News: Clinic inspection week ends with abundance of bravo zulus
Story by Michael DiCicco
For a week, beginning Nov. 5, inspectors from both the Navy Bureau of Medicine and the Joint Commission, a not-for-profit organization that accredits thousands of health care programs throughout the country, walked the halls of Naval Health Clinic Quantico’s main-side clinic, the four other clinics under its command and two more where it has personnel, interviewing patients and staff.
The Medical Inspector General team focuses on 86 areas of inspection, and the Joint Commission has more than 2,000 items on its checklists.
“We only had three findings, and those were minor and easy to correct,” said Capt. Kathy Becker, the clinic’s commanding officer. She said the clinic has always scored well on inspections, but in her 25-year medical career she had never seen a command get only three recommendations in such an inspection.
“As a command, we’re proud and we’re thrilled,” said Vicki Sharp, command evaluation officer and inspector general. “We’re extremely proud of our staff and their effort.”
The clinic received word of the inspections Oct. 29, the day after its employees supported the Marine Corps Marathon, about a week after its Officer Candidates School branch screened hundreds of incoming candidates as part of “Operation Bulldog,” and the day the east coast braced for Hurricane Sandy. A week later, the inspectors arrived.
“I think our staff performed amazingly well,” Becker said. “They really shined through a week of close scrutiny on every level.”
Inspectors also interviewed Marine Corps leadership, evaluated an extensive patient survey and used the “tracer method,” whereby they selected patients and then used their patient records to retrace care processes.
Francesca Cariello, the clinic’s chief of organizational performance improvement, said the staff’s work was “business as usual,” other than taking interviews and scheduling inspections for two different groups at seven clinics.
Cariello took responsibility for preparing for the Joint Commission inspection, which focused on quality of care and risk control. Sharp answered for the Medical Inspector General assessment, which examined not only health care delivery but also fiscal and material management, staff morale, safety and occupational health.
Both organizations carry out inspections every three years.
While the Medical Inspector General represents the Navy, Cariello noted that the Joint Commission holds military facilities to the same standards as private health care organizations, which usually enjoy long-term executive leadership. By contrast, about 75 percent of NHCQ’s leadership turned over between May and September of this year.
The inspectors visited every facility where the clinic has personnel, from the clinic at Navy Information Operations Command Sugar Grove in West Virginia to the dental clinic at Marine Helicopter Squadron 1.
“They said they got the same answers at every facility they went to,” Cariello said.
Sharp said the programs that Bureau of Medicine inspectors singled out for official kudos included staff education and training, case management, command-managed equal opportunity, emergency management, the antifraud hotline and Navy performance evaluation.
Other features that impressed inspectors were Educational and Developmental Intervention Services, Washington Navy Yard’s Substance Abuse Rehabilitation Program, the clinic’s religious ministries program, the relationship between patients and staff, data collection, cost of care and cooperation with the Marine Corps, such as the boot fittings the clinic coordinates with OCS, Cariello said.
One way the clinic prepared for inspections was by carrying out the self-assessments the Medical Inspector General posts online, which Sharp started sending out to program owners in March. She noted, though, that the assessment criteria changed a number of times since then.
“The areas they identified [for improvement] we were aware of ahead of time because we had sent out the self assessments,” she said. “So there weren’t any surprises, which is a good thing.”
Cariello said she expected some criticism to help the clinic refine practices. “The Joint Commission is very expensive, and I expect them to come in and find things we can improve,” she said.
As a result of its high marks on evaluations, Becker said, the clinic often gets calls from other health care facilities asking for advice. “It’s pretty awesome to be one of those commands that gets identified as a best practice.”