Editor’s Note:Medical Travel Today last talked to Paula Wilson in 2011, a few weeks after she assumed her role with Joint Commission International (JCI). As she herself stated, “I don’t think I even knew where the restrooms were at that point.”
Since that time she has not only gained her bearings but has helped JCI advance a number of key initiatives, and continues to contribute to a vision for promoting patient safety and quality initiatives amongst all healthcare organizations — not just those accredited by JCI.
We’re grateful to her for taking time out of her schedule to share with us a bit about JCI’s success and goals for the future.
Medical Travel Today (MTT): It has been a busy few years in your not-so-new role. Looking back, what do you consider to be the most significant activities in which you and JCI have been engaged?
Paula Wilson (PW): Well, it’s never me individually. Everything we do here is always a team effort. I just have the privilege of helping drive the effort.
Looking back, what I see is that we’ve really improved the value of accreditation.
We’ve done this in a few ways and we’re far from done. In fact, we’re in the midst of a lot of change and creating new programs, many of which will be implemented in January 2014.
But in terms of what we’ve already accomplished, we certainly stepped up the International Library of Measures. As an accreditation organization, we’re all about measuring and tracking. We’ve made great strides in terms of amassing important quality and safety data. We’re now able to look at it in new ways, and we’ve developed new methods for gathering it, too.
What this means for our customers is that they’ll be able to view their performance over time, as well as compare it to other organizations in their country, region and even globally. That’s the beautiful thing about accreditation. Everybody is using the same standards of measurement so the comparisons are meaningful. It’s truly apples to apples.
Another significant change is that providing data is no longer voluntary. It’s a requirement of JCI. As a result, collection and measurement is much more consistent. From a global perspective, I believe this is relatively unique. And it’s something that’s truly driven from our leadership. They recognize that the only way to drive performance is to measure performance.
The other major initiative we embarked upon last year and implemented at the beginning of this year is a new set of standards for academic medical centers.
These new standards acknowledge and include medical education and human subject research in the evaluation of quality and patient safety activities of academic medical center hospitals. In the past, these items were essentially unrecognized. This answers a lot of needs from our end, as well as our customers. It’s pretty exciting.
Another area where we’re tightening things up, if you will, is in the area of disease-specific certification. We noticed several health authorities, particularly in the Middle East, where interest in certification programs for specific diseases like diabetes and heart disease is very high. We fine-tuned our ability to certify those clinical programs, too.
In addition, we revamped our whole internal infrastructure. When I came on board everything was paper-based – the applications, tracking scheduling, all of it.
Now it’s all automated. The ease of use for our customers is extremely high. Beginning the first quarter of this year all applications can be completed and submitted online. Last year we introduced technology that allowed our surveyors to do their reporting online. In the next quarter our customers will have that same ease of access. Our goal is to be fully automated.
In 2014, we’ll be issuing the fifth edition of our accreditation standards, as well as a major redesign of the survey process. We’ve done extensive focus groups and have had numerous conversations with customers on how to improve the accreditation process and make it more meaningful — and took their input into consideration as part of the redesign.
The other thing we’ll be exploring is a way to do an unannounced survey in an international environment. There are a number of challenges to making this a reality, but we’re working to solve them.
All these initiatives are a part of bringing more value to accreditation and making it easier for our customers to interact and engage with us. It’s all about creating more touch points.
MTT: How about shifts? How have you seen the industry evolve?
PW: I’m not sure if this is a shift, but everybody is looking for a way to be in this business.
When I first arrived here, the talk was all about big guys – the Bumrungrads, Apollos, and so on.
But recently I was in Germany and spent a day with a smaller organization trying to get accredited. They’re interested.
I also spent time with a public health organization that was working with a non-profit group and trying to figure out how to link their efforts and build a medical travel business in Germany.
Turkey is another growing market, and I think all of the Middle East sees opportunity in the industry. Certainly Malaysia is looking to Singapore as a source of patients. Add to that list South America, the Philippines, Eastern Europe, they’re all now making a play for business.
A few years ago, these countries or regions were either not on the radar of medical travel or at least in the periphery.
The other thing that has happened is the mature market places, like Thailand, are now paying more attention to local populations. Medical travel is certainly part of their growth plan but so is the emerging middle-class and the population of contiguous countries.
The medical traveler has evolved, too. Two years ago the general impression of the typical medical traveler was a Westerner connecting medical travel with a vacation. I may be wrong, but I think now you have more people traveling specifically for care. The choice is now, first, who do I want to replace my knee? And second, can I vacation around it? Before it was about the beach and then what care can I get while I’m there? I see that as having completely reversed.
MTT: Let’s talk about accreditation. Is the demand up or down?
PW: It’s definitely growing at a nice steady pace. In October 2012 we broke the 500 mark for the number of accredited organizations.
The types of organizations seeking accreditation are getting more diverse, too. It used to be just hospitals, but now there’s a steady increase in ambulatory care networks and specific clinics seeking accreditation. It’s changing our case mix and we welcome it.
MTT: To what do you attribute the increase?
PW: I think the insurance companies and other payers are giving more attention to accreditation – and not necessarily just JCI accreditation. That’s helping to drive numbers. Ministries of Health, too, are getting better at the medical travel business and are looking to ensure their country offers a true quality experience. There’s just a much bigger focus on patient safety.
I’ll say this is a very positive environment for anyone in the accreditation business.
MTT:Is the demand for accreditation regional or particular to specific types of facilities?
PW: In the European regionwe’re seeing more interest from academic medical centers.
In the Middle East there’s much more demand coming from ambulatory networks. The same trend is starting to develop in Asia-Pacific countries. I’m not really sure what’s driving the different segment growth in different regions, but it’s definitely how the numbers are running right now.
MTT: What are the biggest obstacles to successful accreditation and has that changed at all over the past two years?
PW: Leadership is such a key part of successful accreditation. You really need a committed CEO and Board. I think this is still the biggest obstacle. Their involvement is key to maintaining accreditation. There’s a saying we use around here – You don’t prepare for the next survey. You prepare for the next patient.
If you’re tending to your patients thoughtfully and responsibly, you should be able to do the survey any day of the week. But that has to be driven from the top down.
International CEOs, like domestic CEOs, are deeply involved in the business of healthcare. That is making payroll, financial and regulatory integrity the big operational stuff… they tend to spend more time on balance sheets than quality reports.
But we see a direct relationship between the attention paid to quality reports and the success of an organization. Our challenge is educating and bringing leadership along to understand that.
Often what happens is a team is appointed inside the hospital and charged with handling accreditation every three years. It’s usually a team of top people, including a senior nurse, who are experts on standards and processes. It’s not uncommon for CEOs to delegate the task and forget it. As long as they make it through the survey they’re happy. For whatever reason, it’s not translating that the data gathering, work and forms are actually related to improving the patient experience and outcomes.
There’s also the matter of physician engagement. Many physicians, not all mind you, but many see quality as something other people do. That’s the quality department’s job. This is especially true for physicians who aren’t employed by the hospital. Right now only 40 percent of physicians are employed by hospitals. The other 60 percent are less vested in the organization. There’s not necessarily a sense of responsibility to the quality measures of the hospital.
The other thing to consider is that we have schools for surgeons, schools for nurses, schools for pharmacists, schools for imaging professionals, and so on. They all become sort of silo-ed experts. But when school is over they have to operate as part of a team. But they don’t get that training. The best care is delivered by a team that understands how to communicate, when to communicate, and whom they should communicate with. When communication breaks down, as it often does, quality suffers.
MTT: What do you anticipate being the key area(s) of focus for JCI in the year ahead?
PW: Continuing to build interactions, be it day-to-day, week-to-week, or month-to-month, with our customers. We really want to drive up the value and the number of touch-points.
In addition, there are a lot of organizations simply not ready for accreditation, but that doesn’t mean they can’t benefit from the knowledge and experience we have to share. We’re looking at ways to have an impact from an educational and training perspective at these organizations, as well as those that are accredited.
Of course we need to do it cost-effectively so they can take advantage. But that’s a goal: to make quality training available to many organizations regardless of their accreditation status.
We actually have a task force on globalization that is charged with global learning in 2013. They’re trying to determine how we can have a greater impact on the education and access to information of all healthcare providers. We really want to extend our influence. We have a lot of good content and knowledge. It’s a matter of figuring out how best to share what we know as broadly as possible.
Finally, we’re also working hard on honing the survey and standards. We’d like to develop a more continuous accreditation methodology so that it’s not just something that happens every three years. We’d like to develop meaningful programs and ongoing opportunities for dialogue for the in-between time. Quality shouldn’t be viewed as something that “happens” as needed. It’s got to be ongoing and we’re going to do what we can to ensure that.
About Paula Wilson
Paula Wilson is president and chief executive officer of Joint Commission Resources (JCR) and its international division, Joint Commission International (JCI). She has more than 30 years of experience in the healthcare industry. Most recently, she provided management and strategic planning expertise as a consultant to public, nonprofit and private organizations. She was previously the vice president for policy at the United Hospital Fund, leading efforts to shape public policy changes related to insurance coverage, healthcare financing and Medicaid. Early in her distinguished career, Ms. Wilson served in several senior positions in the administration of New York Governor Mario Cuomo, including the executive deputy commissioner of the New York State Department of Health. She also served as deputy director of the New York Division of the Budget, and as a program associate for Health and Human Services on the governor’s staff.
Ms. Wilson taught financial management and public and nonprofit administration at Columbia University School of International and Public Affairs, and graduate courses in healthcare financial management and corporate compliance at the Wagner School of Public Service at New York University.
She received her master’s degree in social work from the State University of New York at Albany, is a member of the Board of the New York City Health and Hospitals Corporation, and serves on the finance committee of the Saint Mary’s Center, Inc., a nursing home for people with AIDS.