Joseph L. Cappiello is the recently appointed new chief operating officer of Healthcare Facilities Accreditation Program. Mr. Cappiello previously served for 10 years as vice president of field operations at The Joint Commission.
Q: What are your primary areas of focus at HFAP and what do you hope to achieve?
Joseph Cappiello: There are some important areas that immediately come to mind. Number one is the fact that when you look at HFAP, it's been in existence as an accreditor since 1945. It has been awarded deemed status by CMS since the inception of [the agency] in 1965. We're the oldest accreditor in the business and we are probably one of the best kept secrets in healthcare. So one of the first things I want to do is elevate the awareness of HFAP in the marketplace. I want to ensure that hospitals are aware of us and the positive impact we can make on their organizations. People need to know about us and the value we bring. We want to stop being the quiet accreditor. We want to be able to tell our story and the stories of the organizations we accredit.
The other priority I have is to continually improve our performance and strengthen the partnerships we have with our accredited facilities. One of the things that has always hallmarked the HFAP process is the sense of partnership that our accredited facilities tell us they enjoy with us.
For hospitals, it's important to receive an objective, rigorous third-party evaluation, but it's also important to have a relationship and a trust with your evaluators. Where you can ask them questions and they are comfortable in providing direction and guidance on how you as an organization can improve the quality and safety of the healthcare you deliver to your patients.
I believe that recognition and growth has been the desire of the CEO of HFAP, Michael Zarski. Not only has he brought me aboard, he's also just secured Beverly Robins as our new director of accreditation services. She comes to us as the former director of ambulatory care nursing at the University of Chicago. She worked with me for eight years when I was at the Joint Commission, where she was my field director for ambulatory care accreditation. [HFAP bringing us aboard] is a very clear message to the field about how committed we are about having a more significant presence in the evaluation of healthcare facilities in the United States.
Competition among accreditors is a really good thing. I believe it floats all boats. Everyone gets better, everyone does their job better. The ones that are the beneficiaries of all of that is the public.
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Q: What do you see as the top challenges facing healthcare facilities?
JC: I can't think of any industry that is more challenging than healthcare today. It's the number one topic of politics. The Obama healthcare plan, proposed cuts in Medicare, public disclosure of information, mergers and closures, etc. — the whole gestalt of healthcare is very complex and is being pushed and pulled in many directions.
Now when you get down to the level of interface between our healthcare facilities and the patients they serve, one of the issues that worries me the most is the constantly evolving strains of highly resistant microorganisms. That's a real fear I've had throughout the last 10 years or so as we've seen the evolutions of strains of bacteria that are methicillin-resistant and are becoming resistant to our most potent drugs. The whole issue of hospital-acquired infections, infection control practices, self-protection, and how we limit the spread of disease, I think that's an important challenge to healthcare. It's basic and fundamental but it presents an evolving threat that seems to adapt as quickly as we develop drugs to attack these organisms.
The second issue I have concern with is the ability for staff to stay ahead of the curve when it comes to providing the best healthcare possible — to maintain competency. If you just look at the explosion of knowledge in the healthcare world, every day there are new techniques, new procedures, new drugs and unconventional ways to treat what we have thought were conventional diseases. We're making all of these breakthroughs. That's great! Now how do you make sure staff stay current and able to deliver high-quality, safe care in this complex environment? I think credentialing and privileging and ongoing training of staff is a really big deal.
The third issue is reimbursement. The public and many politicians believe the healthcare system is overfed and wants to put it on a financial diet. Many facilities are struggling in the current cost-cutting environment and are trying to figure out how to streamline processes to make them more efficient and, at the same time, ensure they are providing high-quality, safe care. Additional reductions in reimbursement could put a number of these organizations in significant distress.
Public disclosure and transparency are ascending to a prominent position in healthcare. The release of data such as Medicare Compare and HCAHPS are allowing the public to make comparisons of their hospitals and how they are rated for cleanliness and service along with their ability to provide high-quality care. Trying to maintain a patient-centered approach in an environment of diminishing reimbursement is going to be a significant challenge.
Q: You have spearheaded initiatives on emergency management and disaster response. Where do you see organizations struggling in these areas?
JC: Preparation for disasters is one of the most difficult things to do because you're asking facilities to invest money, time and effort in something that may not occur. If you're not subject to hurricanes each year, don't live along the Mississippi and get flooded, are not in California where you're burnt out or the ground vibrates under your feet — if you don't view yourself as being in a threatened environment, it's very hard to invest any money and justify investing in preparedness infrastructure.
The result is that we are not very well prepared because it costs money and there's a dwindling funding stream for preparedness. Since 9/11, the federal government has spent somewhere around $7 billion in healthcare preparedness and we don't know where the money has gone. There have been monies that have gone out to hospitals and they used it to purchase goods and services they thought appropriate but there was no federal guidance, no direction, and the government has not set up a reliable system to measure our level of preparedness.
Had we gone out and done a rigorous, fulsome review of the state of preparedness in 2001, we would have known where to spend the money. But we didn't. We just threw money at this and hoped it would land at the right spot. Now here we are 10 years later, and we have anecdotal data that that money has improved our level of preparedness. But still there is no measurement. I believe in the old adage that if you can't measure it, you can't manage it. That was never so true than in the areas of disasters and disaster-preparedness.
The other thing we always do is we always prepare for the last disaster. We have prepared for Hurricane Katrina a dozen times but have failed to be concerned about the New Madrid earthquake fault in which St. Louis and most of the states along Mississippi are threatened. It's the most active earthquake fault in the United States but you never hear about it because Katrina comparisons keep getting covered. Then no matter how hard you try to prepare, there's Joplin, Mo. How on earth can you prepare with 10 minutes warning for a tornado that comes through your town and levels your medical center? The issue is not so much you can defend yourself from that; it's how quickly you can restore services. Preparedness is not just about being able to defend yourself but your ability to respond to and recover from a disaster like that.
The biggest threat to preparedness is complacency, [the mentality of], "We haven't had a storm here for five years, what makes you think we're going to have one in the next five?" Complacency kills initiative.
Q: What do you think organizations that excel in quality and patients safety do better than other facilities?
JC: It's very interesting because I don't believe it's always about money, or about resources, or about reputation. It's really about leadership. The key element in healthcare leadership starts with an engaged board. The tone and direction of what that medical center should be, and must be, are set by its board. I've never seen a poor performing hospital led by an enlightened and engaged board. It is then the board's responsibility to install the right leadership — find people who understand what the board wishes to accomplish and that can execute against that plan and in so doing build trust with staff.
I think one of the most important elements to high quality care is a staff that has an unwavering trust in their leadership. They understand what the expectations are, they trust they're going to be able to get the resources they need, and there is a passion that is lived each day in pursuit of the mission of that facility.
Together, they create and build an exceptional healing environment in those hospitals. It's about leadership's commitment to staff and staff's commitment to the mission. I don't care if you're a 25-bed critical access medical center in northern Wisconsin or you're the Mayo Clinic. It's all about leadership.
Learn more about HFAP.
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