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You gotta serve somebody… ‘cause you’ve got HOSPITAL-ity!

A few weeks ago,  I was reading “the nation’s newspaper” (USA TODAY, of course,) and I noticed an article on the front page (below the fold, but definitely front page) about a chain of boutique hotels that has invested in body language training for staff in order to more efficiently identify client needs–just by looking for non-verbal cues. Now, those of you who have been following this blog for a while may remember that my formative years in healthcare were firmly planted in the environmental services realm, so I’ve had what you might call a front row seat for the transformation of certain elements of healthcare from a purely service-oriented pursuit to one that embraces the concept of hospitality.

As safety professionals (and in recognition that sometimes our roles go way past safety), we’re always on the lookout for new trends and this article struck me as, maybe, just maybe, an indication of things to come in how are patients’ expectations may evolve (the evil part of me wants to say mutate, but we’ll leave that be for the moment) based on their experiences in other hospitality/service settings (Catch phrase idea: “Putting the hospital into hospitality.” feel free to make any use of it you might). Depending on the size and complexity of your organization, any number of you folks have responsibilities for front-line staff, be it support services folks, security officers, etc., the number of customer encounters can be rather extensive. I know from my own practice that those types of encounters can be very powerful indeed when it comes to managing the overall patient experience.

So, the question I have for you this day, boys and girls, is: How do we work toward a more customer-focused hospitality sensibility without completely negating our focus on regulatory compliance (basically enforcement of the rules)? I suspect, and perhaps you can confirm or debunk, that this is going to become an increasingly delicate balancing act. Can we still hold the ideals of safety while enhancing the patient experience? What say you, good readers?

I can’t drive – 5?

I recently fielded a question regarding vehicle speed limits on a hospital campus.

I think we can agree that we don’t want folks tearing around our grounds, running into or over people and things, but are there specifics involved? (I think I’m smelling a risk assessment here…)

The situation presented to me revolved around a current practice of posting 5 miles per hour as the campus speed limit, which, as I’m sure you can imagine, can be tough to enforce, regardless of whether you live in NASCAR country. So, the question became: Can the campus speed limit be raised to 10, or even 15, miles per hour?

To my fairly certain knowledge, there is no definitive nationwide regulatory source that would come into play; but, as you can well imagine, there are a number of Authorities Having Jurisdiction who might be willing to offer some assistance in this regard. My immediate thought (and probably the most useful) would be to check with municipal law enforcement to see what they might recommend/require in this regard, and move forward accordingly. I’m thinking that there would be only minor, if any, objection to a raise of the limit to 10 miles per hour, and maybe even 15 miles per hour. But checking with the law enforcement folks is a very fine place to start.

So, how fast can you go?

Cappiello named COO of Healthcare Facilities Accreditation Program

We’d like to report some exciting news: former Joint Commission vice president and long-time advisor to HCPro’s own Briefings on The Joint Commission, Joseph L. Cappiello, has been named the chief operating officer for the Healthcare Facilities Accreditation Program (HFAP). Mr. Cappiello has been a great help to HCPro’s Association for Healthcare Accreditation Professionals (AHAP) and Briefings over the years. You also might know some of the books he’s authored, including The Chapter Leader’s Guide to Emergency Management. We’d like to congratulate Joe on his latest endeavor!

From the official press release:

Joseph L. Cappiello has been appointed new Chief Operating Officer of the Chicago-based Healthcare Facilities Accreditation Program (HFAP). HFAP, the nation’s oldest hospital accreditation organization, has been authorized by the Centers for Medicare and Medicaid Services (CMS) to accredit healthcare facilities for compliance with CMS standards since the beginning of Medicare in 1965.

Cappiello served for 10 years as Vice President of Field Operations at The Joint Commission and brings to HFAP a strong history of accreditation management experience. His role at HFAP will be to direct the nimble and educative approach to facility accreditation that exemplifies the organization, and to lead the continuing evolution of an accreditation process that meets the challenges of the complex healthcare environment. Mr. Cappiello will take his post October 3. He succeeds George A. Reuther, who is stepping down after 25 years of service

“As a smaller organization, HFAP can provide facilities with both a rigorous assessment and a resource for improvement, should they miss the mark,” said Michael J. Zarski, HFAP CEO. “We are thrilled to have Joe join our team, to help us further our personalized approach to the accreditation process. His caliber and experience will provide great value to HFAP and the facilities we work with.”

“HFAP is not just as an evaluator, but an educator,” said Cappiello, “which is what first drew me to the organization. It’s also light on its feet—quickly adaptable to the changing quality environment. And it brings a holistic survey process that creates a true partnership with the facilities it serves. I am pleased to be onboard.”

Cappiello was Vice President for Accreditation Field Operations at The Joint Commission from 1998 to 2008, directing key internal functions as well as the 500-member field surveyor cadre. Known as an innovative and dynamic leader, Cappiello reorganized the operational structure of accreditation operations and made dramatic improvements in the training and operational effectiveness of the surveyor cadre.

Spearheading initiatives on emergency management and disaster response, he led evaluation teams to New York City following the attacks of September 11, testified before Congress after Hurricane Katrina, and advised the governments of Israel and Australia on disaster preparedness. From 2008 to the present, Mr. Cappiello led his own consultancy to help healthcare facilities improve quality and maintain compliance with accreditation standards. He holds a BSN from the University of Rochester and an MA in Heath Facilities Management from Webster University.

The Healthcare Facilities Accreditation Program (HFAP) is a non-profit, nationally recognized accreditation organization. It has been accrediting healthcare facilities for over 60 years and under Medicare since its inception. Its mission is to advance high-quality patient care and safety through objective application of recognized standards. More information on the program can be found at

Mac’s Safety Space: Peeling back the layers of the onion—adventures in the kitchen

I cannot honestly say that this has been cropping up in Joint Commission surveys, but it has been enjoying a more prominent position during state survey.  And, since I’ve found that this one is not always uniformly understood, I figure it’s time to toss it out for the group’s consideration.

A year or so ago, a client facility was cited during a state survey with failing to conduct monthly inspections of their kitchen fire suppression system. Now, I will freely admit that my first response was “bull___,” entirely basing that response on what was enumerated in the Joint Commission standards, or, more precisely, what I “thought” was enumerated in the Joint Commission standards. So, journey with me to that most estimable of destinations: EC.02.03.05 EP #13, which says that hospitals must inspect kitchen’s automatic fire-extinguishing systems every six months and they are expected to keep a record of when these inspections are conducted.  There then follows two notes, one fairly straightforward, which says that fire-extinguishing systems do not need to be discharged, but the other is where we head to our next point in the journey: It says to consult NFPA 96, 1998 edition for performing inspection guidance.

OK, National Fire Protection Association (NFPA) 96 – 1998, let’s see what we have there. OK, so there are a couple of different types of systems that are considered (I don’t know that I would go so far as to say “allowed,” but I think we can intuit that much): carbon dioxide, automatic sprinklers, dry chemical, and wet chemical, with installation, etc. being in accordance with the applicable standard. For the purposes of this particular lesson, we turn to the standards associated with dry chemical (NFPA 17) and wet chemical (NFPA 17A) and find this lovely little item (this is in Chapter 9 in NFPA 17 – 1998 and Chapter 5 in NFPA 17A – 1998, but the requirements are identical; I’m using NFPA 17 here):

9-2 Owner’s Inspection

9-2.1 On a monthly basis, inspection shall be conducted in accordance with the manufacturer’s listed installation and maintenance manual or owner’s manual. As a minimum, this “quick check” or inspection shall include verification of the following:

(a) The extinguishing system is in its proper location.

(b) The manual actuators are unobstructed.

(c) The tamper indicators and seals are intact.

(d) The maintenance tag or certificate is in place.

(e) The system shows no physical damage or condition that might prevent operation.

(f) The pressure gauge(s), if provided, is in operable range.

(g) The nozzle blowoff caps, where provided, are intact and undamaged.

(h) Neither the protected equipment nor the hazard has been replaced, modified, or relocated.

9-2.2 If any deficiencies are found, appropriate corrective action shall be taken immediately.

9-2.3 Personnel making inspections shall keep records for those extinguishing systems that were found to require corrective actions.

9-2.4 At least monthly, the date the inspection is performed and the initials of the person performing  the inspection shall be recorded. The records shall be retained until the next semiannual maintenance.

So, you know the fire extinguisher-type tags that are hanging on your kitchen suppression actuators (or somewhere nearby)—somebody’s supposed to be filling out the monthlies. And guess who would be considered the owner … three guesses and the first two don’t count. Better get a PM started if this was a surprise!

Mac’s Safety Space: A visit to the infusion center

Q: Our Chief Operating Officer (COO) is concerned that The Joint Commission may go to our infusion center. We understand that the life safety surveyor will focus his survey on healthcare occupancies, in our case the main hospital and ambulatory surgery center. Should we be concerned that the survey will include a visit to the infusion center?

Steve MacArthur: Generally speaking (and this would need to be validated, though I’m pretty sure), if the infusion center is not designated as a healthcare occupancy, then the Life Safety Code (LSC) surveyor will not need to visit that location. If we have designated it as ambulatory healthcare (sometimes this is something the state would determine), then it is likely that they will, considering they’ll have two days to fill.

I would check on the e-Statement of Conditions to see how we’ve identified the occupancy type and if it’s a business occupancy (and I suspect that it is), then the LSC surveyor will in all likelihood confine themselves to the main hospital and the Ambulatory Surgical Center. That said, it is also more than likely that at least one member of the survey team will pay a visit to that location, so we want to make sure that we’re appropriately managing general safety stuff, as well as the basics of life safety—no corridor obstructions, fire extinguisher checks in order, nothing stored in front of fire extinguishers, fire alarm pull stations, etc.

Mac’s Safety Space: Temptation eyes…

Here I am back with yet another question for you to ponder, but first, think on this for a moment:

In my rapidly expanding experience (not unlike the Big Bang of yore), I have noticed that the organizations that have “driven” safety out to the far (in Boston, that would be pronounced “fah”) reaches of the environment are the ones that typically manage their surveys with minimal muss and fuss. This is primarily based on having the ability to identify conditions and deficiencies in a much more proactive fashion than merely relying on hazard surveillance rounds. Yes, I know that The Joint Commission (TJC) only requires two visits per annum to patient areas, one visit for everywhere else – but I would consider that a minimum requirement – hey, something else you could evaluate is meeting TJC frequencies enough?

The truth of the matter is this: safety “lives” in every portion of your organization’s environment and, unless you’ve developed a dandy cloning device, you and your staff can’t be everywhere at every moment of the day (though when the fecal matter makes contact with the rotating blades it sure seems like that is the expectation). But you know who’s got eyes everywhere that you’re not – every living, breathing soul working for your hospital.

So the question becomes this – in looking at the results of your hazard surveillance rounds over the past 12 months or so – how many of your “findings” are items that would, or should, nominally have been reported as a function of your work order/work request process (I won’t say system – not everyone has a “system,” but everyone ought to have a process by now). Stuff like stained ceiling tiles, especially those nasty ones that you know have been sitting there for weeks, if not months – you know you’ve seen them, broken electrical receptacle faceplates, gaping holes in the soiled utility rooms from errant trash truck drivers, and the list goes on.

If you can look back and say that those types of things are being captured on a regular basis – bully for you (and if you wanted to share how you made it happen, we’re all ears), but if you can’t say that, you, my friend, have just identified an opportunity.

And now is the time to apply your marketing acumen to the problem. Be silly, give prizes for doing the right thing, don’t be afraid to ask folks to help – and keep asking them. Each of us has a responsibility in this and it’s high time we got everyone to play in the sandbox. So what’s your idea?

Sentinel Event Alert #46 – Managing Suicide Risk in “Other” Environments

Although Sentinel Event Alert #46 does seem to focus mostly on the clinical aspect of managing this particular risk (which is already included in the standards under the National Patient Safety Goal chapter), now the focus is expanding to account for the potential risks associated with patients that might not be exhibiting more “classic” symptoms and behaviors.

The data supporting this expansion is very compelling and quite adeptly moves towards how we would be managing at-risk patients in general areas and in the absence of those “classic” symptoms and behaviors.

We need to start thinking about how we will begin looking at the management of suicide risks in the “rest” of the physical environment. We’ll certainly be leaving most of the diagnosis piece to the clinical folks, but it’s likely to become increasingly important that the rest of the point of care/point of service folks (EVS, Plant Ops, Security) are informed with a certain awareness of what signs to be mindful of.

It will also fall to the safety folks to be closely scrutinizing the manageable risks in the physical environment and identify strategies for quickly “safing” the immediate patient environment when a determination is made that we’ve got someone at risk.

Should be interesting to see how this unfolds.

Determining the need for a quality report on clinical alarms

Q: Is there a certain standard or EP that speaks specifically to alarms of medical equipment and the requirement for someone to do a report?

A: Years ago, there was a NPSG that related to clinical alarm audibility on the units and ensuring that they could be heard on all points on the unit, but this has been gone for some time now. For some reason, (relating to the focus of the NPSG, my opinion is that upon closer examination, it was not so much an equipment management failure mode as it was a function of the behaviors of clinicians) it’s somewhat notorious and exalted status has diminished over time (although, based on information provided at the recent Joint Commission Executive Briefings, there is a sense that concerns surrounding this may be on the rise).


A balancing act – no nets, no problem!

I’m sure you’ve all been discussing the shooting that happened last week at Johns Hopkins, as I have. I don’t know that this changes the landscape all that much – we know this threat exists, and we know that there is only so much preventative medicine that we can employ without turning our facilities into armed camps.

At this point, I am not familiar with a lot of specific detail – sometimes a person’s parent can be the focus of a lot of ill feelings, and sometimes those feelings will prompt an action far in excess of normal behavior. That being said, I trust that you are all establishing a means of continuously identifying workplace violence risks, and establishing response plans with municipal law enforcement.