Episode 22 - Candace Eden - The Joint Commission & A Culture of Safety

Candace Eden, a consultant for the Joint Commission, shares insights gained from helping hospitals pass surveys with Medplace. She explains how to build a 'culture of safety'.

  • 00:10:11 - 05:10:11

    Jerrod Bailey 00:02

    Welcome to reimagining healthcare a new dialogue with risk and patient safety leaders presented by Medplace. We're excited to bring you conversations with top risk and patient safety thought leaders from organizations around the country. Please subscribe to get the latest news and content and if you value this episode, please feel free to share it with your colleagues. We're trying to create meaningful dialogues and other communities around the country. If you're interested in participating as a guest, please send us an email at speakers at Medplace.com My name is Jerrod Bailey. I'm the CEO of Medplace I'm going to play host today, and today I'm joined by Candice Eaton. Hi, Candace. Good afternoon. So Candace, I have here that you are a joint commission consultant and past president of the Florida society for healthcare risk management. Yes. And obviously, or if it's not obvious, the opinions that you're going to share today are yours, and not the Joint Commission's


    Candace Eden 01:18

    to welcome. Right. Thank you. So


    Jerrod Bailey 01:22

    yeah, well, thanks for joining me, I'm super interested in this conversation. It's top of mine. We do a lot of work with hospitals and clinics and all sorts of folks in between around the country. And the Joint Commission's always coming up, right. Right. Before we jump into I'm going to give a little bit of a bio of a bio appears here you tell me if we get this. All right. So Candice is a seasoned DNP executive with 40 years of nursing experience over 28 years of leadership and quality improvement experience. She currently serves as a consultant of the Joint Commission where she helps organizations across the country interested in evaluating their current processes and workflows to aid in continuous improvement. And Joint Commission survey readiness. Exactly. Yes. Love it. I think I need your help in more than a few places, but in your advice, certainly. And by the way, I'll put your LinkedIn and your contact information in the show notes afterwards. But but this is great. So. So tell me a little bit about your backstory. Right. How did you go from bedside care to joint commission with that would that passionately?


    Candace Eden 02:34

    Well, that's a good question. So long ago, I can remember my my very first job Jerrod, I was making $6.35 an hour is an RN, at a major trauma center in Miami, and I was so thrilled. So you can see that's been a while ago. But clinically, I mostly did open heart surgery, cardiology and then fell in love with emergency nursing. It's that adrenaline and you never know what's going to come in the door in the next minute. So I just loved that, and problem solving. So then as I went through my career I was in leadership a few times did some management roles, et cetera. And I decided I needed to vary my experience. So I worked at a trauma center, a community hospital, I worked for ambulatory clinics for a while, then I did an industry like an external partner that was doing patient experience, and got to open a pediatric hospital here in Orlando. So intentionally Yeah, I intentionally chose those things. So I wanted to be marketable. Right. And along with that, my academic career group, so I started with an associate's degree in nursing, got my Bachelor's got my masters. And then I guess I just kept going up my doctor. And so I felt like as I aged in the profession, I would have more to offer with those two combined, and it worked out. You know, now, the last 20 years have been the quality risk patient safety. I just love it. Being able to keep patients safe. Being able to mentor young nurses. It's just a thrill for me. So it's been good.


    Jerrod Bailey 04:19

    Fantastic. And so where did where does then the Joint Commission come in? Where did that intersection start?


    Candace Eden 04:27

    So last year, looking for what exactly did I want to do next in my life, and it was getting to a point where that mentorship was great at the organization I was at because I was at a corporate level organization. That was fine. But I think I just wanted to be able to spread that more. And I have a very good friend who's a joint commission surveyor and she just said, you have to look into the consulting arm and see what you could do because you could bring your experience to that. So I interviewed and they said yes, so We both said Yes to the Dress, and here I am. So really love


    Jerrod Bailey 05:04

    to test it. Well, and you've seen so many different parts of healthcare and you've been in so many different settings, it's going to give you a particularly helpful perspective, right? I don't know, if you're working with any particular type or size of organizations today, is there? Is there any sort of like specific purview that you've got,


    Candace Eden 05:21

    or so it's really all different. So it just so happens, I do the Joint Commission mock surveys, that's getting them ready, right is they are going to be surveyed. And it could be in a hospital, it could be in a laboratory, it could be in an ambulatory care setting or surgery center, or even home care. So they do all of those. And then I started doing CMS consults as well. So again, these are mock consults for CMS coms, and a lot of hospitals will have CMS come look after they'd have their joint commission survey. So it's a little different perspective, more regulatory, but we help them prepare. And then the last thing is I started doing certification. So if you want to be in acute care, hospital and Mark, for cardiac surgery, and market that, or you want to be an advanced hip and knee center, I can also go out and help you get ready for that certification. So all of those things,


    Jerrod Bailey 06:15

    that's a lot good thing, you've probably seen a lot of those things throughout your career. So you know, it's interesting, we're in this risk and patient safety world, and a lot of our audience is there's a lot of folks who are in hospitals, right. And they're doing that type of work in hospitals, a lot of our audiences sitting at carriers that are dealing with risk much further downstream. Right. So it's after bad things have happened, right lawsuits and things like that. And, and so I do a lot of work, I interact with a lot with claims people and attorneys and law firms and things like that. And it's, it's sometimes shocking to me how, how little a lot of folks in that world know about what's happening at the, in the hospital setting from a risk and a patient safety perspective, right? Just things like concepts like peer review, a lot of them have heard of it, but they don't really know how it functions, right. And they don't know the things in the bad things and the dysfunctional things about it and things like that. So in very often, I think they just have sort of an academic view of what Joint Commission even does in the process. Right. So for those of those of the audience that really don't understand the Joint Commission in detail, can you explain it just a little bit kind of flyover. And there's kind of two, two parts of the business, right, the consulting part and sort of the traditional part of joint commissioning.


    Candace Eden 07:33

    Sure, happy to so Joint Commission is deemed by the Centers for Medicare and Medicaid to go to facilities, whether it be that ambulatory center or hospital or physician office even, and either accredit them or certify them in the care that they deliver. So it's to make sure that everything in place for patient and employee safety actually is being done. And it's really a check and balance. So Joint Commission is the survey side. And there's a very definitive firewall, for those who don't know, between that side and what I do for consulting. So we are not allowed to know what findings Joint Commission had for an organization we go to, unless they tell us right, personally, we cannot say where we're going. So the Joint Commission knows what we've looked at. But what's exciting is, is you use consultants we go out, you can tell us all the things that are happening, that you're concerned about all your dirty linen, if you will, you want us to find it so we can help you get ready and really shine when Joint Commission comes in does your actual survey, and you want us to catch that because No, everybody wants to do well, and everybody wants to be considered safe. And I will say, Jerrod, that for the consumer today, you need to be able to demonstrate that you are keeping patients safe so that when they come to you, they feel safe, right? After COVID People were worried about even going to a hospital and many didn't get care, and it was delayed. So we want people to come back, come get your care, we'll take care of you. And we'll do it in the best and safest way possible. So that's really where Joint Commission, I think shines.


    Jerrod Bailey 09:12

    That's great. Now, I've heard that the Joint Commission has an actual goal right here, this goal of zero harm events. That's fantastic. Obviously, it's a goal that we all want to aspire to and actually achieving. It's a whole other animal, right, but there's going to be certain parts of healthcare that are going to be better set up to get to that goal than others. So where's the longest road ahead? That you see or like as far as what areas of health care are really you know, either have the longest road what Yeah, who has the hardest job in front of them?


    Candace Eden 09:51

    Right? zero harm is truly the ideal to go after right? And there's controversy even about that. Can we get there is that is that in the attainable goal. And yeah, I've seen it in different segments in small amounts, especially in infection prevention. But I will tell you, those are those are, that's one of the areas that is the longest to get to. So especially after COVID, we saw an increase in hospital acquired infections across the country. So everyone is looking to prevent those line infections solely catheter infections after surgical infections, I still think we've got a lot of work to do there. Also, I think another big area for us to look at is that miscommunication, or non communication, if you will, in things like handoff. So if you're coming in through the emergency department, and then you go up to a floor, does that information get translated to the right people? Does it get to the physicians that the nurses have heard, and just we're seeing a lot of error come out of that miscommunication, or missed information. So it's really paying attention to that detail and making sure that those things get passed on? I think those are the two biggest areas that we've got a long way to go. And I'll tell you another area that we're seeing a lot recently is, and there's a huge focus from Joint Commission perspective on environmental care. So are you keeping your facility up to snuff? Are the employees that are using the equipment really using it by the manufacturer's instructions? Or have they gotten complacent with how they do it? They learned it from one person a certain way, and maybe that wasn't the right way. So we're really finding a lot of things in the upkeep of the facility, and the safety of that facility. So it's so there's a big emphasis on that, too.


    Jerrod Bailey 11:41

    That's fascinating. You know, just you mentioned a second ago, the handoff part of the process, how critical that is. There's I did an interview with the founder of a company called iPass. Yes, weeks ago, do you know about them? Yeah. The stats that they're putting out as far as like, how to just take error out of the process by focusing on that handoff and facilitating cleaner and more rich handoffs is just really, really fascinating.


    Candace Eden 12:10

    Yeah, and we'll talk about peer review, again, because there's a lot of ways that you can prevent that error from doing excellent peer review. Right. So Oh, my


    Jerrod Bailey 12:18

    gosh, yeah, definitely, definitely get into that. Any other one of the big obstacles? Like what what's keeping quality improvement from moving forward right now? Is it that just those things you just mentioned are there? Because it feels to me like there's maybe there's some cultural issues in certain settings. And there's other things that are kind of holding back? Yeah, definitely. Quality man. Yeah,


    Candace Eden 12:42

    right. Yeah, yes, Jerrod, definitely cultural issues. And we'll even talk about that a little bit more developing that culture of safety. And that really is the accountability of leadership. And I'm talking all the way to the board, if they must be engaged. But some of the other obstacles are, first of all, patients don't really know what is good quality, versus what is poor quality. And I think sometimes they just accept poor quality when they don't need to, like for example, if you don't speak the language, if Spanish, for example, is your primary language, we need to make sure that we are providing all health care information in the language you best understand, right? And not just using your your five year old or your 10 year old child to translate that for you. So I'm seeing that a lot across the country Truett country also, and organizations are stepping up to make sure they have those translation services available, but that that's important that you can as a patient speak up and say, I don't understand or could you explain more, so they make good decisions. And also, quality and safety is not necessarily a moneymaker. Right. And we're seeing hospitals all over the country you see in Becker's and other reports, they're losing $1.5 billion dollars, Kaiser's losing money, Cleveland Clinic as everyone is talking about it. So we're going to have to think about how do we work together to make sure that community gets the services they need, and maybe not have those redundant services and other facilities in our community? And we're going to have to think about that. I know that's controversial. But


    Jerrod Bailey 14:14

    it's, it's an interesting topic, because when you look at the business of risk, there's it's funny how many hospitals have this firewall between risks patient safety, right? And in so what's happening on the patient safety side is there's all this good stuff happening and then underneath all the good stuff there all these you know, sort of bad habits and a procedure that's just sort of been done wrong from the beginning. It's it just keeps getting done wrong, and there's like, hidden underneath all of the great things that we're doing everyday than a hospital setting are the things that we're going to get sued for five years from now. Yeah, right. It's happening and it has $1 amount to it everything from to Cubitus ulcer. URLs which are common to lots and lots of other things, they're happening right now. But they're not being exposed, elevated, or seen or identified. And so they end up becoming a problem later. And those problems later have real dollars associated with them. It is some people in the risk world that are really good at thinking about risk from a business perspective, and making sure that that these programs are being articulated in the dollars and cents perspective, and a lot of lot of nurses didn't come up in, in business school and you know, there's this, there's this friction between the C suite and in in those that are actually providing clinical care. But you know, I think of like, like Pamela poppet, Gallagher, Bassett, she's really good. She was the former president of Ashe room, she's really good at identifying the business case behind the, the quality and safety systems that should be implemented, right, because she sees it on the on the other end and form of lawsuits and claims and things like that. So I think it's kind of a dream for next year, I want to do, I want to get some folks like Pamela and some others to just do a tour of like how to build business cases around patient safety measures, because I think that's a missing piece that there's a lot of power behind that.


    Candace Eden 16:17

    I agree completely. And that's really important what you're saying, Jerrod, because first of all, patient safety was always kind of behind the scenes risk management even more behind the scenes, right. And it was intentional, that we kept things quiet. You know, attorneys were afraid that if we disclosed, errors were happening, that patients wouldn't come to us, but it's completely the opposite. So we talked briefly about the culture of safety, so expand on a little bit more, it's being transparent. That's what we're looking for today, I worked with a risk manager locally here in Orlando, who's excellent, excellent a director of risk. And we work together from a patient safety and risk perspective, when I was in that role, to have communication with the leaders from all of those facilities that we worked with, to disclose errors. So we shared them. And it was like revolutionary to these leaders, they had never heard what each individual hospital had done and what they did to make it from happening again. But that prevents it everywhere. And then we took a series we created a series called it could happen to you. And it happened to me. And it was a physician that we had a nurse than we had others and they would tell their story of maybe leaving a sponge in a patient after surgery, it happened to me and it could happen to you, and what could we do to make that not happen again. And we then sent those videos out to all the staff, and it got such great feedback, because Transparency is key, you've got to be open and talking to your patients talking to your consumers, your families, and your staff. So they'll speak up, right, we want them comfortable. I have to we have to do something to make sure nurses will tell us when something goes awry.


    Jerrod Bailey 18:00

    Oh, I know, right? Gosh, the stuff that nurses are having to consider now, who would have thought we'd be here, right from a year ago. So you know, I think there's a there's a lot of power in when providers when nurses and doctors and specialists when they collaborate with each other in in a see the silos and silos are very much either in departments, or they're at least siloed within an organization and will it's very often I'll meet like, a hospital system that's in one part of the country. And they just sort of do the things that they know to do, right. And they continue to do that. And maybe they have some new doctors come in, and they bring a little bit of new blood. But I honestly think one of the revolutions of healthcare in the next two to five years is going to be the dismantling of the silos and creating more opportunities for collaboration, right, we're doing it, I can take an operating clinician in Mayo Clinic, and where they normally would be geographically bound, their influence is geographically bound to Scottsdale, all of a sudden, now they can influence hospitals on the other side of the country, right. And you start creating, you're getting rid of the friction in between the talent and the experience. And I think we're going to see a big revolution as far as quality patient safety, the velocity of learning, the velocity of implementing new procedures and things like that. It's going to be awesome.


    Candace Eden 19:34

    I we're back to your business case discussion. In Pam. And yes, absolutely. We need to make that business case that that collaboration is key, and that we're joining. So for example, you had mentioned earlier, I was president of fish from last year, which is that Florida state organization of risk and patient safety. And we work very closely with our state organization, which is called Acha. And they come and present at our conference, our Annual Conference, we collaborate and present together. So we are trying to establish that collaborative relationship, if you will, with other agencies that we're working with also the Florida Nurse Association and the Florida Hospital Association. And now we're branching out with some of our educational offerings in the southeast. So we're looking to involve Georgia and Alabama and North and South Carolina, and have that same kind of consistent education. All it's all about collaboration with Jerrod, it's all about that business case. It's all about us all joining forces and, and making improvements. Well,


    Jerrod Bailey 20:35

    Candace, so what do we do about the lawyers?


    Candace Eden 20:40

    We can't do without the lawyers, so we have to have them in there great advisors, or bring them along with us, I think we just need to include them in those conversations. And just like we've learned to be transparent in hospitals, where we were afraid, we just got to bring them along and say, Look, there's no need to be fearful of this, this is how we reduce the money you're going to have to pay out, right? Because we're going to make that business case, look at these things and prevent it from happening. So you know,


    Jerrod Bailey 21:10

    the more the frankly, the more we collaborate through initiatives like Candello in rehab data collaboration, flowing, the more we can learn faster than just what's happening under our roof. And we can make decisions that are based on like, sort of industry, macro trends and things like that. And so yeah, I think the more of that, that we see the more data that goes into systems like Candela, the more that can come out and make, again, better decisions,


    Candace Eden 21:35

    right. And we're hearing to Jerrod all over that there are different industries that are looking to come in and manage the emergency department, for example, or imagine manage practices for physicians and stuff. So there's, there's a lot of people that are creeping in to our business. So we need to make sure that we you know, have a voice in that conversation is like, that's great.

How can hospitals find areas of risk before they lead to inspection deficits or patient injury? How can healthcare make better use of its data and collaborate for better care? Candace Eden, a Joint Commission consultant, answers these questions and explains how a 'culture of safety' can mitigate risk in this episode. Stay tuned and listen to episode 23 for part two of this discussion.

Candace Eden

Joint Commission Consultant

Candace is a seasoned DNP executive with 40 years of nursing experience and over 28 years of leadership and quality improvement experience. She currently serves as a consultant of the Joint Commission, where she helps organizations across the country interested in evaluating their current processes and
workflows to aid in continuous improvement and Joint Commission survey readiness.

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