How has your perspective of the Joint Commission changed now that you are on its board?
I don't know that it has changed. If you look at the history of it, it is made up of member groups--the American College of Surgeons, the AMA, the American Hospital Association and some consumers. Within those member groups, the purpose from the beginning was to be sure that there was a quality product that the public could feel good about. So knowing that, I really didn't change my view.

It's amazing to listen to the dialogue [among the commissioners] and participate in the dialogue because the basic question is, "Is this right for the patient who is receiving care from one of those organizations?" Seeing that has strengthened my commitment.

The JCAHO reviews many types of organizations, not just acute care hospitals--behavioral health, home health, long-term care, etc.

So, when there is any standard on the table [the commissioners] are definitely asking that question and discussing that in-depth before the decision is made about a standard.

What do you hope to accomplish on the JCAHO board?
To continue raising the issue of what is a best practice-what are the best things that should be done for patient care-and as the external environment continues to have new challenges, like nurse staffing and patient safety issues, to use my knowledge of nursing and patient care to help the discussion and decisions that are made at the board level.

Since the Institute of Medicine's report "To Err is Human" was published, there's been a lot of industry focus on reducing medical errors. What role should the JCAHO play in this?
I want to go back to the Joint Commission's purpose--to create the safest environment it can through the accreditation process.

If the mission is to create the safest environment for patients, then medical errors/patient safety are definitely issues that the Joint Commission will be implementing.

One of the methodologies that the JCAHO continually discusses with its clients [purchasers of the accreditation] is an effective quality improvement process within organizations. That's a guide and a resource to each organization to look at how they do their work, their business, their patient care, and identify if there are any places where improvement is needed or can occur.

That process is extremely important to improving patient safety out in the field.

The other piece that is significant is the sentinel event process. Taking an engineering concept of root/cause analysis and applying it to health care was a unique contribution the JCAHO has made in the field.

In my organization [Desert Samaritan Medical Center], we use that concept even if we don't have a sentinel event. We use it when we have an opportunity to look at a situation and say it could be improved and how can we analyze it. The root/cause analysis process has made all the difference in how we make improvements on a regular basis at my organization. The JCAHO has made a significant contribution to the field in the safety/quality arena through tools like this.

What is a sentinel event?
Essentially, a sentinel event is an event that had a negative outcome with a patient that people do not want to happen again. The review of that situation is called root/cause analysis, in which people gather significant contributors to the knowledge of what has occurred and review the event in a systematic way.

A basic principle of the process is that we are not looking at people; we are looking at processes. We want to know what broke down in the process and what needs to be fixed. We try to determine what in the system went wrong that caused this event to occur within a no-blame culture.

Because of that, there is a more effective look at situations that could be prevented in the future. Again, I believe the JCAHO was a catalyst for that in the field.

Have there been changes in how the JCAHO responds to sentinel events since the IOM report?
It has been the way they have dealt with them for the last two years. JCAHO news releases include sentinel event alerts. These sentinel event alerts provide information to the field based on a particular finding.

For example, potassium chloride was packaged like another drug, and there was a significant event where the wrong drug was given.

Because of root/cause analysis and this review, the pharmacological industry changed packaging so that there was one less opportunity for error between these two drugs. Those are the kinds of things that come from this process and decrease the risk to patients throughout the country.

As a nurse, what contributions will you make to the JCAHO governance and its understanding of nursing and patient care issues?
Of the 28 commissioner seats, there is one nursing seat. Sally Sample has had that seat for eight years. Her term is coming up and she will be replaced by another nurse.

I say that because there is a nurse there who brings and has brought forward the kinds of things I believe I also can contribute-an understanding of patient care processes.

I understand because nursing is in all of the continuum of care. Nursing is the one constant that is with a patient consistently. That's what I think I can also contribute.

I have been the chief operating officer in other hospitals and senior administrator here [at Desert Samaritan].

I can bring-along with the experience in direct patient care processes and the nursing understanding-the overall understanding of operating an institution.

So I believe it is a good blend to understand all of those aspects of our business, and then be able to contribute to the mission of the Joint Commission, which again is to continuously improve the safety and quality of care through accreditation.

The nursing piece helps a lot, just as with the physicians on the board; their clinical knowledge and patient care knowledge help tremendously.

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