Ambulatory care: Explore the journey to Joint Commission accreditation
Laura Huete, MD, MBA, FACMQ, CMQ, Senior Medical Director, WellMed
Seeing relationships between clinicians and patients as crucial to wellness, and with a vision for improving health care delivery for seniors, Dr. George Rapier III founded WellMed in 1990.
The organization is a capitated, full-risk Management Services Organization (MSO) specializing in care for older adults.
WellMed provides care for more than 340,000 patients, most of whom receive Medicare. Using the WellMed Care model which adopts the philosophies of an Accountable Care Organization (ACO), WellMed, part of Optum, continuously strives to improve quality and lower cost.
With a strong focus on primary and preventive care, and using advanced informatics, WellMed produces high-quality outcomes.
Why start down the path to an accreditation? The Joint Commission, the oldest and largest accrediting body in health care in the United States, is famously rigorous.
Seeking to earn the ambulatory care accreditation, held by fewer than 250 organizations, was a significant challenge. But, since WellMed was founded in 1990 our standards have been exceedingly high and our expectations for superior patient care drive us to accept great challenges.
The road to the Joint Commission
The journey to accreditation aligns with the goals of WellMed, now 89 primary care clinics across two states.
WellMed’s physician-led executive team seized the opportunity to unite the organization in meeting the highest standards of patient care and safety, to be the best place to receive care, the best place to practice, and the best place to work.
Accreditation was a chance to acknowledge the excellence that exists in the WellMed organization and further refine our processes, providing ever-improving care.
Leadership laid out the plan for accreditation over an 18-month period. A core team of dedicated senior leaders met weekly to appraise progress and designate next steps.
Chapter champions — committees made up of physician, nurse, administration, and executive leaders attached to specific improvement projects — met regularly and coordinated policy change throughout the organization.
WellMed created a Market Nurse Leader position to provide hands-on communication and education. These nurses carried the process improvement mission to their clinics, engaging with doctors, nurses, and support staff on the front lines.
They did the work of explaining the “whys” and “what fors” of change, opening direct channels between leadership and direct patient care providers. This role encouraged crucial support from the grassroots of the organization.
Delivering process improvement
With a large network of clinics, standardization was key. From Texas to Florida, in urban markets and rural, individual clinics develop unique processes and cultures. While the WellMed care model was universal, the accreditation journey brought the chance to unite all clinics.
The mission had three clear goals:
- Deliver an exceptional patient experience: This includes everything from ensuring patient safety, meeting clinical practice guidelines and assisting patients with transportation to and from medical appointments.
- Exceed patient expectations for access: Access is very important to our patients (and integral to the medical home model). This includes answering the phone when they call, providing them with 24-hour access to the clinic and arranging for appointments when they need them.
- Create a healthier organization: A well-supported workforce — physicians, advanced practice clinicians, nurses and ancillary staff — is essential to provide the best possible care. Striving for this goal helped ensure appropriate staffing, training, development and recognition for all employees.
Workgroups addressed dozens of issues essential to patient safety and quality care. Standardizing medical equipment reduces training cost and user error.
Paring down the stock formulary from nearly 1,000 medications to 300 helps prevent medication error. Educating staff on preventing falls — the potentially devastating and most-reported injury in primary care clinics — reduces the likelihood of those injuries.
Standard reporting across all clinic electronic health records (EHRs) provides accurate measurements for change impact. All of these process improvements directly impact patient outcomes.
To improve access to care, WellMed opened the 24-hour Patient Service Center (PSC) in one employed clinic in November of 2017, with an aggressive schedule to roll out to all WellMed clinics by the end of 2019.
This dedicated team of nurses and customer service representatives handles patient requests for appointment setting, transportation, medication refills, nurse triage and provider access around the clock.
PSC’s convenience is a big driver of satisfaction. It reduces hold times during daytime heavy call volume and gives patients access to primary care no matter the time of day.
Bringing home the gold seal
After 18 months of preparation and four intense days of on-site visits by Joint Commission accreditors, WellMed received the ambulatory health care accreditation and primary care medical home certification on August 14, 2017.
With great pride, we shared the news across the organization.
Through this rigorous process we have experienced the benefits of improved organizational collaboration and communication.
Our patients have responded to our work with overwhelming positivity: The Optum annual Patient Health and Safety Assessment (PHSA) increased from 79 percent in 2015 to 97 percent in 2017.
WellMed is proud to be among the select number of ambulatory care providers able to say with authority they are giving the best to their patients and employees. We look forward to continuing to reach for our goals.
This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice.