The mark of "Excellent": DGMC tops inspection score, receives accreditation Published Jan. 7, 2009 By Jim Spellman 60th Medical Group Public Affairs TRAVIS AIR FORCE BASE, Calif. -- To the roar and raucous cheers of a standing audience, the medical staff at David Grant USAF Medical Center received an overall "Excellent" rating and full accreditation status for another three years. A no-advance notice review and survey was conducted by the Air Force Inspection Agency and the Joint Commission Dec. 8 through 12 at DGMC, which is the largest medical facility in Air Mobility Command, and second largest Air Force hospital in the nation. "Let me tell you a little bit about this . . . we've had the opportunity to now inspect every single medical center in the Air Force inventory over these past 36 months," said Col. Gary Forthman, director of the Air Force Inspection Agency's Healthcare Services Inspection team, "and David Grant Medical Center blew the other four out the door." The AFIA's survey team performed a rigorous inspection of DGMC's operational support functions in four major categories covering 19 areas measuring 1,264 criteria, comprised of 116 elements with 21 receiving particularly special focus, as directed by the Air Force Surgeon General office. The categories included Expeditionary Medical Operations, In-Garrison Medical Operations, Leadership and Special Missions. Health services inspections are conducted in accordance with Air Force Instruction 90-201, Inspector General Activities. All Air Force medical facilities are also required to submit to an accreditation survey conducted by the pre-eminent national accrediting organization, the Joint Commission in fulfillment of both Department of Defense and Air Force requirements for inpatient facilities across the Military Health Service. The Joint Commission evaluates and accredits more than 15,000 health care organizations and programs in the United States. An independent, not-for-profit organization, the Joint Commission is the nation's predominant standards-setting and accrediting body in health care. Since 1951, the Joint Commission has maintained state-of-the-art standards that focus on improving the quality and safety of care provided by health care organizations. The Joint Commission' s comprehensive accreditation process evaluates an organization's compliance with these standards and other accreditation requirements. Although the HSI and JC survey are separate entities, the combined HSI and JC visits improve efficiency by eliminating the need for separate visits by each team. "HSIs are performed by experienced medical teams assigned to AFIA," said Rees Donneson, 60th Medical Group chief of Quality Management and Compliance. "These inspections are conducted under the auspices of the Air Force Inspector General, and are similar to the Unit Compliance Inspections our own 60th Air Mobility Wing periodically undergoes." Receiving "absolutely zero unsatisfactory ratings," according to Colonel Forthman, six areas were categorized as "Satisfactory": Force Fitness, Workplace Surveillance, Worker Protection, Executive Oversight, Community Support and Aerospace Medicine Special Missions. "This is a 'Sustained Performance' inspection," explained Colonel Forthman. "In the way we do inspections, we look at sustained performance in this day and age . . . By definition, 'Satisfactory' is you are performing your mission in a rock solid way . . . there is absolutely nothing that should cause you to hold your head down in shame when you see a 'Satisfactory' in this day." According to Colonel Forthman, a couple of years ago a "Satisfactory" rating would have meant a totally different situation. However, in 2007, the AFIA's score of methodology changed and became much more stringent. Three areas that exceeded AFIA's requirements and have the distinction of being categorized as "Excellent" were Medical Readiness Training, Population Health and Human Resource Management. "And every once in a blue moon, there are those areas that just far exceeded anything that we can really expect," Colonel Forthman said. "And sure enough, you guys managed to pull it off." Nine areas within DGMC were rated "Outstanding," including Medical Readiness Planning and Oversight, Deployment Processing, Operational Medicine, Epidemiology and Public Health Surveillance, Dentistry, Mental Health and Business Management. "You all should be very proud of yourselves. That is awesome," said Colonel (Dr.) Lee Payne, 60th Medical Group commander. "I've been so impressed and the feedback we've been getting from the inspectors said some things that made me very, very proud of you all," Dr. Payne told the medical staff after the HSI out-brief. "They said, 'incredibly professional staff,' 'open,' 'engaging,' 'willing to listen,' 'willing to learn,' 'great dialogue,' 'focused on patient safety.'" "The feedback from our community said 'the hospital is a place that's focused on customer service, that the quality of care they get at DGMC and the access to care is exceptional,'" Dr. Payne explained. "There were no complaints of access to care in their sessions, so you all are doing something right, and to be the best medical center in the Air Force through a 36-month cycle is absolutely awesome. I couldn't ask for anything better, I really couldn't," Dr. Payne said. On the other side of the coin, to earn and maintain the Joint Commission's Gold Seal of Approval, a medical facility like DGMC must undergo an on-site survey by the Joint Commission's team of inspectors at least every three years. Laboratories must be surveyed every two years. DGMC's last survey was conducted in December 2005. "The Joint Commission inspectors were very complimentary of DGMC's staff, especially the positive attitude exhibited by everyone for a short-notice inspection," said Col. (Dr.) Gary Walker, 60th Medical Group deputy commander. "Opportunities for improvement were identified by the Joint Commission and will be the focus of our efforts here in the future." "Most public and private hospitals in the U.S. are Joint Commission-accredited, since this is acknowledged as the gold standard for external validation that patient care services are effectively managed and professionally administered," explained Mr. Donneson. "At DGMC, this is also important for our graduate medical education and officer and enlisted specialty training programs, since such training is most often conducted in accredited healthcare organizations." According to Mr. Donneson, the Joint Commission's accreditation carries the recognition that DGMC adheres to the same standards in providing safe patient care that other accredited institutions across the U.S. adhere to. It also communicates to the medical community nationwide that DGMC physicians, nurses, allied health professionals and technical and support staffs meet or exceed standards associated with their roles in patient care. "Our ability to provide a high-quality, full spectrum of healthcare to those entrusted to our care while conducting world-wide deployments in the support of the Global War on Terrorism has been fully validated by the Joint Commission," said Dr. Payne.