SAFER in practice; Thoughts on Joint Commission's new scoring matrix

There's been much ado about The Joint Commission's new scoring system, the Survey Analysis for Evaluating Risk (SAFER) matrix. The matrix is a 3 x 3 grid with the Y-axis ranking the likelihood of a problem occurring and the X-axis measuring how widespread the issue is. The matrix replaced the old "Category A/C" method this January, and all accredited organizations can expect to see the grid during their next survey.

Unless you happened to be one of the facilities surveyed in the last four months, it means that you still haven't seen SAFER in practice. So what are people saying about the new system? Is it better or worse than the one that came before?

Victoria Fennel, PhD, RN-BC, CPHQ, director of accreditation and clinical compliance at Compass Clinical Consulting, says Compass has heard from clients who've experienced the matrix and most of the feedback has been very positive.

"Some people have said, 'This was the best survey ever,'" she says. "Others have said that this has been a very smooth process. [Overall] the feedback has been that the SAFER Matrix has been well-received by organizations"

Some facilities have said they're seeing a change of perspective on the survey process, even amongst hospital leadership. The visual aspect of the matrix helps people think more about the risk to patient safety rather than focusing on the scoring, she adds. And the tool appears to be changing views of the survey process as being punitive.

"Several organizations indicated that The Joint Commission surveyors were sharing more information with the staff than they had in the past," she says. "The takeaway from the leaders was that this was a more collaborative survey process."

To acclimatize organizations to SAFER, Joint Commission surveyors have been giving presentations on it during their opening orientation session with hospitals. And on each day of the survey, surveyors start the day by showing staff all their findings and where they lay in the grid.

 "That way organizations can easily see where things are in the matrix," says Fennel. "For example, when they look at the matrix and it shows a deficiency in the red, leaders know this is serious, but is the issue limited, a pattern, or is it widespread? And if it turns out to be limited, they need to focus efforts quickly to make sure the deficiency doesn't show up in other areas in the hospital."

"It's a good visual aid to help you see where your deficiencies are," she added. "So that you can focus your improvement efforts not only after the survey, but during the survey."

The Joint Commission has been releasing documents and presentations on the SAFER matrix since last May, including PowerPoints, infographics, webinars, and sample reports. Fennel says Compass has been incorporating that information into mock surveys to help prepare facilities for their next survey. But the best bet for facilities is to speak with colleagues who've experienced the matrix firsthand.

"I think as far as mock surveys, the more information we can share the better," she says. "Particularly for people who may be new to the accreditation roles in their hospitals. Just having more time to completely understand the SAFER matrix and how they can use that tool to help drive improvement within their organization will prove to be helpful."

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