Joint Commission issues an alert to all accredited healthcare organizations that Environment of Care and Life Safety issues continue to be cited.

1. 1/16/2015 It’s Time to Solve the Long Standing Environment of Care Issues | Joint Commission
http://www.jointcommission.org/leadership_blog/its_time_to_solve_the_long_standing_environment_of_care_issues/ 1/2
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It’s Time to Solve the Long Standing Environment of Care Issues
Jan 14, 2015 | 2004 Views
By Mark Pelletier, R.N., M.S., Chief Operating Officer, The Joint Commission
In looking over the standards non­compliance trends in the last few years, the environment of
care and life safety code issues continue to be the most often scored non­compliant standards
in hospitals.
With so many other challenges that hospitals and other health care organizations have to
overcome, to some extent from the accreditation viewpoint, they’re still stumbling over the
same issues with no real positive change in conquering these problems. Consistently
struggling with the same non­clinical standards is also alarming in that it’s disproportionate to
the clinical standards areas, where you would think more negative trends would exist since
caring for patients is the primary purpose of health care organizations as opposed to building
maintenance issues. Perhaps it’s good that organizations have more problems with environmental issues as opposed to
care giving, yet it’s a problem nonetheless.
It’s also a vicious cycle – faulty environment of care issues lead to infection control issues, so the environment, in fact,
harms humans. Who’s responsible to help break the cycle?
Many of the issues focus around aging buildings and campuses and lack of updating systems to stay in compliance with
safety issues. In 2014, 53 percent of surveys analyzed indicate that the most frequently cited finding was related to
improper air pressure relationships, air exchange rates and filtration. As organizations add or renovate buildings, older
systems are expected to continue to meet safety needs but frequently this issue is overlooked, leading to negative findings
during an accreditation survey.
Many of the issues in these areas are assigned to staff that are often not provided enough training and education on the
correlation of the physical plant and patient safety. We’ve found that many facilities leaders estimate that less than 15
percent of their management time is spent on compliance issues.
Another recurring issue is the discovery of holes in walls and door safety issues discovered during survey. When
organizations complain that their IT staff created physical plant issues while installing the electronic record system, that
probably wasn’t an expected result but its effect and potential harm can be prevented by reporting the damage to physical
plant personnel.
I talk to the health care C­suite folks frequently and from my viewpoint, 99 percent of them feel these non­compliance
issues rest with their engineering or facilities team. The engineering and facilities personnel point to the quality or
accreditation people and they in turn say it’s the individual floor personnel and facilities staff who need to be responsible.
So another circular argument ensues.
The problem in all of this is that the finger pointing doesn’t solve the problem. In reality, the responsibility for the
environment of care and life safety issues probably lies at the feet of many departments. There’s no one owner.
I suggest it’s not the tactical issues of just not doing something that is perpetuating these problems but instead a matter of
behavior – no one is owning the problem. Life safety code specialists indicate that funds are not allocated for education for
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2. 1/16/2015 It’s Time to Solve the Long Standing Environment of Care Issues | Joint Commission
http://www.jointcommission.org/leadership_blog/its_time_to_solve_the_long_standing_environment_of_care_issues/ 2/2
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them in the area of patient safety. Perhaps that’s a starting point. Educating the individual floor staff and departments to
report barriers to exits, safe maneuvering of equipment, holes in walls due to machinery installation etc., could be another
positive tactic. Capital dollars for infrastructure maintenance and upgrades are needed to support the changing environment
and critically needed to help maintain patient safety. Having the C­suite recognize the solution is probably not in just one
area seems like a potential positive step in the right direction as well.
For our part, we are working toward developing education opportunities for hospitals to help their staff better identify and
work toward conquering the consistently out of sync environment of care and life safety code issues.
I’m hoping health care organizations rally around the war on the “same old, same old problems” and realize everyone in an
organization owns the environment of care.
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Comments (1 Comments)
Beth Boynton, RN, MS ­ Portsmouth, NH
Dear Mark, Thank you for raising such important points and being a voice of reason! You are getting at underlying issues
that plague us with Environment of Care as well as workplace violence, morale and injuries among healthcare professionals,
horizontal and vertical violence between staff and abuse from patients/families all have powerful roots in human behavior
and communication. I don't mean to add layers of complicating issues to obscure your important points, but rather to state
that these issues are persistent, pervasive, and complicated. The circular arguments and finger­pointing you mention are
symptoms sick buildings and sick cultures. Some solutions I recommend are 'whole systems' work for culture change,
interactive workshops on communication skills and with respect to nurses, teaches them to be assertive for themselves as
well as patients, and utilizing 'out­of­the­box' ideas like Medical Improv to build people skills, critical thinking, EQ,
relationships and decrease stress. Also, it is crucial to recognize how complex healthcare work is and in particular that of
nurses. I and other guestbloggers at www.confidentvoices.com speak to these issues frequently and I'd be most happy to
share some specific posts re: this issue and my response. Again, thank you. Beth
2:44 PM Jan 14th
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