As compliance professionals, we are well-versed in following rules and regulations set forth by The
Joint Commission, Centers for Medicare &
Medicaid Services, Office of Inspector General,
and other organizations. Compliance
professionals are accustomed to mea-
suring performance and standards,
and ensuring patient and staff safety.
Reviewing The Joint Commission
standards1 and the National Patient
Safety Goals2 yearly and making
them part of your compliance plan
will help you focus on items you may
not have considered and will serve to improve
patient care and safety in your facility.
Being prepared will improve communication within your organization, and it can be
another topic of discussion with your staff.
By engaging a diverse group in your Joint
Commission Readiness team, you can engage
with other caregivers and staff members,
including environmental services, engineer-
ing, facilities management and housekeeping,
and contractors with whom you may not have
had any prior interactions. By reviewing all
areas of your facility with perspectives from
your readiness group, you can make changes
and improvements to reduce the likelihood of
issues with life safety and facilities manage-
ment during your survey.
You can also use The Joint Commission
Standards and National Patient Safety Goals to
look at your policies and procedures to determine whether updates or changes are needed.
Education can also be another benefit. Are we
practicing safely? Do we have the proper medication management practices in place? What
else can we do?
Tips for finding solutions
This information can reveal opportunities for
growth and lead to the development of new
tools that can add to the effectiveness of your
program and organization. From the compliance perspective, you can assist and look at
concerns and/or problems and help facilitate
solutions. Prepare, round on units, and engage
others to do the right thing at all times, not
just in preparation for an upcoming survey.
I found it fascinating to be involved in the
Communication team as a rapid educator. The
by Karen L. Parton, CHC
Joint Commission readiness
» Add The Joint Commission standards to your compliance program.
» Use yearly National Patient Safety Goals to stay on top of emerging issues.
» Be part of The Joint Commission Readiness team.
» Add to the effectiveness of your hospital preparedness.
» Use the team-based approach at your facility.
Karen L. Parton ( email@example.com) is the Surgical Services
Administration Compliance Analyst at University Medical Center of Southern
Nevada in Las Vegas.