Managing a hospital is never more stressful than on the morning a Joint Commission survey team arrives in the lobby, unannounced, to spend the next five days examining your facility for compliance with Joint Commission, CMS and state requirements.
I manage survey coordination for Reading Hospital, a 714-bed facility with multiple outpatient and specialty-care units spread across 22 buildings in West Reading, Pennsylvania. During a Joint Commission survey we may have up to nine surveyors working concurrently, checking everything from life safety to patient care to infection control – and every nook and cranny in between.
Each surveyor generates a daily stream of observations, questions, and requests for documentation, policies, procedures, contracts, and access to individuals. To have a successful survey, we must respond to every request quickly, accurately, and completely while keeping our own team fully informed about the survey status and progress.
Prior to this survey, Reading Hospital took a conventional approach to survey coordination. We matched each surveyor with an escort to help navigate the facility and a scribe to record inquiries and requests. At the end of each survey day, scribes pooled their notes and began a process of collecting information and composing responses that often ran late into the night. Responses were delivered the following morning, many hours after the inquiries that prompted them. This did not meet the surveyor’s expectations nor ours.
This process had many drawbacks. The built-in delays prevented us from quickly addressing simple issues, ensuring they didn’t recur, or correcting the misinterpretation of a process or procedure. We knew we needed a way to monitor and support the survey process in real time. A way to centralize and track the query streams from multiple surveyors and coordinate immediate responses.
I turned to our hospital’s IT group for help in developing a command center approach. We needed to track up to 10 surveyors at a time, with real-time, two-way communication. We needed the ability to aggregate, sort, track, and manage all events on a central display. They recommended we use Vocera Collaboration Suite, a healthcare mobile app that provides secure texting. Because the Vocera system is already in use by our staff, their proposal made a lot of sense.
We installed Vocera Collaboration Suite on smartphones for our scribes. We created a command center with several computers, large monitors, and a core coordination group that included a nurse executive, a nurse educator, a survey administrator, clinical IT expert, our infection preventionist, and me.
Then we set up a mock survey and we practiced. We developed a communication guide so that everyone understood the kinds of information and events we wanted to capture and how to communicate them. When the Joint Commission team arrived for our next general survey in April 2016, we were ready.
With Vocera Collaboration Suite we monitored each surveyor’s movements and alerted the next department in line that an inspection was imminent. We responded to surveyors’ inquiries and requests immediately. If they couldn’t find something in the patient’s chart, we dispatched someone to navigate our EPIC electronic health records system and locate the document. If they asked for a policy, we instantly pulled the relevant document. If they raised an issue with potential safety implications, we started a risk assessment process and took immediate action to mitigate the concern.
In one instance, a surveyor asked for a cardiac perfusionist’s contract and quality assurance plan while the operating team was prepping to start a procedure. Our scribe relayed the request to the command center staff, which immediately delivered the appropriate documents to the surveyor’s temporary office.
In another instance, a surveyor raised a concern about a laboratory analyzer. Our scribe captured the request and took a picture to identify the device and the concern. The command center notified the maintenance department, and when the surveyor returned to the lab three hours later, the entire modification was complete and installed.
By the end of the general survey, we knew we had built something powerful. When we successfully completed a lab survey in Fall 2017, even the Joint Commission surveyors seemed to sense something special. One commented that Reading Hospital was now the gold standard in how a lab should be run and how a survey should be conducted.
Our command center solution for survey coordination based on Vocera Collaboration Suite has shifted Reading Hospital from a posture of delayed reaction to one of proactive response. We now have incredible, moment-to-moment intelligence on each surveyor’s movements through the facility, on what they see, and on how they appear to interpret it. We routinely resolve issues in near real time, almost as quickly as they present themselves to surveyors. Most issues are closed by the end of the day, and we no longer work late into the night. Our leadership team can track the survey process on their phones without interrupting their own routines or calling the command center for updates.
Most importantly, this solution helps us treat the survey teams as customers while they’re on site. Because we can respond to their needs more quickly and easily, we achieve a survey experience that truly helps make our hospital better and safer for our patients. The entire process is more effective and productive for all involved.