Cope with lack of control during new survey process

Surveyors don’t want an entourage

Perhaps the hardest thing to get used to about the Joint Commission on Accreditation of Healthcare Organizations’ new survey process is the lack of any set agenda, says Helena Feather, vice president of compliance and health information at Trident Health System in Charleston, SC. "Before, you knew that certain surveyors were assigned to specific interviews, and you knew exactly what date and time they would occur. This is very different. You do not know which surveyors will be going through what tracers."

Surveyors were continually "out and about" during the facility’s five-day pilot survey, talking to staff about their role in improving patient care. "It is no longer the administrator’s survey, nor the director’s," says Feather. In fact, she says that at the opening session, the surveyors made a point of saying, "Now, when we go out on the floors, or the units, or departments, we’re not going to see a whole crowd standing there waiting for us, are we?"

In addition to not having handlers, the survey team wasn’t interested in seeing storyboards, Feather says. "For previous surveys, I had minutes, functional team books, notebooks, and all kinds of data available in the boardroom. This time, I had none of that," she says. "They wanted to know about the care provided to the patient, not wade through a storyboard presentation."

For the first few days of the pilot survey, the new process was trying for both the facility and the surveyors, Feather points out. "It was very confusing to start with, because it was so unlike any way they’ve ever surveyed before," she says. "We needed to see it in action for a while, and it took until Day 3 until it all jelled. After that, the process was very good. It’s just a matter of getting used to something brand-new."

If you feel confused during the survey about what is being requested, you should ask for an explanation, Feather advises. "I wouldn’t have a problem saying, The standards read this way. Please help me understand how what you are asking relates to the standard,’" she says.

Feather advises you to pay very close attention during your first survey day so you can grasp the process quickly. In addition, she recommends talking to quality managers who have been through a pilot survey or early 2004 survey to determine the dynamics of the survey team and individual surveyors. "Learn as much as possible in advance about how they are going to survey, so you are ready for them to walk in the door."

In the end, you must allow the survey team to take the lead, Feather adds. "The surveyors will be the decision makers in terms of tracing patients, records, and processes through facilities. Sometimes they would just take off and lose you, which was a little bit unsettling. You don’t have a lot of control."

Since you won’t have any advance warning about where surveyors are headed, it will be a challenge to make sure key staff members and physicians are present, says Debra Anthony Larson, director of quality management at Mercy Hospital Grayling (MI).

"In the past, you knew the surveyors would be going to a certain unit at a certain time, so you could get all your staff together," she explains. "You don’t have that opportunity now."

That means physician participation will be more difficult, she says, especially for physicians with office practices, since they won’t know if one of their patients will be selected to be traced, or if so, which day it will occur.

"But even with it being hit or miss, the surveyors were able to interact with our physicians," Larson notes. "However, unlike in the past, it’s more one-on-one instead of a group discussion."

Another difficulty arose since, as a small hospital, Mercy Hospital Grayling has only one social worker and spiritual care provider to interact with multiple surveyors, Larson says.

It is no longer possible to coordinate interviews so they aren’t happening simultaneously, she explains. "If they happen to be ready to do a multidisciplinary conference, staff can’t be in two places at one time," she says.

Despite the lack of control over scheduling, Feather points out that the patient tracers do give surveyors a better picture of your compliance, and the process is good preparation for the upcoming unannounced surveys, which will occur in 2006.

"So what if you don’t have an agenda? You won’t have one when they come in unannounced either," she says.