Ambulatory Health Care Surveyor Spotlight

I have been a surveyor for a year and a half. I retired after 40+ years of nursing practice, and of those years, I'd been directly involved in ophthalmology for the majority of them. I typically do two surveys a week, and they're typically a two-day survey. Sometimes it's only one per week if it's a three-day survey.

I am an OR (operating room) nurse. My background is in OR and critical care. I actually started out as a scrub tech 45 years ago, scrubbing and assisting the surgeon, and then went to nursing school. And then from there, critical care and OR. I'm certified in perioperative nursing.

I was always asking questions: Why are we doing it this way? Who's telling us that we have to do it this way? I never really accepted that this is how we've always done it. I always wanted to know the rationale and understand the standards that would dictate why we would do a specific process. As a little kid, I was always asking why, and it carried over into my adulthood. So that really helped me understand the foundation of accreditation and quality of patient care versus performing a task, not really knowing why — just doing it because I was told to do it.

Back in my hospital days, when the Joint Commission’s focus was very different, a large group of surveyors would come to the hospital and sit in the boardroom and request this document and that document; you had to do presentations to tell the story about what you were doing as an organization or a leader in the organization. In those days, I thought, Oh, dear Lord, I would not want to be a surveyor. It's just boring.

But when I started my first surgery center in '99, that center was accredited by the Joint Commission. And that survey was so different compared to my experiences in the hospital. I just remember the surveyors spending time with me explaining quality studies, explaining steps I could take, and really opening my eyes as an ambulatory leader or administrator of a surgery center. And I thought, Oh, golly, this is really cool stuff and someday I want to be a surveyor.

Early in my career, I was Vice President of Clinical Services, so I would do what we call “mock surveys” in centers to prepare them and make certain they are ready for a survey at all times. And I just really enjoyed digging and peeling the onion back, asking why. You want to go deeper to make certain they are following the standards and the organization's policy. So it’s the detective work that is exciting for me.

I enjoy getting out and seeing organizations, seeing what they're doing, what the organization's culture is like, meeting new folks, and getting to understand where they are at, their career path, and what they contribute to the organization to make it a really stellar organization.

I don't just focus on the leadership. I want to talk to the staff. I don't care if it's a housekeeper or a nursing assistant or the OR charge nurse. I want to talk to all of them just to get to know them and understand what they're doing. That's what's exciting about it: seeing how organizations or staff practice and how organizations tap on their top performers to make the organization what it is.

I have enjoyed sharing experiences that I have had to help organizations or leaders so they don't make the same mistakes I've made in my career. I feel like I'm impacting the quality of care provided in the United States just by being a surveyor.

I see more consistency, and I feel I can directly relate that to the SIG, the Standards Interpretation Group. I have had experiences with other accreditors where a surveyor may have “baggage.” They want a specific thing because they want it and it's not really the standard. So they will cite you or that would be a finding, but it's just because I'm the surveyor and I said you need to do that.

With the Joint Commission, there's a gatekeeper. So there's a lot more standardization across the organization of the Joint Commission with what we're surveying and what we observe. You can't just observe something and say, “I don't like that,” because Big Brother in Chicago is watching over us to make certain that what we're documenting, or what our Requirements for Improvement (RFIs) might be, are truly based on the standards and not personal.

Joint Commission has such a vast bench of clinical experts across all specialties. It’s really nice when you can call and talk to a CRNA or you can talk to a physician about an issue.

It really takes a village. And by a “village,” it's the account executive, the Joint Commission resources, the organization, the staff, the entire team, everybody working together to prepare. And for organizations undergoing their initial surveys, they have to realize it's going to be a lot of education. Don't expect to be perfect as you head out the gate. It's a starting point.

Accreditation is continuous. Quality should be discussed in every meeting. It's continuous to prepare for any survey and to keep the organization ready for the survey at any point in time. Because you’re preparing processes and making certain there are checks and balances so that we can, as a team, strive to reduce patient harm.

Centers are more prepared when the staff is involved and the staff knows what they're doing. The staff and centers are so proud of what they're doing and so proud to say, “We are Joint Commission,” because when surgery centers are competing with a lot of hospitals, having that Gold Seal means so much to them. I really see that pride. So it's continuous. Everybody has to work together, and we're continuously learning.