BB&T Contributing Writer

CHICAGO — Organizations can set goals, but what then? What if the goals are not to be reached by the organization itself but by the audience the organization addresses?

That is the constant dilemma of the Joint Commission on Accreditation of Health Care Organizations (JCAHO; Oakbrook Terrace, Illinois), an organization whose primary job is goal-setting for hospitals and trying to encourage hospitals to do what they are supposed to do best: heal rather than harm.

The organization most recently rolled out a set of four goals and requirements, in draft form, targeting patient safety.

They are:

• To improve recognition and response to changes in a patient's condition;
• To reduce the risk of post-operative complications for patients with obstructive sleep apnea;
• to prevent patient harm associated with healthcare worker fatigue;
• and to prevent catheter misconnections.

The organization has set Jan. 26 as the deadline for receiving comment on the goals.

But the JCAHO's president, Dennis O'Leary, MD, at the organization's 20th annual national conference on Patient Safety, in mid-November appeared to acknowledge that there are a whole host of human elements that block hospitals for being truly safe, no matter what persuasion is used by the JCAHO.

Using the results of the organization's 2005 annual survey, O'Leary highlighted key items focused on patient safety and asked: "What's holding us back from improving on patient safety?"

Leary clarified the difference between patient quality and safety, saying, "safety operates on a risk reduction activity such as 'Do this and you will have fewer problems' while quality measures errors of omission — things you should have done but didn't." The goal of patient safety is to prevent human error from reaching the patient with a system for measuring this.

"One key barrier towards improved patient safety is the absence of a national leadereship platform," he said. "That is, there is no government leadership role to help make the goal of improved patient safety happen." He added: "Currently, the system pays equally for good or bad patient care, and what the government wants, which in itself undermines patient safety. … [I]f the government want sto accomplish a standardized care, it needs to create a budget and a leaer in order to achieve the goals they desire, such as performance measurements, quality improvement and sharing of information.

Leary concluded that given the extent and difficulty of these issues there are key factors for success that individual hospitals should embrace for the best in patient safety. Among these: an organizational culture of safety and quality, systems for measuring uality and safety, use of root cause analysis; engaging the patient in reporting problems and problem solving, and apologizing sincerly for mistakes.