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Around Harvard
A quality conversation with Dr. John Helfrick
Senior Consultant
Partners Harvard Medical International
As a PHMI Senior Consultant, Dr. Helfrick plays a key role in programs aimed at helping health care institutions institute best practices for high-quality care and patient safety. Trained as an oral and maxillofacial surgeon, Dr. Helfrick has served in various capacities with the Joint Commission on Accreditation of Healthcare Organizations since 1984, and for eight years was a member of its Board of Commissioners. While serving as Chairman of the Board of the Joint Commission in 1997 and 1998, he oversaw the creation of numerous task forces to address important emerging issues. Among these
was the JC Oversight Group, which developed Joint Commission International, the accrediting group responsible for evaluating health care delivery organizations outside the U.S. Since he began working with PHMI, Dr. Helfrick has been a familiar face in the corridors of client institutions in Dubai, Greece, and India.
Q: You practiced in your clinical field for more than a quarter century, first at Sinai Hospital in Detroit, and later at the University of Texas Health Science Center in Houston. How did work around clinical quality issues become a central focus of your career?
Helfrick: I was influenced greatly by the hospital I trained in and a mentor, Dr. Eli Brown, who was the Chief of Anesthesiology and Chief of the medical staff at the time. The hospital truly had a culture of quality that influenced everyone’s approach to clinical care, education, and research. I “grew up” professionally believing that quality in those three areas was simply the way things were to be done. Eli Brown was the principle driver of this from both clinical and educational perspectives. As a result of his influence and support, I began surveying training programs in my specialty in the mid 1970s and in 1984 I was appointed to the Joint Commission’s Hospital Accreditation Advisory Committee, which was chaired by Dr. Brown. I later chaired that committee and in 1992 was appointed to the Joint Commission’s Board of Commissioners. I was influenced by my mentors at the start of my career to understand that “quality” was to be the focus in clinical care and education and that a standards-based process of accreditation was an important tool to assure both.
Q: There is tremendous interest now in accreditation among hospitals around the world—but there is more to it than simply making a book of guidelines into standard operating procedure. What are the attributes of hospitals that are truly ready to undertake a quality improvement journey?
Helfrick: “Accreditation” is generally not well understood. It is a process, not an event. There is a “validation” survey but it’s the maintenance of good processes and the improvement of deficient ones that occurs between surveys that really constitutes accreditation. Most “accreditationists” believe that health care outcomes are dependent on the quality of the structures and processes in place in a health care organization. The accreditation process is designed to assist organizations in implementing and then improving their structures and processes. The effectiveness of this process is borne out by the measurement of and, hopefully, the improvement in the outcomes of care.
Q: In your experience, are there certain areas of standards that are commonly very difficult for institutions to address?
Helfrick: There are easy ones: for example, the development of policy and procedure manuals that describe the hospital processes described above. The difficult task is effectively educating caregivers as to what these policies and processes are so that they are implemented consistently. For example, the Pharmacy and Therapeutics Committee can develop an excellent policy/process for medication delivery. However, if everyone in the organization is not fully aware of the process, or should they decide to take short cuts, the process as designed is not adhered to and adverse events may occur.
Q: What does JCI accreditation tell us about a hospital?
Helfrick: It tells us that the hospital MAY have made a commitment to continuous quality improvement and patient safety. Some hospitals pursue accreditation to give themselves a marketing advantage; others do it for the right reason. Interestingly, it’s this latter group that has the most effective marketing approach: commit to high-quality, safe care, and the patients will come. Hospitals that go through the triennial cycle once and then drop out have most likely become accredited for the wrong reason.
Q: Quality improvement initiatives require significant investments in time, energy, and commitment from clinical staff and administrators. Aside from the stamp of accreditation, what is the business case for undertaking such work?
Helfrick: Let me cut to the chase on this one: high-quality, efficient care is more cost-effective than low-quality, inefficient care. Recently, more emphasis has been placed on the “business case for quality.” Health care has learned a great deal from the auto industry, which discovered years ago that quality sold cars, that efficiency improves the bottom line, and that errors are costly.
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