How to ace a Joint Commission survey
Many hospitals hire consultants and conduct mock surveys to prepare for a visit from the Joint Commission on Accreditation of Healthcare Organizations. Still, it’s hard to know what a particular surveyor may target for more in-depth questions. Here is some advice from employee health professionals who went through surveys in the past year:
"Make sure you highlight the information you want them to have. I have a main page with our main accomplishments, and the supporting data further back in the presentation. We made sure we would have charts and graphs and reports, and I think that made a big difference." — Steven Weiner, FNP, MS, MPA, clinical manager, employee health service, New York University Medical Center, New York City.
"[Realize that] you’re never going to be perfect, and you’re never going to succeed in hiding stuff. Once you realize you’re never going to be perfect ,it makes it a lot easier" — Geoff Kelafant, MD, MSPH, FACOEM, medical director, occupational health department, Sarah Bush Lincoln Health System, Mattoon, IL. He is also chairman of the Medical Center Occupational Health Section of the American College of Occupational and Environmental Medicine in Arlington Heights, IL.
"Your employees should be prepared to answer questions. The biggest change for 2001 is that a lot of the survey process involves talking directly with employees. It’s important for you to send out fact sheets to employees on key issues so they’ll know the answers."— Patrice Spath, RHIT, health care quality specialist, Brown-Spath & Associates, Forest Grove, OR.
"Know your regulations. Also, you can read the Joint Commission suggestions as to what they’re looking for on their web site (www.jcaho.org)."— Mary Shock, RN, an employee health nurse at Kettering (OH) Medical Center.
"Be able to identify a project or a problem and show how you resolved that problem. Show how you got down to the root cause and how you work with various departments. They want to look at quality improvement."— Patricia Dalton, RN, COHN-S, administrator of occupational health at Pitt County Memorial Hospital in Greenville, NC.
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