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accreditation

Yale New Haven Hospital is expecting The Joint Commission (TJC) to arrive unannounced this fall or early winter to conduct its triennial accreditation survey, which measures hospital performance.

Over the next several months, Accreditation, Safety and Regulatory Affairs (ASRA) will distribute educational and informational tools to help employees prepare for the visit. Achieving accreditation is a nationwide seal of approval that means the hospital has met or exceeded TJC performance standards.

"Our success will depend upon staff demonstration, articulation and documentation of our safety and quality practices," said Victoria Dahl Vickers, RN, director, ASRA. "Crucial to success with regulatory preparedness and surveys are safety and quality practices that become habitual parts of our daily routine – they become how we care for our patients."

This summer, managers will introduce a set of flash cards to use in safety huddles and staff meetings. The flash cards cover national patient safety goals, life safety, medication management and other topics TJC surveyors will review with staff when they survey the hospital.

In addition, bi-monthly tip sheets will inform employees about safety matters, providing valuable updates that keep issues top-of-mind. Clinical staff will also receive a small spiral handbook that will fit in pockets for quick reference. This guide contains reminders on many environment-of-care and clinical safety practices, such as fire response and fall prevention strategies. Non-clinical staff will also receive a pocket-sized brochure for reference.

Beginning this month, ASRA liaisons will offer brief in-services at staff meetings and huddles.

"We have the tools to help employees get ready for The Joint Commission," Dahl Vickers said. "Our goal is to prepare a workforce that is confident and interacts effectively with surveyors. We provide safe, high-quality care, and this survey will give us the opportunity to demonstrate the excellent work we do."