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Access managers tend to seek out any bits of information they can from their peers who have recently undergone a visit from the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations (JCAHO). That goes double when the surveyed organization receives high marks, as was the case last summer with Aurora HealthCare in Milwaukee, whose five metro-area hospitals got JCAHO scores ranging from 97% to 99%, according to Charlene Freimark, supervisor of patient access services.
Freimark was on hand at two of the hospitals — Sinai Samaritan Medical Center and St. Luke’s South Shore, which is part of St. Luke’s Medical Center — to field questions from JCAHO surveyors, she says. In her first encounter, Freimark says, she was asked how the department handled patient confidentiality, and whether it had implemented any recent quality improvements, particularly those that involved collaboration with other areas of the hospital.
"The way we have it set up here is that patients go into a room [to be registered] and can close a glass door if they need to," she explains. "There are three rooms in a row, and each has a desk and two chairs and a sliding glass door. [The surveyor] said that was the ideal way to have it [arranged] because of confidentiality concerns."
As for quality initiatives, Freimark explained that the access department had worked with nursing to improve the giving of advance directives to patients, she says. The concern was that because 50% of Aurora’s patients were admitted through the emergency department (ED), having access personnel handle the advance directives was not the most efficient way to do it, Freimark adds. "We had the responsibility transferred to the nursing desk on the floor," she says. When the nurse goes into the room to do the initial assessment, he or she also goes through the advance directives with the patient, Freimark says. "We made sure every patient got them and got an explanation."
The JCAHO surveyor asked whether things were done differently at the various metro hospitals, she says, and her response was that the procedures were the same at all five facilities, with different codes used to indicate the different hospitals. The surveyor also questioned Freimark about the admitting department hours, and expressed concern that at the end of the day there is just one person on duty, she notes. "She asked how that person was kept safe. That’s the first time I’ve heard that kind of question." The JCAHO representative was satisfied, Freimark adds, with the explanation that the employee has access to a distress button that can sound an alarm at the switchboard.
Another question had to do with how patient satisfaction is measured, "how we know we’re doing a good job," she says. Freimark explained that in addition to formal surveys that are sent out to patients after their hospital experience, Aurora also has "complaint and compliment" forms available throughout its facilities.
The surveyor Freimark spoke with at Sinai Samaritan, she says, asked her what she looked for when interviewing a new employee. "I told him the normal things, like experience with customer service and a background in insurance, but that’s not what he was looking for." Instead, she adds, the surveyor made the point that "the up-and-coming thing was that admitting people should be trained in medical terminology, probably because in order to get the bill paid, you now need to be more specific as to why the patient is having a test done."
That surveyor also questioned Freimark about the orientation that new employees receive, "whether we go through the rules and regulations, describe how the time clock works, and [introduce] the employee to the workplace and co-workers," she says. "We had told him that no employee ever starts without a formal orientation and a department orientation. He didn’t seem to believe it, but it’s the truth."
Her understanding had been that, in line with a new JCAHO policy, the surveyors would make visits during the evening and night shifts, Freimark notes, and that did happen, although not in the admitting areas. "We knew it would probably happen, but we didn’t know when. They usually came in, and went to a specific area." The targeted areas varied at each hospital, she says, but did not include admitting.
These off-shift visits are a new focus for JCAHO, confirms Charlene Hill, an agency spokeswoman. They will be part of the process for 24-hour facilities when the survey lasts two days or more. Most hospital surveys, she notes, last three days. "We did a pilot test, and the organizations [that participated] were supportive," Hill says. "They felt it added value and should be part of the regular survey process." The weekend visits, she adds, happen only when the survey time includes a weekend.
(Editor’s note: Look for information on the JCAHO’s 2001 survey process — and hear from hospitals who’ve experienced it — in the next issue of Hospital Access Management. News about JCAHO is available on the agency’s Web site at www.jcaho.org.)