One of the ways Picker Institute supports patient-centered care is by recognizing people in healthcare who have made significant contributions to achieving patient-centered care worldwide.
“Conversations with Leaders in the Field of Patient-Centered Care” is a regular feature that highlights people who have promoted patient-centered care in their work or through their organization. This Conversation is with Jerod M. Loeb, Ph.D., executive vice president for healthcare quality evaluation at The Joint Commission and a member of the National Steering Committee for the Always Event™ initiative.
Jerod M. Loeb, Ph.D.
Jerod M. Loeb, Ph.D., is executive vice president for healthcare quality evaluation at The Joint Commission, an independent nonprofit organization that accredits and certifies more than 18,000 healthcare organizations and programs in the United States. Dr. Loeb was one of many leaders in the field of patient-centered care who were consulted in the course of developing the initiative. Here are some of his thoughts.
What do you think of the concept of an Always Event™?
I think it’s a very good idea, with some qualifications. The term “never events” has never been very popular, and it has been replaced with “serious reportable events.” Clearly, serious reportable events are very different from an “always event” in the patient experience of care. But the more I thought about the idea of an Always Event™, the more it resonated with me. There are some really discrete things that are codified in The Joint Commission’s National Patient Safety Goals, one of the most important being correct patient identification. It’s very frustrating that we still continue to see hospitals fail to identify the right patient, the right body part, the right procedure, and we’ve seen nearly one thousand errors in the last decade or so. This is a very basic thing—Identify the right patient—and I think it’s one of many things that could fall into the Always Event™ realm.
Can you suggest other Always Events ™?
I’d include disclosure and apology. When an adverse event occurs, the patient ought always to expect disclosure and apology—they’re crucial to the patient experience.
How do you think an Always Event™ can be measured? Can it be accurate?
The CAHPS [Consumer Assessment of Healthcare Providers and Systems, developed by the Agency for Healthcare Quality and Research] survey has become a standardized tool that is commonly used to evaluate a patient’s experience in a specific care setting. It is a relatively generic tool, and as such it is sometimes difficult to define denominators, numerators, exclusionary characteristics, etc. Some have said that defining quality in healthcare is much like the Supreme Court Justice’s definition of pornography from years ago: “I know it when I see it.” The same could be said of an Always Event™. There are some elements of “always events” that can probably be captured fairly easily, and others that will be much more difficult.
Do you think the term “Always Event™” captures the essence of the initiative?
It has a galvanizing, conceptual resonance and a degree of positive acceptance, much more so than “never events” ever had. But it does carry some baggage, if only because “always events” represents the antithesis of “never events,” and I don’t think promoting it is going to be easy.
From my Joint Commission–centric view of the healthcare world, some of the things we’re tried to codify in our National Patient Safety Goals––for example, accuracy of patient identification, medication reconciliation, falls and pressure-ulcer prevention, hands-off communications—really ought to be always events.
What direction do you think the initiative will take?
A lot of Always Events™ will probably tend toward those designed to keep a patient safe from unintentional harm. This is because these are much easier to quantify than what have been described by some as the “touchy-feely” aspects of care delivery that are just as important to the patient but a lot harder to define and measure in a reliable and valid manner so as to permit benchmarking and comparisons. What do you do about language proficiency? We did a pilot study a few years ago that showed that the incidence and severity of adverse events within our test hospitals were significantly higher when the patient had a limited command of English—and we didn’t even look at the English proficiency of the care provider!
What challenges do you think the Always Event™ initiative will face?
I think one of the biggest will be, How is Always Events™ different from some of the things healthcare providers are already being asked to do, by the Centers for Medicare and Medicaid Services as a payer, by the Joint Commission as an accrediting organization? Is this another unfunded mandate? How do we benchmark? What’s the incentive?
There was an interesting patient-safety study from Stanford a few years ago that looked at the attitudes and beliefs of front-line staff versus the C[orporate]-suite staff relative to safety. Front-line caregivers were much more cognizant of vulnerabilities at the sharp end of care delivery while the vast majority of C-suite executives seems oblivious to the risk of adverse events, as they often thought everything was being done as it ought to be. But the doctors, the nurses, the therapists are well aware that the right thing is not happening all the time.
Are you interested in participating in the Always Event™ initiative?
I’d be happy to take part, both personally and in my role at The Joint Commission. My older daughter, who graduated from the University of Michigan in May and is attending the University of Illinois College of Medicine in Chicago, is very focused as a student on quality and safety. Even after hearing all my frustrations with the system, she’s still going for it. She’s saying to me, “I’m going to fix this, Dad.” She’s got the bug.