Heritage Snapshot: Part 245

LOMA LINDA>> By the year 2000, the nursing staff at Sir Run Run Shaw Hospital (SRRSH), in Hangzhou, China reached an improvement plateau. It was about that same time that Joint Commission International developed international hospital standards. JCI is a World Health Organization-authorized institution designed to evaluate medical quality. Established in 1997, JCI aims to improve the safety and quality of health care around the world. SRRSH considered it to be a challenge and wanted to be the first public hospital in China to be accredited by JCI. In 2003, after almost 10 years of service, the hospital set as its paramount goal to become a world-class institution, on par with the best in international practice. In order to accomplish this, hospital leadership set eventual JCI accreditation, an international Gold Standard, as a goal for SRRSH. Joint Commission International standards published in a sample form motivated the nursing staff to be internationally recognized. They then started reaching to improve, to learn, and to grow further. David D. McFadden, MD, who had been a missionary in Taiwan, Dr. He Chao, the president of SRRSH, and Zhu Jun Ya, the first director of the quality office, translated JCI standards into Chinese Mandarin to be understood by staff. In 2005, Elizabeth Geffers, an RN from Orange County, went to China to consult for JCI. Joanna Yang, RN, MS, DPN, a nurse practitioner at Loma Linda University Medical Center who speaks Mandarin, volunteered to go to China to conduct mock surveys, which helped various groups standardize services throughout the institution. Her travel expenses were covered by LLUMC, and SRRSH provided accommodations for her visit. Joanna was born and reared in China, studied nursing at a school of medicine in Shanghai, and earned her master’s degree in nursing at Loma Linda University. Earlier, she had taught SRRSH nurses about advanced practice nursing, which led the hospital to develop an advanced practice nursing program in many specialties. At first, the Loma Linda team met a lot of resistance. Everyone was busy, particularly the physicians. They wondered why did they need to do all of the extra work necessary to be accredited by JCI. According to Joanna, everyone was quite nervous during the first survey. Hospital personnel didn’t quite know what to expect and feared that surveyors might find something wrong. Some cultural differences had to be explained. Daniel W. Giang, MD, Loma Linda University Health vice president for Graduate Medical Education, also went to China to help the Chinese hospital prepare for JCI accreditation. Preparations included mock surveys from Loma Linda in 2005. The first JCI survey was thorough. The lead surveyor who spoke Chinese even climbed on ladders and checked the walls above the ceiling to see if there were any holes in the firewall where smoke or fire could come through. She found several small holes where cables penetrated the wall. “This has to be fixed,” she said. These deficits were repaired by the next day, which favorably impressed JCI surveyors. All of the departments had performance improvement projects which were described as “impressive” and “above and beyond” requirements. The performance improvement project in the outpatient dialysis center, for example, included a poster illustrating improvement data over time with a graph. According to Joanna, the surveyor “was totally impressed.” Four LLUMC representatives were there for the first survey. “I thought the folks at Sir Run Run Shaw did a great job,” said Giang. “The nurses clearly demonstrated how enthusiastic they were about quality improvement and care for their patients. I know the joint commission surveyors were astounded by the number of nurses who had gotten advanced certification in their specialty from Western organizations (including Loma Linda University). I thought the physicians did an amazing job of being able to showcase what they were doing to improve patient care.” In 2006, Sir Run Run Shaw Hospital became the first public hospital in China to be awarded the JCI certificate for quality health care. A special ceremony, attended by more than 300 governors, international and domestic hospital administrators, clients and media, was held at Sir Run Run Shaw Hospital on Thursday, May 17. During the second survey, staff were well prepared and wanted the surveyor to come to their departments. They were confident, and their confidence showed on their faces. During the second survey, one of the questions asked was, “What are you proud of?” During one session, Ye Zhihong (Jenny) RN, PhD, the vice president for nursing, presented all of her Advanced Practice Nurses. They worked in education, cardiology, wound care, diabetes, psychological care, pain management, and on the intravenous central IV line management team. SRRSH was the first hospital in China to have all those APN roles. The surveyor was very impressed. Under the united effort of the hospital’s entire staff, the hospital was re-accredited by JCI with high scores in 2009, 2013, and again in 2016. It has been continuously accredited by Joint Commission International since 2006. Today, almost 60 other university hospitals in China are accredited by JCI. In the process, the Chinese government noticed and raised their standards to match JCI standards. Then they required their university hospitals to mentor their community hospitals. This initiative, starting with Sir Run Run Shaw Hospital, has improved the quality of hospital care throughout The People’s Republic of China.