Encabezado Boletin
ISSN 2525-040X   

Número 17, JuLio de 2017


Gestión del cambio en la Joint Commission

Culture of Quality: How we work: Process improvement program breeds quality culture, empowers staff. By Tyler Gaskill, June 2016


Descriptores: <Estados Unidos> <Acreditación&> <Gestión del cambio&> <Adaptación al cambio> <Cambio cultural> <Cambio organizacional> <Cambio tecnológico> <Evaluación> <Hospitales> <Indicadores> <Servicios de salud> <Atención médica> <Auditoría> <Autoaprendizaje> <Calidad&> <Normas de calidad> <Seguridad> <Educación sobre seguridad> <Certificados> <Calificaciones>

Abstract: The Joint Commission’s robust process improvement program trains employees in lean Six Sigma and change management, making continuous improvement an intrinsic job function for everyone. • Using disciplined problem-solving approaches and soft skills, employees cultivated a self-sustaining culture of quality that works from the bottom up and top down.


When the Joint Commission—a not-for-profit organization based in Oakbrook Terrace, IL, which accredits or certifies more than 21,000 U.S. healthcare organizations—developed its “Robust Process Improvement” (RPI) program, its leadership knew lean Six Sigma could arm employees with a systematic approach to improvement. But it also knew change management would be the engine facilitating that improvement.

“At a high level, lean tools and Six Sigma tools produce a better process,” said Joint Commission CEO and president Mark R. Chassin, M.D. “[The process] is more efficient and has better outcomes … But all of that, in order to produce an actual improvement, has to be accepted and implemented by the organization.”

The Joint Commission started its RPI program in 2008 to improve its own internal processes, and GE initially trained staff in GE’s change acceleration process and workout tool—an approach for creating sustainable improvements by bringing together cross-functional teams consisting of leaders and employees who are closest to a process.

For an organization that works to improve healthcare safety and quality through its various accreditations and certifications, the RPI program was a way for the Joint Commission to practice what it preached. Chassin said there were two goals in developing the RPI program: to improve the organization’s operations and make its staff experts in using quality tools.

Today, the Joint Commission’s in-house curriculum offers employees training in change management and lean Six Sigma. Fifty-nine percent of its workforce has completed some level of RPI training. And 60% of its board members are trained in change management or lean Six Sigma. Even Chassin is a Six Sigma Green Belt (GB).

Eight-year evolution

After RPI was introduced, Chassin said the staff response was similar to most organizations’ experiences. There were early adopters, late adopters and people who continued to resist.

“The adoption of the tools never proceeds in a linear and homogeneous fashion,” Chassin said. “Some parts of an organization just don’t believe they need it because they already know how to do improvement. They don’t believe what works over there will work over here because, ‘We’re different.’”

In the program’s first year, many presentations were created to encourage employee participation. Anne Marie Benedicto, Joint Commission executive vice president, support operations and chief of staff, explained that the organization resisted forcing people to join. Benedicto said, “Desire is very important.” She explained that if training were mandatory and an employee had to work on a data set for a GB project until 3 a.m. just so she could do her regular work the next day, it would be “a very bitter experience.”

According to Benedicto, there was a “secret list of people” the organization hoped would join, and over time, it achieved a good representation of the individuals on that list.

“Our goal was to find the people in each unit of the organization who their manager couldn’t do without,” Chassin said, adding that asking a manager whom they’d recommend for the training could lead to a response of, “Oh here, take Bill. He’s got plenty of time.” Some people are asked to apply, but they’re vetted in an interview before being added to the training program.

Their managers also had to be consulted. “How do you convince managers that it’s worth their while to let their most valuable staff person go for six months?” Benedicto asked. The answer: “Because they will come back better and happier.”

It is the Joint Commission’s goal to train every employee, but some of its curriculums can be rigorous and last up to six months, and not everyone’s job function requires that level of commitment. This led to the development of the Yellow Belt (YB) curriculum, which provides enough RPI knowledge for employees to improve their daily work and is offered as online modules.

Change management

The phrase “culture eats strategy for breakfast” is used often to emphasize the people side of quality—how improvement initiatives don’t take place in vacuums, and how human factors won’t show up on control c arts. This was why the Joint Commission developed its change management curriculum known as “Facilitating Change”

“In looking at programs that have gotten started in healthcare and gotten little traction and then failed, it’s typically because change management has been ignored or not acknowledged as equal to—if not greater than—the other two parts of RPI,” Chassin said.

According to Chassin, the Joint Commission’s change management approach is equally as systematic as lean Six Sigma: As an improvement team develops new processes, change management focuses on how it gets an organization to accept, implement and sustain the change.

Leaders have to find a better fit between their organization’s needs and their people’s capabilities … In the past, many staff functions were driven by control rather than adding value. Staffs with that focus have to be eliminated. They sap emotional energy in the organization. According to Chassin, the Joint Commission’s goal of training every employee to use RPI tools isn’t just so it can say it trained everyone. The goal is to have an approach for improvement that’s embedded throughout the entire organization.

Reseñó e indizó JLT

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Nota del Editor: El editor no se responsabiliza por los conceptos u opiniones vertidos en las entrevistas, artículos y documentos reseñados en este Boletín, los cuales son de exclusiva responsabilidad de los respectivos entrevistados, autores o colaboradores.


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Lic. José Luis Tesoro
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