Dr.Paul Chang,MD,MBA,MPH,CPHQ,FACHE,Vice President, Accreditation,Standards and Measurement,Joint Commission International.
Dr. Paul Chang is Vice President of Accreditation,Standards and Measurement. In this capacity, he leads a global team of talented and dedicated accreditation professionals to serve health care organizations throughout the world.
In prior positions, he served in a variety of roles in the Singapore Ministry of Health.Later, Dr.Chang oversaw clinical quality, risk management, quality improvement, and JCI accreditation at Changi General Hospital, an 800-bed Singaporean public hospital. He was part of the management team that led the hospital to achieve JCI accreditation in 2005 and JCI disease-specific certification in two cardiology programs (Acute Myocardial Infarction and Heart Failure) in 2007.
He went on to serve as JCI’s Asia-Pacific office Managing Director from 2007 to 2013. While in the Asia-Pacific region, Dr. Chang collaborated with regional ministries of health, governmental and nongovernmental agencies, hospitals, laboratories, and various health care organizations to develop ways to improve health outcomes and patient safety. In 2013, he joined JCI’s executive team as Senior Executive Director of Accreditation and Standards prior to assuming his current role.
Dr. Chang earned his medical degree and a Master of Public Health from the National University of Singapore and an MBA from the UCLA Anderson School of Management. He is a trained JCI accreditation and International Society for Quality in Healthcare (ISQua) surveyor.
1.Why are CPGs necessary in obtaining JCI accreditation?
For JCI, our mission is to improve the quality and safety of healthcare globally. Towards that end implementing Clinical Practice Guidelines (CPGs) in health care organizations is critical if providers are intent towards practicing evidence-based medicine, which is transforming solid research evidence into impactful patient care. CPGs are useful tools for organizations to achieve this aim.
2.In your experience, what are some of the key challenges that providers or hospitals face when trying to implement CPGs across the board?
Some of the key challenges that providers or hospitals face include the following:
- Gaps still persist between theory and implementation, as CPGs are sometimes poorly developed and implementation is a complex and arduous process.
- Lack of awareness about guidelines availability. Physicians must be made aware of available guidelines in order to apply them properly and critically in clinical practice.
- CPGs are often presented as lengthy narratives rather than as actionable, synoptic content, thus making it challenging for physicians to rapidly determine the critical steps that lead to the desired outcomes.
- Lack of familiarity with guidelines. Although physicians know recommendations for particular diseases exist, this does not guarantee ready familiarity with the CPG information at the time and location of care delivery.
3.What are some incentives that hospitals can provide to encourage usage of CPGs among physicians? Can you give any examples?
One way to incent the use of CPGs is to consider the guidance from Joint Commission International (JCI) in its hospital standards, which require that department/service leaders select and implement CPGs and related clinical pathways and/or clinical protocols to guide clinical care (Standard GLD.11.2. Joint Commission International Accreditation Standards for Hospitals, 5th Edition).
This standard requires that department/service leaders work together annually to determine at least five hospital-wide priority areas on which to focus the use of CPGs.The department/service leaders must then implement CPGs and any associated clinical pathways or clinical protocols for each identified priority area as relevant to the department/service and demonstrate how the use of CPGs, clinical pathways, and/or clinical protocols has reduced variation in processes and outcomes.
4.How does quality of care or patient safety get impacted when CPGs are not used?
A recent study estimated that if clinicians in the United States followed six heart failure guideline recommendations, nearly 68,000 deaths a year could be prevented.
5.For hospitals that have yet to start implementing CPGs, what advice can you offer in terms of how and where can they get started?
Hospitals can follow the following process to select and implement CPGs, which include the following:
6.This process can require lots of manpower, time and cost, are there cost-efficient ways to do so?
- Select CPGs from among those applicable to the services and patients of the hospital (mandatory national guidelines, if available, are included in this process);
- Evaluate CPGs for their relevance to identified patient populations;
- Adapt CPGs when needed to the technology, drugs, and other resources of the hospital or to accepted national professional norms;
- Assess CPGs for their scientific evidence and endorsement by an authoritative source;
- Formally have the hospital approve or adopt the selected CPGs;
- Implement selected CPGs and measure for consistent use and effectiveness;
- Support CPGs by training clinical staff to apply the guidelines or pathways; and
- Periodically update CPGs based on changes in the evidence and evaluation of processes and outcomes.
Today, technology and clinical decision support solutions are readily available to help transform research into practice and recommendations. These solutions take clinically-approved best practice guidelines and match them with each patient to provide a recommended and customized care pathway for optimal outcomes. They can also be configured to meet the needs of each organization, taking into consideration local needs and practices.