Challenges to implementing Joint Commission Requirements on FMEA

Key Takeaway:

Although the Joint Commission requirements on healthcare FMEA have been enacted with benign intentions and are beyond reproach as to their purpose; there are practical challenges to implementing them.

The Joint Commission periodically issues essential requirements to member hospitals on conducting Failure Modes and Effects Analysis (FMEA). While being popular at the industry level as an important method for ensuring better quality patient outcomes; these Joint Commission requirements on FMEA are not without their challenges.

First, a look at the core requirement

Shorn of all their processes and methodologies; the Joint Commission requirements on FMEA center on the member hospital's need for conducting a healthcare Failure Modes and Effects Analysis (FMEA) by selecting at least one critical process every year by every member hospital.

Challenges in implementing the Joint Commission requirements on FMEA

A valuable means for the hospital in assessing the risk of patient injury; the Joint Commission requirements on FMEA are considered preventive, because it exhorts hospitals to anticipate failures and nip them in the bud rather than tackle them when they arise. Yet, Joint Commission requirements on FMEA are weighed down by some constraints at the implementation level.

Obsession with the peripheral

Most important, some experts believe that by focusing extensively on protocols and processes; the Joint Commission requirements on FMEA give too much importance to the periphery rather than to the core. While processes are very important, what is more important in healthcare administration is intuitiveness and presence of mind. Processes do matter, but adherence to them should not be at the cost of delivering care.

A real life example of overemphasis on the process emerged during a major study of nearly 300,000 surgeries over a 25-year period starting in the mid-80's, in the US. While there were no complaints per se against following processes set out as part of the Joint Commission requirements on FMEA; it was noticed that during many surgeries, surgeons were preoccupied with analyzing FMEA and religiously implementing these processes, as a result of which they overlooked the most important aspects of a surgery, such as locating the proper site of surgery.

This is an example of how giving greater importance to adhering to processes could be potentially dangerous, while coming at the cost of patient outcomes. In turning their attention to the FMEA analysis, it is possible many surgeons unintentionally bypass more important aspects.

Porous classification that can be easily assailed

One of the core Joint Commission requirements on FMEA is selecting at least one high risk process by each hospital each year. This is no doubt a laudable step, but is fraught with practical difficulties. How do hospitals determine the most important high risk process? Given that risk itself is a moving target and a subjective criterion for assessment; it is easily possible to vaguely categorize a process as high risk and fulfill the Joint Commission requirements on FMEA just to satisfy the requirements, purely on paper. This loophole makes it very easy to manipulate the core of the Joint Commission requirements on FMEA and carry out these functions ritualistically just to "tick boxes" while easily deviating from the spirit of the requirement.

Click Here to Explore More