus as a model to the community," Speer says. "This was a real issue, because a lot of patients' family members smoked. Now, even the staff has to go off property to smoke." Speer adds that smoking cessation programs and medications were also made available to the staff.