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Dr. Mark A. Chassin, president of the Joint Commission (TJC) and the Center for Transforming Healthcare, presented the lecture "Overcoming Obstacles to High Reliability Healthcare," to hundreds of Walter Reed National Military Medical Center (WRNMMC) leaders, health-care providers and staffers who attended the special presentation in Laurel Clark Memorial Auditorium Friday.

"I'm delighted to be helpful in this great enterprise you've undertaken to [integrate] two amazingly world-class organizations to serve service members even more effectively," said Chassin, a nationally-recognized leader and champion of safe, quality health care.

During his June 8 lecture, Chassin defined high reliability as "consistent excellence." As the Joint Commission leader's first visit to WRNMMC since the Army medical center and Navy medical center joined forces in September 2011 to form the first joint military treatment facility in the country. The newly integrated medical center received full accreditation in March after WRNMMC successfully completed its first TJC survey, which evaluated the hospital's quality of health care and efficiency of administrative procedures.

"Consistent excellence is everything that we do in health care, and that's an aim that I think all of us share but it's a goal that's pretty elusive," he said. Chassin cited an Institute of Medicine report published 12 years ago "that galvanized a patient safety movement" to attain consistent excellence.

Chassin counted hand hygiene, medication administration, patient identification, and communication in transitions of care as more common areas of concern in the delivery of quality health care; however, some of the less frequent, preventable adverse events, like wrong-site surgeries, fires in the OR, infant abductions and inpatient suicides, make newspaper headlines, he said.

Chassin's lecture also illustrated how communication failed at multiple levels at hospitals and other health-care facilities where patient identification protocols were ignored, teamwork was not present, and there was a lack of coordination between services, and informed consent was disregarded.

"What can you do?" Chassin asked the audience, before offering suggestions. He urged health-care leaders and staff to be watchful of bypassing of safety policies and procedures - they are unsafe practices, according to the presenter. Not having the information you need about a patient is also an unsafe condition. In addition, be alert to intimidating behavior: impatience, a condescending tone or verbal abuse among fellow staffers. Maintain accountability to safe practices, and also recognize close calls when patient safety could be compromised, explained the expert.

A safety culture and leadership that moves forward to high reliability involves trust, reporting and improvement. Chassin continued by citing a real-life example involving a case of mistaken identity that resulted in unnecessary surgery for the wrong patient after a series of mostly small errors by many individuals who failed to speak up or recognize the unsafe conditions and practices. The physician said there were several chances to avoid this event yet conditions in this instance are very common.

According to Chassin, events like this have resulted in the Joint Commission launching a Center for Transforming Healthcare to create solutions for high reliability health care. Utilizing the Lean Six Sigma management methodology, the center began a project in 2009 where participating accredited hospitals utilized an interactive, data-driven technology tool to combat focused concerns such as hand hygiene, wrong-site surgery, colorectal surgical site infections, sepsis and medication safety.

"We should always be ready to provide safe and high quality care for our patients and their families," said Gene Monroe, Walter Reed Bethesda Joint Commission specialist, following the medical center's successful survey in March. "The Joint Commission standards help us to accomplish that. Each time our staff demonstrates how they safely provide high quality care, and how they partner with the patient and their family in the planning of their care consistently, then we've gone a long way to staying continuously survey ready."

The Joint Commission is a U.S.-based non-profit organization that surveys more than 19,000 health-care organizations and programs in the United States for accreditation, "to continuously improve health care for the public, in collaboration with other stakeholders, by evaluation health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value," according to the TJC website.