Merhaba;
Bayram dolayısıyla yazılarımıza biraz ara vermek zorunda kaldık. Genelde köşe yazarları birkaç gün yazmayınca bu şekilde bir not düşerler yazıya başlamadan önce.Ben de böyle yazayım dedim. Yani yavaş yavaş kendimi birşeyler yapma hevesine girmişin farkında olmadan:)) Şu ana kadar sayfamı da benden ve birkaç arkadaşlarıma rica sonucu dosttan başka kimse okumadı ama ben yine de büyük tirajlı bir gazetenin köşe yazarı gibi davranmaya bir süre devam edeceğim:))
Bu arada sayın KARAÇAM ile bugün yüzyüze görüşme fısatı buldum ,sağolsun blogdaki çağrıma kulak vermiş(mecburen:) ve yazılarıyla tecrübelerini ara ara bizlerle paylaşacak.
Yazımın başlığında yazdığım gibi bugün hastanelerde uygulanan kalite sistemlerinden ve süreçlerinden biraz bahsetmek istiyorum. Öyle detay teknik konulardan bahsedecek değilim zaten istesemde o kadar bilgim yok malesef. Eeee işi uzmanına bırakmak gerekir. Ben sadece hastanelerde süregelen kalite çalışmaları daha doğrusu koşturmalarına değinmek istiyorum. Koşuşturma diyorum çünkü benim gözlem ve görüşüm hastanelerde; özel- kamu farketmeksizin kalite süreci bir koşuşturma havasında geçiyor. İşi sahiplenen bir kaç kişi, yönetim katılımı da olacak ya, tepe yönetimden gelen kalite işine önem verin yoksa... yazılı detay mesajlarla insanlar bir koşuşturmaya giriyor ve ardından konuşma ve yazışmalar, haftaya geliyorlar,yarın buradalar şeklinde devam ediyor.
Sonra bir ekip geliyor ,denetimler yapılıyor ,gözlemler paylaşılıyor ve ardından ekip gidiyor. Ve sonra; çok şükür bitti!!, gttiler sonunda ,çok uğraştık ama, şeklinde devam eden cümleler.
Yani kalite yolculuğu derler ya; aslında hakikaten tam bir yolculuk; belgelendirmeyi verecek kişilerin gelmesine kadar devam edip,gitmesiyle son bulan bir yolculuk. Aslında tabii ki böyle değil ve bu işi gerçek anlamda yönetimin ve stratejilerinin bir parçası yapmış fazlasıyla kurum ve kuruluş elbette ki ülkemizde mevcut ve onların kalite yolculuğu devamlı gelişerek ve geliştirerek devam eden sonsuz bir yolculuk. Ama bazıları için ise başlangıcı ve sonu olan ve kağıdı duvara astıktan sonra biten kısa bir yolculuk.
Dedim ya başlangıçta da bu konuda kesinlikle hep böyledir demiyorum sadece kendi deneyimlerimden gözlemlerimi paylaşmaya çalışıyorum.
Neden bu yazıyı yazmayı istediğime gelince, sadece birkaç yıl öncesine kadar sadece özel hastanelerin ilgisini çeken JCI(Joınt Commıssıon Internatıonal) belgelendirmesi son birkaç yılda kamu hastaneleri ile üniversite hastanelerinin de ilgisini çekmeye başladı ve hatta Sağlık Bakanlığı'nda bu konu için bildiğim kadarıyla bir koordinatörlük bile kuruldu. Aslında tüm hastanelerimizin Dünya'nın geçerli standartlerına göre belgelendirilmesi guru verici ama diğer tarafran da hala hasta bakımında başlangıç düzeyinde olan yerlerde bile bu belgeleri görebilecek olmamız insanda bir ACABA şüphesi uyandırmıyor değil malesef. İnsan düşünmeden edemiyor malesef. Bu konuda ilerleyen zamanlarda bir kaç söz daha söylemek isterim tabii ki.
Herkese iyi bayramlar diliyorum
23 Aralık 2007 Pazar
20 Aralık 2007 Perşembe
Teşekkürler
Sevgili dostum KARAÇAM;
Öncelikle yorumun için çok teşekkür ediyorum ve ümit ediyorum ki; ilerleyen zamanlarda senin sağlık ve kalite sektöründeki bilgi birikimlerinden bu sayfalarda yararlanma fırsatı bulabiliriz.
Öncelikle yorumun için çok teşekkür ediyorum ve ümit ediyorum ki; ilerleyen zamanlarda senin sağlık ve kalite sektöründeki bilgi birikimlerinden bu sayfalarda yararlanma fırsatı bulabiliriz.
17 Aralık 2007 Pazartesi
Adres yanlışlığı
Merhaba;
2 habaerim var başlıklı yazıdaki link yanlış yazılmış. Doğrusu http://runningahospital.blogspot.com/2007/12/talking-turkish.html
2 habaerim var başlıklı yazıdaki link yanlış yazılmış. Doğrusu http://runningahospital.blogspot.com/2007/12/talking-turkish.html
Yeni 2 haberim var
Herkese merhaba ve iyi akşamlar;
Daha çok yeni olmasına rağmen blog hakkında çoktan 2 yorum aldık bile. Her ikisi de Amerikada yer alan iyi hastanelerden biri olan Beth Israel hastanesinin CEO'su Paul LEVY ve orgaanizasyonel gelişim başkanı Joanne AYOUB'tan geldi. Sayfada bunları görme fırsatınız olacak. Ayrıca Paul kendi blog adresinde blogumuz hakkında çok güzel yorumlarda bulunmuş.
www.runnigahospital.blogspot.com adresinden yorumları görebilme fırsatınız var.
Hı Paul & Jo;
Thank you so much for your nıce thoughts as wel as kındness to gıve attentıon to my blog. I already know that Acıbadem Healthcare Group and BIDMC has become 2 close frıend organizatıon by your efforts.I wısh we keep thıs good relatıonshıp alıve as much as we can.
Özcan ÇİÇEK
Daha çok yeni olmasına rağmen blog hakkında çoktan 2 yorum aldık bile. Her ikisi de Amerikada yer alan iyi hastanelerden biri olan Beth Israel hastanesinin CEO'su Paul LEVY ve orgaanizasyonel gelişim başkanı Joanne AYOUB'tan geldi. Sayfada bunları görme fırsatınız olacak. Ayrıca Paul kendi blog adresinde blogumuz hakkında çok güzel yorumlarda bulunmuş.
www.runnigahospital.blogspot.com adresinden yorumları görebilme fırsatınız var.
Hı Paul & Jo;
Thank you so much for your nıce thoughts as wel as kındness to gıve attentıon to my blog. I already know that Acıbadem Healthcare Group and BIDMC has become 2 close frıend organizatıon by your efforts.I wısh we keep thıs good relatıonshıp alıve as much as we can.
Özcan ÇİÇEK
14 Aralık 2007 Cuma
Beth Isreal Deaconess Medical Center 2006 yılı JCI survey raporu
Organization Identification Number: 5501
Boston, MA 02215
330 Brookline Avenue
Beth Israel Deaconess Medical Center
19
Date(s) of Survey: 7/23/2007 - 7/27/2007
Hospital Accreditation Program
PROGRAM(S)
Charles W. Wilson, MBA
Emalyn Bravo, RN
Kenneth E. Blackwell
Robert D. Larsen, MD
Robert N. Westerman, MBA, MD
Wendel J. Schmitt, FACHE
SURVEYOR(S)
Executive Summary
As a result of the accreditation activity conducted on the above date, your organization must submit Evidence
of Standards Compliance (ESC) within 45 days from the day this report is posted to your organization’s
extranet site. If your organization does not make sufficient progress in the area(s) noted below, your
accreditation may be negatively affected.
The results of this accreditation activity do not affect any other Requirement(s) for Improvement that may exist
on your current accreditation decision.
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Assessment and Care/Services
Standard: PC.8.10
Program: HAP
Standard Text: Pain is assessed in all patients.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : C
1. A comprehensive pain assessment is conducted as appropriate to the patient's condition and the
scope of care, treatment, and services provided.
Scoring Category : C
3. Regular reassessment and follow-up occur according to criteria developed by the hospital.
Surveyor Findings
Organization Identification Number: 5501 Page 2 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
EP 1
Observed in Emergency Department at Beth Israel Deaconess Medical Center - East and West Campus
site.
One of the hospital's processes relevant to pain assessment included the documentation of severity
scale of 0-10. During a tracer activity it was noted that a pain scale was not documented on a patient
who had abdominal pain.
Observed in Emergency Department at Beth Israel Deaconess Medical Center - East and West Campus
site.
During a tracer activity, it was noted that initial pain assessment by the licensed nurse was not
documented on the medical record for a patient who had shortness of breath and congestive heart
failure.
Observed in CC 7A at Beth Israel Deaconess Medical Center - East and West Campus site.
On review of closed medical records, it was noted that initial pain assessment was not documented by
the ED nurse for a patient who had Pneumonia, Respiratory failure and acute renal failure.
Observed in CC 7A at Beth Israel Deaconess Medical Center - East and West Campus site.
During a tracer activity, it was noted on a closed medical record that pain evaluation was not
documented by the ED licensed nurse for a patient who had a history of fall.
Observed in a dialysis patient tracer record at Beth Israel Deaconess Medical Center - East and West
Campus site.
There was no pain assessment of the patient on July 21 as required by organization policy.
EP 3
Observed in an orthopedic patient tracer record at Beth Israel Deaconess Medical Center - East and
West Campus site.
Pain was not reassessed after the 12;45 pm administration of pain medication in the record reviewed.
Observed in an orthopedic patient tracer record at Beth Israel Deaconess Medical Center - East and
West Campus site.
Pain was not reassessed after a 4pm administration of pain medication in the record reviewed.
Observed in an orthopedic patient tracer record at Beth Israel Deaconess Medical Center - East and
West Campus site.
Pain was reassessed at 9:30pm after a 6pm administration of pain medication. The organization's policy
required a reassessment to be conducted within approximately one half hour after the administration of
pain relieving medication.
Observed in a dialysis patient record at Beth Israel Deaconess Medical Center - East and West Campus
site.
There was no pain reassessment of the patient recorded within the record after pain medication was
administered to the patient on July 21.
Organization Identification Number: 5501 Page 3 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Credentialed Practitioners
Standard: HR.1.20
Program: HAP
Standard Text: Staff qualifications are consistent with his or her job responsibilities.
Secondary Priority Focus Area(s): Organizational Structure
Element(s) of Performance
Scoring Category : A
3. When current licensure, certification, or registration are required by law or regulation to practice a
profession*, the hospital verifies these credentials with the primary source at the time of hire and upon
expiration of the credentials.Note: It is acceptable to verify current licensure, certification, or registration
with the primary source via a secure electronic communication or by telephone, if this verification is
documented. For additional information, see “primary source verification” in the Glossary.
Note: A primary source of information may designate another agency to communicate credentials
information. The designated agency then can be used as a primary source.
Note: An external organization [for example, a credentials verification organization (CVO)] may be used
to collect credentials information. A CVO must meet the CVO guidelines listed in the Glossary.
*Profession is a specialized work function within society, generally performed by a professional. It often
refers specifically to fields that require extensive study and mastery of specialized knowledge and
skills.
Surveyor Findings
EP 3
Observed in credentials review at Beth Israel Deaconess Medical Center - East and West Campus site.
At the credentials session, the file of a nurse practitioner was reviewed. At the time her license expired
in June of 2004, there was no documentation that verification of its renewal had been done on or before
the expiration date. There was a copy of the renewal notice which had been downloaded from the web
site five months later in November. The same nurse practitioner's license was due for renewal again in
June of 2006. Although the file contained a copy of the nurse's current license which will expire in June
2008, there was no documentation that verification of its renewal had occurred at the time of renewal,
Observed in the credentials review at Beth Israel Deaconess Medical Center - East and West Campus
site.
During discussion with medical staff at the credentials review session, the process for credentialing and
privileging advanced practice nurses and physician assistants was reviewed. Three nurse practitioner
files were reviewed in detail. At the time of initial appointment, the individual files were presented to the
credentials committee and subsequently approved by the executive committee with recommendations
for privileges as described in a scope of practice document. At the two year interval, when
reappointment would have been expected, these individuals were not presented again to the credentials
committee and executive committee. The individuals were never formally recredentialed and
reappointed. Although their activities had been monitored by their respective supervising physician,
there was no evidence of peer recommendations having been elicited, and their files did not go through
the same rigorous process applied to their initial appointment.
Organization Identification Number: 5501 Page 4 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Equipment Use
Standard: EC.5.40
Program: HAP
Standard Text: The hospital maintains fire-safety equipment and building features.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : A
9. For water-based automatic fire-extinguishing systems, all fire pumps are tested at least annually
under flow.
Scoring Category : A
10. Kitchen automatic fire-extinguishing systems are inspected for proper operation at least
semiannually (actual discharge of the fire-extinguishing system is not required).
Surveyor Findings
EP 9
Observed in Document Review at Beth Israel Deaconess Medical Center - East and West Campus site.
The organization last tested it's fire pump on 5/20/06; however, they were not able to provide testing
documentation for year 2007.
EP 10
Observed in Document Review at Beth Israel Deaconess Medical Center - East and West Campus site.
The organization was unable to provide current inspection documentation for the kitchen
fire-extinguishing system. The last inspection was completed in 12-06.
See report
Organization Identification Number: 5501 Page 5 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Medication Management
Standard: MM.2.30
Program: HAP
Standard Text: Emergency medications and/or supplies, if any, are consistently available, controlled,
and secured.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : B
3. Emergency medications are available in unit-dose, age-specific, and ready-to-administer forms
whenever possible.
Scoring Category : A
6. Emergency medications are stored in sealed or in locked containers; in a locked room; or under
constant supervision in accordance with law or regulation.
Surveyor Findings
EP 3
Observed in an East 11 & 7 Stoneman Units at Beth Israel Deaconess Medical Center - East and West
Campus site.
The emergency medication carts contained a bag of numerous plastic numbered locks as part of their
supply complement. These locks were the same type and appearance as the lock securing the exterior
of the cart which signified that the cart had not been tampered with. Since these locks would be
available to someone opening the cart on an authorized as well as unauthorized basis, the integrity of
the cart as well as the availability of its medication contents to respond to an emergency could not be
assured.
EP 6
Observed in Central Supply Distribution Area at Beth Israel Deaconess Medical Center - East and West
Campus site.
During a tracer activity it was noted that seven crash carts which contained several emergency
medications were stored in a room where it was not locked nor supervised. The area was accessible to
non clinical and technical staff.
Organization Identification Number: 5501 Page 6 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Patient Safety
Standard: NPSG Requirement 8B
Program: HAP
Standard Text: A complete list of the patient's medications is communicated to the next provider of
service when a patient is referred or transferred to another setting, service, practitioner
or level of care within or outside the organization. The complete list of medications is
also provided to the patient on discharge from the organization.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : C
1. The patient’s accurate medication reconciliation list (complete with medications prescribed by the
first provider of service) is communicated to the next provider of service, whether it be within or outside
the organization
Surveyor Findings
Organization Identification Number: 5501 Page 7 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
EP 1
Observed in Emergency Department at Beth Israel Deaconess Medical Center - East and West Campus
site.
During a tracer activity it was noted that the current medication list was not completed for a patient who
was transferred to another hospital.
Observed in Emergency Department at Beth Israel Deaconess Medical Center - East and West Campus
site.
During a tracer activity it was noted that three of the five medications which the patient were taking at
home were not reconciled by the licensed nursing staff to reassess if the meds were to be continued,
changed or stopped as per hospital policy.
Observed in Neurology Clinic at Beth Israel Deaconess Medical Center - East and West Campus site.
The hospital has been transitioning to an electronic outpatient record for several years. Presently, some
clinics rely almost exclusively on the electronic record while others continue to supplement it with a
backup paper record accessible to that clinic. The medication list in the electronic record initially
consists of medications that have been ordered using the electronic system, but the list can be modified
by adding or removing medications. This list has, in most instances, replaced the paper summary
medication list. The hospital has also made this list a key component of the medication reconciliation
process because it is visible to outpatient care providers, the emergency department, and admitting
physicians. This system allows for a current, accurate, reconciled medication list to be communicated
to the next provider of care. The effectiveness of this process currently depends on the provider updating
the list at the time of the patient visit. Some providers have incorporated updating the electronic list into
the patient encounter while others have not.
During a patient tracer of the neurology clinic, an interview with the physician providing the patient care
revealed that it was not this physician's current practice to update the electronic medication list. A
review of the medical record revealed that the electronic medication list contained one medication which
the paper record indicated was discontinued. Alternatively, the paper record included a medication not in
the electronic list.
Observed in Rheumatology Clinic at Beth Israel Deaconess Medical Center - East and West Campus
site.
During a patient tracer in the rheumatology clinic, an interview of the physician providing the patient care
revealed that it was not the physician's current practice to update the electronic medication list. A
comparison of the electronic medication list with the medications in the physician's recently dictated
note revealed a number of discrepancies. For example the physician's dictated note included five
medications which are not updated in the computer medication list.
Observed in Orthopedic Clinic at Beth Israel Deaconess Medical Center - East and West Campus site.
During a patient tracer in the orthopedic clinic, an interview with the physician providing the patient care
revealed that it was not this physician's current practice to update the electronic medication list. A
comparison of the paper based medication list questionnaire completed by the patient and the electronic
medication list showed that one medication listed by the patient was not added to the medication list.
Organization Identification Number: 5501 Page 8 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Physical Environment
Standard: EC.1.10
Program: HAP
Standard Text: The hospital manages safety risks.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : C
5. The hospital uses the risks identified to select and implement procedures and controls to achieve
the lowest potential for adverse impact on the safety and health of patients, staff, and other people
coming to the hospital’s facilities.
Surveyor Findings
Organization Identification Number: 5501 Page 9 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
EP 5
Observed in Kitchen at Beth Israel Deaconess Medical Center - East and West Campus site.
There were several C02 cylinders unsecured
Observed in the basement central gas cylinder room at Beth Israel Deaconess Medical Center - East
and West Campus site.
An unsecured E cylinder of compressed gas was noted within the East basement central compressed
gas cylinder storage room.
Observed in the outside gas cylinder storage room at Beth Israel Deaconess Medical Center - East and
West Campus site.
Five E cylinders of acetylene and three K cylinders or nitrogen were unsecure within the exterior storage
room by the loading dock.
Observed in the building tour at Beth Israel Deaconess Medical Center - East and West Campus site.
An unsecured K cylinder of helium was noted within the West Gift Shop.
Observed in the West building tour at Beth Israel Deaconess Medical Center - East and West Campus
site.
Six K and twelve E cylinders of compressed gas were unsecure within the basement Nitrous / CO2
Storage Room.
Observed in the West building tour at Beth Israel Deaconess Medical Center - East and West Campus
site.
An unsecured K cylinder of nitrogen was noted within the West Cath Lab Storage Room #FA0412.
Observed in the West building tour at Beth Israel Deaconess Medical Center - East and West Campus
site.
Several emergency stairwell doors were physically locked leading from the stairwell into the building,
however, no "Door Locked - NO Entry" signage was posted on the stairwell side of the door.
Observed in the Deaconess building tour at Beth Israel Deaconess Medical Center - East and West
Campus site.
The wall mounted picture frames and clock within the patient corridor of the Deaconess 4 locked
Inpatient Psychiatric Unit were not adequately secured to prevent their unauthorized removal by a
distraught patient and potentially utilized as a weapon.
Standard: EC.5.20
Program: HAP
Standard Text: Newly constructed and existing environments are designed and maintained to comply
with the Life Safety Code®.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : B
1. Each building in which patients are housed or receive care, treatment, and services complies with
the LSC, NFPA 101® 2000; OREach building in which patients are housed or receive care, treatment,
and services does not comply with the LSC, but the resolution of all deficiencies is evidenced through
the following:
An equivalency approved by the Joint Commission Or
Organization Identification Number: 5501 Page 10 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
Standard: EC.5.20
Program: HAP
Standard Text: Newly constructed and existing environments are designed and maintained to comply
with the Life Safety Code®.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Continued progress in completing an acceptable Plan For Improvement (Statement of Conditions™,
Part 4)
Surveyor Findings
See Life Safety Code.
Organization Identification Number: 5501 Page 11 of 19
The Joint Commission
Accreditation Survey Findings
Life Safety Code
Inpatient Occupancy Existing Healthcare Occupancies; Section I - Buildings
EC.A.1A.4.b Requirement:
Existing Health Care Occupancies The following assemblies are constructed of materials
with the minimum fire resistance rating based upon the type of construction: structural
frame. (EC.A.1A)(EC.A.1A.4)(EC.A.1A.4.b)
Phrase:
Surveyor Findings:
Fireproof was missing on the structural steel in the sprinkler system zone valve room on the 8th floor of
Risman.
EC.A.1C.3 Requirement:
Existing Health Care Occupancies Doors in two-hour fire resistance rated separations
are: self-closing or automatic closing. (EC.A.1C)(EC.A.1C.3)
Phrase:
Surveyor Findings:
Elevator machine room did not close and latch in the Risman building.
EC.A.1C.4 Requirement:
Existing Health Care Occupancies Doors in two-hour fire resistance rated separations
are: provided with <= 1/8 in. gaps between meeting edges of door pairs. (EC.A.1C)
(EC.A.1C.4)
Phrase:
Surveyor Findings:
NICU had > 1/8 inch gap on the 1 hour rated smoke door
EC.A.1H Requirement:
Existing Health Care Occupancies When the following penetrate fire resistance rated wall
assemblies, the spaces between the item and the wall are filled with an appropriate fire
resistance rated material: pipes, conduits, bus ducts, cables/wires, air ducts and
pneumatic tubes. (EC.A.1H)
Phrase:
Surveyor Findings:
Two pipe penetrations were found in 1 hour rated wall assemblies in the 9th floor stairwell and room RA
B13 pneumatic tube system
Organization Identification Number: 5501 Page 12 of 19
The Joint Commission
Accreditation Survey Findings
Life Safety Code
Inpatient Occupancy Existing Healthcare Occupancies; Section II - Rooms
EC.A.2I.4 Requirement:
Existing Health Care Occupancies Corridor doors are: arranged to have not more than
3/4-inch undercuts. (EC.A.2I)(EC.A.2I.4)
Phrase:
Surveyor Findings:
The following corridor doors exceeded the maximum allowable 1/8 inch between the door sections: 1)
entrance corridor doors to the East MICU, 2) 4 Cath Lab in the Farr building, 3) dutch door into the
Psychiatry 4 medication room, 4) West building basement Receiving Department, & 5) West MICU door
# 780,
EC.A.2K Requirement:
Existing Health Care Occupancies Hazardous areas are appropriately protected.
(EC.A.2K)
Phrase:
Surveyor Findings:
Room for PFI 06EC 9.14 was being used for non flammable medical gas storage in excess of 3000 cubic
feet (32 e cylinders, 32 H cylinders and 2 C cylinders.
EC.A.2L.2 Requirement:
Existing Health Care Occupancies Doors in partitions enclosing hazardous areas are:
self-closing or automatic closing. (EC.A.2L)(EC.A.2L.2)
Phrase:
Surveyor Findings:
Soil Utility room #FD 719 door self-closing device is broken and inoperable.
Organization Identification Number: 5501 Page 13 of 19
The Joint Commission
Accreditation Survey Findings
Life Safety Code
Inpatient Occupancy Existing Healthcare Occupancies; Section III - Compartments
EC.A.3C.1 Requirement:
Existing Health Care Occupancies Smoke barriers are: continuous from outside wall to
outside wall. (EC.A.3C)(EC.A.3C.1)
Phrase:
Surveyor Findings:
Horizontal penetrations were noted in the following locations: 1) Farr building 13 floor FAS#1 emergency
stairwell, 2) Farr building 11 Medical / Surgical unit electric room corridor wall. Additionally, a vertical
penetration was noted in the 3rd floor Deaconess building elevator room #300A.
EC.A.3D.1 Requirement:
Existing Health Care Occupancies Doors in smoke barriers are: fitted to prevent the
spread of smoke. (EC.A.3D)(EC.A.3D.1)
Phrase:
Surveyor Findings:
The following smoke compartment fire / smoke doors exceeded the maximum allowable 1/8 inch median
gap between door sections: 1) Farr 3 to Deaconess 3 buildings, 2) Lowry and West buildings basement
tunnel connector, & 3) West building 7th floor. In addition, the following interbuilding fire doors did not
properly close and latch: 1) 3rd floor Farr to Clinical center building, 2) Lowry to West building basement
tunnel connector, & 3) West 7th floor by Clinical Nutrition Services.
Inpatient Occupancy Existing Healthcare Occupancies; Section IV - Floor Assemblies
EC.A.4B.1.a Requirement:
Existing Health Care Occupancies Linen/waste chutes. Service (inlet) doors have:
self-closing devices. (EC.A.4B)(EC.A.4B.1.a)
Phrase:
Surveyor Findings:
The trash chute door in FA03L1C at the West campus was being held open by a floor scrubber
EC.A.4B.2.a Requirement:
Existing Health Care Occupancies Linen/waste chutes. Outlet (discharge) doors have:
self-closing devices (fusible link or electrical hold-open devices are acceptable). (EC.A.4B)
(EC.A.4B.2)(EC.A.4B.2.a)
Phrase:
Surveyor Findings:
The rash exit chute door at the West Campus was missing
Organization Identification Number: 5501 Page 14 of 19
Boston, MA 02215
330 Brookline Avenue
Beth Israel Deaconess Medical Center
19
Date(s) of Survey: 7/23/2007 - 7/27/2007
Hospital Accreditation Program
PROGRAM(S)
Charles W. Wilson, MBA
Emalyn Bravo, RN
Kenneth E. Blackwell
Robert D. Larsen, MD
Robert N. Westerman, MBA, MD
Wendel J. Schmitt, FACHE
SURVEYOR(S)
Executive Summary
As a result of the accreditation activity conducted on the above date, your organization must submit Evidence
of Standards Compliance (ESC) within 45 days from the day this report is posted to your organization’s
extranet site. If your organization does not make sufficient progress in the area(s) noted below, your
accreditation may be negatively affected.
The results of this accreditation activity do not affect any other Requirement(s) for Improvement that may exist
on your current accreditation decision.
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Assessment and Care/Services
Standard: PC.8.10
Program: HAP
Standard Text: Pain is assessed in all patients.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : C
1. A comprehensive pain assessment is conducted as appropriate to the patient's condition and the
scope of care, treatment, and services provided.
Scoring Category : C
3. Regular reassessment and follow-up occur according to criteria developed by the hospital.
Surveyor Findings
Organization Identification Number: 5501 Page 2 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
EP 1
Observed in Emergency Department at Beth Israel Deaconess Medical Center - East and West Campus
site.
One of the hospital's processes relevant to pain assessment included the documentation of severity
scale of 0-10. During a tracer activity it was noted that a pain scale was not documented on a patient
who had abdominal pain.
Observed in Emergency Department at Beth Israel Deaconess Medical Center - East and West Campus
site.
During a tracer activity, it was noted that initial pain assessment by the licensed nurse was not
documented on the medical record for a patient who had shortness of breath and congestive heart
failure.
Observed in CC 7A at Beth Israel Deaconess Medical Center - East and West Campus site.
On review of closed medical records, it was noted that initial pain assessment was not documented by
the ED nurse for a patient who had Pneumonia, Respiratory failure and acute renal failure.
Observed in CC 7A at Beth Israel Deaconess Medical Center - East and West Campus site.
During a tracer activity, it was noted on a closed medical record that pain evaluation was not
documented by the ED licensed nurse for a patient who had a history of fall.
Observed in a dialysis patient tracer record at Beth Israel Deaconess Medical Center - East and West
Campus site.
There was no pain assessment of the patient on July 21 as required by organization policy.
EP 3
Observed in an orthopedic patient tracer record at Beth Israel Deaconess Medical Center - East and
West Campus site.
Pain was not reassessed after the 12;45 pm administration of pain medication in the record reviewed.
Observed in an orthopedic patient tracer record at Beth Israel Deaconess Medical Center - East and
West Campus site.
Pain was not reassessed after a 4pm administration of pain medication in the record reviewed.
Observed in an orthopedic patient tracer record at Beth Israel Deaconess Medical Center - East and
West Campus site.
Pain was reassessed at 9:30pm after a 6pm administration of pain medication. The organization's policy
required a reassessment to be conducted within approximately one half hour after the administration of
pain relieving medication.
Observed in a dialysis patient record at Beth Israel Deaconess Medical Center - East and West Campus
site.
There was no pain reassessment of the patient recorded within the record after pain medication was
administered to the patient on July 21.
Organization Identification Number: 5501 Page 3 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Credentialed Practitioners
Standard: HR.1.20
Program: HAP
Standard Text: Staff qualifications are consistent with his or her job responsibilities.
Secondary Priority Focus Area(s): Organizational Structure
Element(s) of Performance
Scoring Category : A
3. When current licensure, certification, or registration are required by law or regulation to practice a
profession*, the hospital verifies these credentials with the primary source at the time of hire and upon
expiration of the credentials.Note: It is acceptable to verify current licensure, certification, or registration
with the primary source via a secure electronic communication or by telephone, if this verification is
documented. For additional information, see “primary source verification” in the Glossary.
Note: A primary source of information may designate another agency to communicate credentials
information. The designated agency then can be used as a primary source.
Note: An external organization [for example, a credentials verification organization (CVO)] may be used
to collect credentials information. A CVO must meet the CVO guidelines listed in the Glossary.
*Profession is a specialized work function within society, generally performed by a professional. It often
refers specifically to fields that require extensive study and mastery of specialized knowledge and
skills.
Surveyor Findings
EP 3
Observed in credentials review at Beth Israel Deaconess Medical Center - East and West Campus site.
At the credentials session, the file of a nurse practitioner was reviewed. At the time her license expired
in June of 2004, there was no documentation that verification of its renewal had been done on or before
the expiration date. There was a copy of the renewal notice which had been downloaded from the web
site five months later in November. The same nurse practitioner's license was due for renewal again in
June of 2006. Although the file contained a copy of the nurse's current license which will expire in June
2008, there was no documentation that verification of its renewal had occurred at the time of renewal,
Observed in the credentials review at Beth Israel Deaconess Medical Center - East and West Campus
site.
During discussion with medical staff at the credentials review session, the process for credentialing and
privileging advanced practice nurses and physician assistants was reviewed. Three nurse practitioner
files were reviewed in detail. At the time of initial appointment, the individual files were presented to the
credentials committee and subsequently approved by the executive committee with recommendations
for privileges as described in a scope of practice document. At the two year interval, when
reappointment would have been expected, these individuals were not presented again to the credentials
committee and executive committee. The individuals were never formally recredentialed and
reappointed. Although their activities had been monitored by their respective supervising physician,
there was no evidence of peer recommendations having been elicited, and their files did not go through
the same rigorous process applied to their initial appointment.
Organization Identification Number: 5501 Page 4 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Equipment Use
Standard: EC.5.40
Program: HAP
Standard Text: The hospital maintains fire-safety equipment and building features.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : A
9. For water-based automatic fire-extinguishing systems, all fire pumps are tested at least annually
under flow.
Scoring Category : A
10. Kitchen automatic fire-extinguishing systems are inspected for proper operation at least
semiannually (actual discharge of the fire-extinguishing system is not required).
Surveyor Findings
EP 9
Observed in Document Review at Beth Israel Deaconess Medical Center - East and West Campus site.
The organization last tested it's fire pump on 5/20/06; however, they were not able to provide testing
documentation for year 2007.
EP 10
Observed in Document Review at Beth Israel Deaconess Medical Center - East and West Campus site.
The organization was unable to provide current inspection documentation for the kitchen
fire-extinguishing system. The last inspection was completed in 12-06.
See report
Organization Identification Number: 5501 Page 5 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Medication Management
Standard: MM.2.30
Program: HAP
Standard Text: Emergency medications and/or supplies, if any, are consistently available, controlled,
and secured.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : B
3. Emergency medications are available in unit-dose, age-specific, and ready-to-administer forms
whenever possible.
Scoring Category : A
6. Emergency medications are stored in sealed or in locked containers; in a locked room; or under
constant supervision in accordance with law or regulation.
Surveyor Findings
EP 3
Observed in an East 11 & 7 Stoneman Units at Beth Israel Deaconess Medical Center - East and West
Campus site.
The emergency medication carts contained a bag of numerous plastic numbered locks as part of their
supply complement. These locks were the same type and appearance as the lock securing the exterior
of the cart which signified that the cart had not been tampered with. Since these locks would be
available to someone opening the cart on an authorized as well as unauthorized basis, the integrity of
the cart as well as the availability of its medication contents to respond to an emergency could not be
assured.
EP 6
Observed in Central Supply Distribution Area at Beth Israel Deaconess Medical Center - East and West
Campus site.
During a tracer activity it was noted that seven crash carts which contained several emergency
medications were stored in a room where it was not locked nor supervised. The area was accessible to
non clinical and technical staff.
Organization Identification Number: 5501 Page 6 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Patient Safety
Standard: NPSG Requirement 8B
Program: HAP
Standard Text: A complete list of the patient's medications is communicated to the next provider of
service when a patient is referred or transferred to another setting, service, practitioner
or level of care within or outside the organization. The complete list of medications is
also provided to the patient on discharge from the organization.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : C
1. The patient’s accurate medication reconciliation list (complete with medications prescribed by the
first provider of service) is communicated to the next provider of service, whether it be within or outside
the organization
Surveyor Findings
Organization Identification Number: 5501 Page 7 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
EP 1
Observed in Emergency Department at Beth Israel Deaconess Medical Center - East and West Campus
site.
During a tracer activity it was noted that the current medication list was not completed for a patient who
was transferred to another hospital.
Observed in Emergency Department at Beth Israel Deaconess Medical Center - East and West Campus
site.
During a tracer activity it was noted that three of the five medications which the patient were taking at
home were not reconciled by the licensed nursing staff to reassess if the meds were to be continued,
changed or stopped as per hospital policy.
Observed in Neurology Clinic at Beth Israel Deaconess Medical Center - East and West Campus site.
The hospital has been transitioning to an electronic outpatient record for several years. Presently, some
clinics rely almost exclusively on the electronic record while others continue to supplement it with a
backup paper record accessible to that clinic. The medication list in the electronic record initially
consists of medications that have been ordered using the electronic system, but the list can be modified
by adding or removing medications. This list has, in most instances, replaced the paper summary
medication list. The hospital has also made this list a key component of the medication reconciliation
process because it is visible to outpatient care providers, the emergency department, and admitting
physicians. This system allows for a current, accurate, reconciled medication list to be communicated
to the next provider of care. The effectiveness of this process currently depends on the provider updating
the list at the time of the patient visit. Some providers have incorporated updating the electronic list into
the patient encounter while others have not.
During a patient tracer of the neurology clinic, an interview with the physician providing the patient care
revealed that it was not this physician's current practice to update the electronic medication list. A
review of the medical record revealed that the electronic medication list contained one medication which
the paper record indicated was discontinued. Alternatively, the paper record included a medication not in
the electronic list.
Observed in Rheumatology Clinic at Beth Israel Deaconess Medical Center - East and West Campus
site.
During a patient tracer in the rheumatology clinic, an interview of the physician providing the patient care
revealed that it was not the physician's current practice to update the electronic medication list. A
comparison of the electronic medication list with the medications in the physician's recently dictated
note revealed a number of discrepancies. For example the physician's dictated note included five
medications which are not updated in the computer medication list.
Observed in Orthopedic Clinic at Beth Israel Deaconess Medical Center - East and West Campus site.
During a patient tracer in the orthopedic clinic, an interview with the physician providing the patient care
revealed that it was not this physician's current practice to update the electronic medication list. A
comparison of the paper based medication list questionnaire completed by the patient and the electronic
medication list showed that one medication listed by the patient was not added to the medication list.
Organization Identification Number: 5501 Page 8 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
These are the Requirements for Improvement related to the Primary Priority Focus Area:
Physical Environment
Standard: EC.1.10
Program: HAP
Standard Text: The hospital manages safety risks.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : C
5. The hospital uses the risks identified to select and implement procedures and controls to achieve
the lowest potential for adverse impact on the safety and health of patients, staff, and other people
coming to the hospital’s facilities.
Surveyor Findings
Organization Identification Number: 5501 Page 9 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
EP 5
Observed in Kitchen at Beth Israel Deaconess Medical Center - East and West Campus site.
There were several C02 cylinders unsecured
Observed in the basement central gas cylinder room at Beth Israel Deaconess Medical Center - East
and West Campus site.
An unsecured E cylinder of compressed gas was noted within the East basement central compressed
gas cylinder storage room.
Observed in the outside gas cylinder storage room at Beth Israel Deaconess Medical Center - East and
West Campus site.
Five E cylinders of acetylene and three K cylinders or nitrogen were unsecure within the exterior storage
room by the loading dock.
Observed in the building tour at Beth Israel Deaconess Medical Center - East and West Campus site.
An unsecured K cylinder of helium was noted within the West Gift Shop.
Observed in the West building tour at Beth Israel Deaconess Medical Center - East and West Campus
site.
Six K and twelve E cylinders of compressed gas were unsecure within the basement Nitrous / CO2
Storage Room.
Observed in the West building tour at Beth Israel Deaconess Medical Center - East and West Campus
site.
An unsecured K cylinder of nitrogen was noted within the West Cath Lab Storage Room #FA0412.
Observed in the West building tour at Beth Israel Deaconess Medical Center - East and West Campus
site.
Several emergency stairwell doors were physically locked leading from the stairwell into the building,
however, no "Door Locked - NO Entry" signage was posted on the stairwell side of the door.
Observed in the Deaconess building tour at Beth Israel Deaconess Medical Center - East and West
Campus site.
The wall mounted picture frames and clock within the patient corridor of the Deaconess 4 locked
Inpatient Psychiatric Unit were not adequately secured to prevent their unauthorized removal by a
distraught patient and potentially utilized as a weapon.
Standard: EC.5.20
Program: HAP
Standard Text: Newly constructed and existing environments are designed and maintained to comply
with the Life Safety Code®.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Scoring Category : B
1. Each building in which patients are housed or receive care, treatment, and services complies with
the LSC, NFPA 101® 2000; OREach building in which patients are housed or receive care, treatment,
and services does not comply with the LSC, but the resolution of all deficiencies is evidenced through
the following:
An equivalency approved by the Joint Commission Or
Organization Identification Number: 5501 Page 10 of 19
The Joint Commission
Accreditation Survey Findings
Requirement(s) for Improvement
Standard: EC.5.20
Program: HAP
Standard Text: Newly constructed and existing environments are designed and maintained to comply
with the Life Safety Code®.
Secondary Priority Focus Area(s): N/A
Element(s) of Performance
Continued progress in completing an acceptable Plan For Improvement (Statement of Conditions™,
Part 4)
Surveyor Findings
See Life Safety Code.
Organization Identification Number: 5501 Page 11 of 19
The Joint Commission
Accreditation Survey Findings
Life Safety Code
Inpatient Occupancy Existing Healthcare Occupancies; Section I - Buildings
EC.A.1A.4.b Requirement:
Existing Health Care Occupancies The following assemblies are constructed of materials
with the minimum fire resistance rating based upon the type of construction: structural
frame. (EC.A.1A)(EC.A.1A.4)(EC.A.1A.4.b)
Phrase:
Surveyor Findings:
Fireproof was missing on the structural steel in the sprinkler system zone valve room on the 8th floor of
Risman.
EC.A.1C.3 Requirement:
Existing Health Care Occupancies Doors in two-hour fire resistance rated separations
are: self-closing or automatic closing. (EC.A.1C)(EC.A.1C.3)
Phrase:
Surveyor Findings:
Elevator machine room did not close and latch in the Risman building.
EC.A.1C.4 Requirement:
Existing Health Care Occupancies Doors in two-hour fire resistance rated separations
are: provided with <= 1/8 in. gaps between meeting edges of door pairs. (EC.A.1C)
(EC.A.1C.4)
Phrase:
Surveyor Findings:
NICU had > 1/8 inch gap on the 1 hour rated smoke door
EC.A.1H Requirement:
Existing Health Care Occupancies When the following penetrate fire resistance rated wall
assemblies, the spaces between the item and the wall are filled with an appropriate fire
resistance rated material: pipes, conduits, bus ducts, cables/wires, air ducts and
pneumatic tubes. (EC.A.1H)
Phrase:
Surveyor Findings:
Two pipe penetrations were found in 1 hour rated wall assemblies in the 9th floor stairwell and room RA
B13 pneumatic tube system
Organization Identification Number: 5501 Page 12 of 19
The Joint Commission
Accreditation Survey Findings
Life Safety Code
Inpatient Occupancy Existing Healthcare Occupancies; Section II - Rooms
EC.A.2I.4 Requirement:
Existing Health Care Occupancies Corridor doors are: arranged to have not more than
3/4-inch undercuts. (EC.A.2I)(EC.A.2I.4)
Phrase:
Surveyor Findings:
The following corridor doors exceeded the maximum allowable 1/8 inch between the door sections: 1)
entrance corridor doors to the East MICU, 2) 4 Cath Lab in the Farr building, 3) dutch door into the
Psychiatry 4 medication room, 4) West building basement Receiving Department, & 5) West MICU door
# 780,
EC.A.2K Requirement:
Existing Health Care Occupancies Hazardous areas are appropriately protected.
(EC.A.2K)
Phrase:
Surveyor Findings:
Room for PFI 06EC 9.14 was being used for non flammable medical gas storage in excess of 3000 cubic
feet (32 e cylinders, 32 H cylinders and 2 C cylinders.
EC.A.2L.2 Requirement:
Existing Health Care Occupancies Doors in partitions enclosing hazardous areas are:
self-closing or automatic closing. (EC.A.2L)(EC.A.2L.2)
Phrase:
Surveyor Findings:
Soil Utility room #FD 719 door self-closing device is broken and inoperable.
Organization Identification Number: 5501 Page 13 of 19
The Joint Commission
Accreditation Survey Findings
Life Safety Code
Inpatient Occupancy Existing Healthcare Occupancies; Section III - Compartments
EC.A.3C.1 Requirement:
Existing Health Care Occupancies Smoke barriers are: continuous from outside wall to
outside wall. (EC.A.3C)(EC.A.3C.1)
Phrase:
Surveyor Findings:
Horizontal penetrations were noted in the following locations: 1) Farr building 13 floor FAS#1 emergency
stairwell, 2) Farr building 11 Medical / Surgical unit electric room corridor wall. Additionally, a vertical
penetration was noted in the 3rd floor Deaconess building elevator room #300A.
EC.A.3D.1 Requirement:
Existing Health Care Occupancies Doors in smoke barriers are: fitted to prevent the
spread of smoke. (EC.A.3D)(EC.A.3D.1)
Phrase:
Surveyor Findings:
The following smoke compartment fire / smoke doors exceeded the maximum allowable 1/8 inch median
gap between door sections: 1) Farr 3 to Deaconess 3 buildings, 2) Lowry and West buildings basement
tunnel connector, & 3) West building 7th floor. In addition, the following interbuilding fire doors did not
properly close and latch: 1) 3rd floor Farr to Clinical center building, 2) Lowry to West building basement
tunnel connector, & 3) West 7th floor by Clinical Nutrition Services.
Inpatient Occupancy Existing Healthcare Occupancies; Section IV - Floor Assemblies
EC.A.4B.1.a Requirement:
Existing Health Care Occupancies Linen/waste chutes. Service (inlet) doors have:
self-closing devices. (EC.A.4B)(EC.A.4B.1.a)
Phrase:
Surveyor Findings:
The trash chute door in FA03L1C at the West campus was being held open by a floor scrubber
EC.A.4B.2.a Requirement:
Existing Health Care Occupancies Linen/waste chutes. Outlet (discharge) doors have:
self-closing devices (fusible link or electrical hold-open devices are acceptable). (EC.A.4B)
(EC.A.4B.2)(EC.A.4B.2.a)
Phrase:
Surveyor Findings:
The rash exit chute door at the West Campus was missing
Organization Identification Number: 5501 Page 14 of 19
Hastanelerde maliyetlendirme ve yatırım
Merhaba ve iyi akşamlar herkese;
Oluşturduğum blog'un ilk yazısını yazmak gerçekten çok heyecanlı. Bu fikri Amerikada eğitimde iken bir hastanenin CEO'su ve yönetim kurulu başkanı olan Paul LEVY'den aldım. Gerçekten fikir çok güzel ve değişikti. Paul'un kendine ait blog'u vardı ve Amerikanın en iyi hastanelerinden olan Beth Isreal Deaconess Medical Center (BIDMC) hastanesini yönetiyordu. Yani göz önünde olan bir hastaneni en tepedeki adamı idi. Ama o çekinmeden hertürlü bilgiyi bloguna dahil olşan herkesle çekinmeden paylaşabilecek bir cesareti kendisinde bulmuştiki hergün hastanesi ve Amerikan sağlık sistemi hakkındaki olumlu / olumsuz tüm düşünceleri orada insanlarla paylaşıyordu. Bizim için ne kadar garip bir uygulama örneği aslında değil mi? Kim ister kötü yanlarını / kirli çamaşırlarını başkaları da görsün? Ama o yazdıkça insanların hastanede farkındalıkları arttı ve insanlar olaylara dah titiz yaklamaya ve aslında yaşadıkları sorunların hastane içerisinde hepisinin ortak sorunları olduğunu anlamaya başladı. Yani sorunlar sadece Paul'e ait değildi ve Paul tek başına bunları çözemezdi. zaten bunu da sayfasında açıkca dile getirmekten hiçbir zaman çekinmedi ve hala da öyle.
Dilerseniz Paul'un blogunu hergün ziyaret edip yazılarını okuma fırsatı bulabilirsiniz http://runningahospital.blogspot.com/
Evet başlıkta da belirttiğim gibi amacım bu sayfadan hepimizin ortak sorunu ve çözümü olan konuların başkaları tarafından da görünmesini ve diğerlerinin çözümlerini uygulama fırsatları yaratmak. Bu arada Türkçe yazım hatalarım için şimdiden hepinizden özür diliyorum:)
Evet hergün konular ve fikirlerle buluşmak üzere hepiniz sağlıcakla kalın
Özcan ÇİÇEK
Oluşturduğum blog'un ilk yazısını yazmak gerçekten çok heyecanlı. Bu fikri Amerikada eğitimde iken bir hastanenin CEO'su ve yönetim kurulu başkanı olan Paul LEVY'den aldım. Gerçekten fikir çok güzel ve değişikti. Paul'un kendine ait blog'u vardı ve Amerikanın en iyi hastanelerinden olan Beth Isreal Deaconess Medical Center (BIDMC) hastanesini yönetiyordu. Yani göz önünde olan bir hastaneni en tepedeki adamı idi. Ama o çekinmeden hertürlü bilgiyi bloguna dahil olşan herkesle çekinmeden paylaşabilecek bir cesareti kendisinde bulmuştiki hergün hastanesi ve Amerikan sağlık sistemi hakkındaki olumlu / olumsuz tüm düşünceleri orada insanlarla paylaşıyordu. Bizim için ne kadar garip bir uygulama örneği aslında değil mi? Kim ister kötü yanlarını / kirli çamaşırlarını başkaları da görsün? Ama o yazdıkça insanların hastanede farkındalıkları arttı ve insanlar olaylara dah titiz yaklamaya ve aslında yaşadıkları sorunların hastane içerisinde hepisinin ortak sorunları olduğunu anlamaya başladı. Yani sorunlar sadece Paul'e ait değildi ve Paul tek başına bunları çözemezdi. zaten bunu da sayfasında açıkca dile getirmekten hiçbir zaman çekinmedi ve hala da öyle.
Dilerseniz Paul'un blogunu hergün ziyaret edip yazılarını okuma fırsatı bulabilirsiniz http://runningahospital.blogspot.com/
Evet başlıkta da belirttiğim gibi amacım bu sayfadan hepimizin ortak sorunu ve çözümü olan konuların başkaları tarafından da görünmesini ve diğerlerinin çözümlerini uygulama fırsatları yaratmak. Bu arada Türkçe yazım hatalarım için şimdiden hepinizden özür diliyorum:)
Evet hergün konular ve fikirlerle buluşmak üzere hepiniz sağlıcakla kalın
Özcan ÇİÇEK
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