Andrea Hall

Internal Audits: Setting the Stage for Joint Commission Surveys

For biomedical and clinical engineering (CE) departments looking for another way to get ready for Joint Commission unannounced surveys, internal audits or mock surveys can be used as a dress rehearsal. Done with or without the assistance of an outside consultant, these dry runs can identify defi ciencies before a surveyor does, and give all staff a chance to prepare for the Joint Commission’s visit. “The key is to make sure you’re doing the equipment testing to ensure that you have a safe environment for patients and the hospital,” says Gary Slack, president of Healthcare Engineering Consultants in Springfi eld, OH. This involves two steps: regulatory compliance and “moving beyond the requirements,” he says. “To impress the surveyor, be prepared to discuss some performance improvement measures that demonstrate you’re in an ongoing quest to improve your department.” This may include shortening turnaround time for service requests, improving customer satisfaction with the departments you’re serving, or reducing costs, Slack says. According to George Mills, senior engineer in the Joint Commission’s standards interpretations group, there are three reasons someone might want to do an internal audit: to get ready for a survey by identifying gaps and weaknesses in their program as they relate to the Joint Commission standards; as a new department manager, to assess the state of the department; or to rehearse for surveys done by the state or other agencies, such as the Centers for Medicare and Medicaid Services.

New Emergency Standards Challenge Biomeds to Think Outside the Box

With memories of 9/11 and Katrina still lingering, it is natural for you to wonder how your department would fare in a similar disaster. Emergencies such as a loss of power or flooding of a basement shop have certainly crossed your mind. But the Joint Commission would now like clinical engineering (CE) departments to think more strategically. Joint Commission standards EC 4.10 and EC 4.20 currently require healthcare facilities to address emergency management by conducting a hazard vulnerability analysis and developing and maintaining an emergency management plan. These facilities also must conduct regular exercises to test their preparedness. According to George Mills, senior engineer in the Joint Commission’s Standards Interpretation Group, these existing standards are “somewhat one-dimensional” and don’t prepare hospitals for an escalation of events. Since 2000, the Joint Commission has visited the sites of floods, electrical utility outages, terrorist attacks, and hurricanes seeking ways to improve the standards. A year and a half ago, the group sat down to create what has turned out to be “a pretty radical change to our existing emergency management standards,” says Mills. The new standards, which will take effect in January 2008, broaden and clarify the existing rules by expanding the current requirements. Escalating Events As a result of its visits to disaster sites, “the Joint Commission concluded that it is not sufficient to require healthcare organizations to plan for a single event; rather, they should be able to demonstrate sufficient flexibility to respond effectively to combinations of escalating events,” the new standards state. During many disasters, events intensify over a period of days, weeks, or even years, Mills says. For example, Hurricane Katrina brought high winds, then flooding. Civic unrest, including looting and violence, followed the storm. Once people were evacuated, cleanup and rebuilding began and continues today. The new standards address this theme of escalation by forcing hospitals to anticipate these events and fashion appropriate responses. New standard EC 4.20, for example, requires organizations to test their emergency operations plans twice a year, with one of those drills being escalated “to evaluate how effectively the organization performs when it cannot be supported by the local community.” Under the existing emergency management standards, “all of us were ready for the first wave,” Mills says. The devices are in stock, functioning, and can be repaired as necessary. However, if there’s flooding and the CE department is in the basement, what’s the next step? “Do you have contacts at other facilities or with vendors that can supply equipment? Can you move your benches to other locations, or is that even feasible?” Mills encourages all facilities to examine how quickly they can get tools on carts and out of their normal location. During the first 30 minutes of flooding in Hurricane Katrina, water was entering buildings about two inches every five minutes, leaving little time to act and even less to plan. “You don’t want to be making decisions during the crisis,” Mills says.

Manage contractors like employees to ensure JCAHO compliance.

W hen contractors, rather than hospital employees, provide equipment maintenance services, JCAHO’s expectations for competency assessment may have biomedical equipment technicians (BMETs) and clinical engineers (CEs) wondering how to comply. Even when BMETs and CEs think they’re in compliance, often they are not. “The most common misconception about competency assessment as it relates to non-employee equipment technicians is that the hospital doesn’t have to have evidence of competency,” says George Mills, senior engineer with JCAHO’s Standards Interpretations Group. “The hospital has to be able to supply evidence of competence.” The standards in the Human Resource chapter apply to direct, contract, and volunteer personnel providing patient care and/or services on behalf of an organization, regardless of whether the contracted organization is accredited, according to JCAHO’s website. In addition, “organizations must manage contracted services and personnel just as they must manage services and personnel who are provided by direct employees.” You should review the contractor’s personnel practices and staff qualifications to see if they mesh with your requirements, JCAHO advises. If they do, you can adopt those policies and practices for the contract staff. If the contractor’s practices are not acceptable, you can either define your requirements in the contract or perform the assessments yourself, according to JCAHO. Mills also advises hospitals to look to JCAHO standard LD 3.50, which addresses contract management. That section states that services provided by contract must meet applicable JCAHO standards and “the hospital retains overall responsibility and authority for services furnished under a contract.” “From my understanding, JCAHO expects the hospitals to hold us to the same standards that they would if our people were their employees,” says Raymond Zambuto, president of Technology in Medicine, Inc., of Holliston, MA. “We are expected to provide professional development for our people and provide a means of assuring that they have the correct level of training to do the work that they are assigned.” You should develop mechanisms to assure that the contractor is meeting your requirements, according to JCAHO. You also should have verified information, where relevant, regarding each contractor’s education and training; certification; experience and competence to perform the assigned duties; performance evaluations; and references. According to Mills, this evidence may or may not include verification provided to you. The contractor may conduct internal audits of its staff’s competence, and give you a summary, rather than the actual performance evaluations. Verification may also include information Manage Contractors Like Employees to Ensure JCAHO Compliance

Laughter is the Best Medicine

It’s true: laughter is strong medicine. It draws people together in ways that trigger healthy physical and emotional changes in the body. Laughter strengthens your immune system, boosts mood, diminishes pain, and protects you from the damaging effects of stress. Nothing works faster or more dependably to bring your mind and body back into balance than a good laugh. Humor lightens your burdens, inspires hope, connects you to others, and keeps you grounded, focused, and alert. It also helps you release anger and forgive sooner.

Working Outside the Hospital Presents New Opportunities

A s a student preparing for a job in medical technology, you may envision a career working inside a hospital. However, many have chosen alternative paths that they have found both challenging and rewarding. Take, for example, the four medical technology professionals profiled in this article, who made very different decisions. “When I left college, I never imagined the career path I’d take,” says Elliot Sloane, PhD. As a college professor and advisor to hospitals and agencies, Sloane has been able to weave two career paths together. He currently splits his time equally between Villanova University, where he is an assistant professor in the Department of Decision and Information Technology; and as a consultant, helping hospitals around the globe decide what equipment to purchase, as well as investigating accidents and deaths, and improving standards. Brian Poplin, CHE, CBET, has worked inside hospitals, for a major corporation, and as a member of a hospital’s board of trustees. After four years as a BMET in the Air Force, Poplin worked his way up the career ladder at ServiceMaster (and its successor company, ARAMARK). He is currently the vice president of strategic development for ARAMARK’s Healthcare Management Services, providing clinical engineering management to healthcare facilities nationwide. For Nancy Pressly, she began her career with the FDA 18 years ago when she was hired as a biomedical engineer just out of college. She liked it, stayed, and today is a policy analyst at the FDA’s Center for Devices and Radiological Health (CDRH), bringing an engineer’s perspective to solving problems associated with medical device adverse events. As a healthcare engineering consultant, Tom O’Dea, PhD, PE, CCE, works with developers of medical devices. “I help them establish a theoretical framework, write an article for the technical literature, help create a prototype, and work with a patent lawyer,” he says. Education is Key Although the four took very different career paths, all agree that education is vital to success. Poplin, for example, finished his education while working full-time, earning a bachelor’s degree in business administration and a master’s degree in business management, “because I wanted the advancement,” he says. He is also board certified in healthcare management by the American College of Healthcare Executives, another component he felt was important in moving his career forward.