Medical Tourism Blog

Today we bring to you an interview with Brain E. Gooch, of Gooch & Associates. The kind of information you'll be getting in this interview can be found when you apply for JCI accreditation or hire Gooch & Associates and nowhere else. So you better read the whole thing carefully.

The company helps healthcare providers, both domestic and international, with their planning and preparation for accreditation by the Joint Commission. For international hospitals, the accreditating organization is Joint Commission International, or as it is better known, simply JCI.

This past week, Brian Gooch was on a tour of his clients' facilities in Asia, and our communication was mostly via blackberry. Finally, I managed to coax him away from his blackberry, and sit in front of a computer long enough to answer a few questions. The service he provides and the knowledge of healthcare facility surveying procedures he brings to the table is quite unique and specialized.

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Question: Your firm, Gooch & Associates, Inc., provides consulting services to healthcare providers worldwide. Your expertise, and current focus, is on helping your clients achieve Joint Commission ( JCI for International Healthcare Providers ) accreditation. Is that correct? What kind of help do you provide to healthcare providers, and what is your background and experience, as pertaining to the Joint Commission?
Brian Gooch: Our core business is Joint Commission International (JCI) accreditation preparation, i.e., doing whatever it takes to help the client achieve their goal of accreditation. We firmly believe that even if a client never takes the final step and applies for accreditation, simply by aligning themselves with the JCI accreditation standards, they will be a stronger organization.

Our services would typically start with a baseline evaluation or “mock survey” (I will explain this term in a moment) to determine where the organization is currently relative to the accreditation standards. We ask that they do NO preparation for this baseline evaluation. We do not even want them to obtain a copy of the accreditation standards. The mock survey that I mentioned is Joint Commission speak. They refer to their accreditation evaluation as a survey. So, our evaluation is a “practice” or “pretend” survey because it is not official but we use the same techniques and methodology they do in the real thing. That way we have a more accurate picture of where the organization stands and what will need to be done so that they will be able to comply with the accreditation standards.

Following the mock survey, we provide a detailed report or gap analysis identifying the standards where there are issues, the observations that led us to that conclusion and the specific recommendations to bring themselves into compliance. They can take that report and run with it, so to speak, and prepare themselves for accreditation. Or, they can engage us for a second phase which would include the development of a detailed, phased action plan to take them to accreditation. Typically it takes organizations 24 months, on average, to prepare for accreditation. Those with support can achieve that result in 12 months. Those without support, through trial and error, arrive at that goal in 36 months. Thus the 24 month average.

We also can provide education programs and infrastructure development to help hospitals run more efficiently.

Our background? Well, besides having many years of experience as practicing physicians, nurse executives and hospital managers, we have all been trained by the Joint Commission as surveyors or evaluators. To my knowledge, we are the only consultancy in the world, supporting organizations preparing for JCI accreditation, that is comprised of former Joint Commission surveyors. There are other consultancies, including the Joint Commission, but we are the only ones with (extensive) surveyor experience.

Question: Could you please tell us a bit more about the methodology, the measurable elements and other issues which come up during the accreditation process.
Brian Gooch: The accreditation standards are broken into two groups; those related to patient care, e.g., assessment, medication management, education, etc. and those related to organizational structures, e.g., leadership, facility management, information management, human resources, etc. Each standard includes the standard itself; an intent statement, which is further explanation of what the standard means; and the measurable elements, which are the questions the JC surveyors will have to answer (and score) to determine whether the organization meets that standard.

In an accreditation survey, the JC will use a combination of (minimal) document review, (staff and possibly patient) interviews, observations of patient care. They will also take several patients and follow or trace their actual care through the departments and services the patient encountered during their hospital admission. The so called “tracer methodology” the JC uses now is VERY effective in uncovering standards-related deficiencies.

Question: Let's say a hospital hires you. What's the time frame we're talking about here? Do they have to contact you before they get in touch with JCI, or is the actual accreditation process, which I understand sometimes rolls over into multiple years, work on a parallel track with your efforts?
Brian Gooch: If an organization hires us to take them to accreditation, we can provide an estimate of the time frame. There are still a number of factors that are out of our control, such as how committed the leadership is to achieving accreditation and how stable the organization is. We worked with one organization from construction through to accreditation (and are continuing to work with them). The amount of management staff turnover in the first few years was incredible. We had difficulty getting any traction because there were new faces every time we came back. With almost every visit we were continuing to start over from the beginning and train the new managers.

In general, it will take an organization 24 months to achieve accreditation. Some will take 36 months (likely without outside help or support); some will take 12 months (most probably WITH outside help and support).

Question: What's your track record, so to speak? How many clients have you taken on so far, and how did they do?
Brian Gooch: Gooch and Associates has never had an organization that went forward to accreditation NOT make it. Two international hospitals that went to accreditation scored 99% and 99.5% respectively. When the Joint Commission was giving scores on the domestic side, we had three organizations score 100%.

Question: Providing consulting services for JCI accreditation is kind of a specialized sector, with just over a 110 accredited hospitals worldwide so far. With medical tourism being a hot subject in the media, and more and more international patients becoming quality conscious, seems like companies like yours are going to be kept pretty busy. But just for the record, does your company focus on, or plan to, on any other areas?
Brian Gooch: You are right, it is specialized. We work on the domestic side as well as internationally, though personally I find the international side much more interesting and satisfying. And yes, we do other work as well – educational programs, e.g., data analysis; infrastructure development, policy & procedures, bylaws development, etc.

Question: The Joint Commission also has a resources, or consultancy division, known as JCR. JCR, if I'm not mistaken, provides consultancy to healthcare providers which helps them prepare for accreditation. Which sounds suspiciously close to your own job description. Or is there a difference here that I'm missing?
Brian Gooch: You are right – they are suspiciously close! There are several important differences: one is price – we are almost half the cost of JCI. We do not have the huge overhead & licensing fees that JCI must pay to the parent company, JCAHO. Second, we are the only international consultancy that I am aware of that is comprised of former JC surveyors. When I worked at the Joint Commission, a surveyor could also consult for JCR & JCI (and I did). JCI will claim to use experienced surveyors as consultants, however right after Enron & WorldCom the Joint Commission established very strict policies that surveyors could not consult and consultants could not survey. So, their consultants are consultants only with limited or no survey experience. Third and most important is commitment. The Joint Commission is a large organization and like any large organization, for a number of people working there “it’s a job.” The folks at Gooch & Associates work together and do what we do because we really enjoy working together, helping people and helping their organizations improve the quality of the services they provide to their patients. For us, it’s a passion! THAT is a significant difference.

There are other differences, but those are the most important.

Question: Tell us more about your team. What kind of people do you have working for you, and with you? I see mention of a Dr. Saxena on your website. What exactly is Dr. Saxena's role and background?
Brian Gooch: I have already mentioned that the bulk of our folks are former JC trained surveyor/evaluators. There are some who are specialists, e.g., pharmacy, or physicians and nurses who are not surveyors who provide services outside of the survey preparation venue. Dr. Saxena is a physician who trained in India and came to the U.S. for graduate work. Because he understands the Asian culture, he is focused on developing business there and networking with other consultancy firms there.

Question: I understand the symbolic value of being accredited by the JCI, in terms of prestige and assuring patients of their safety and the healthcare standards. But actually speaking, from your experience, is there a big change in the way the hospitals are run, after they get accredited, or is the change more of a 'touchup'?
Brian Gooch: Very good question. I tell folks that even if they do not take the final step and go for accreditation, just by following the accreditation standards, they will be a better organization – better for their physicians, better for their staff and most importantly, better for their patients. Whether an organization accomplishes anything more than superficial change to achieve accreditation is up to them. The client that I mentioned earlier that had such problems with management turnover, recently surprised me be demonstrating the JCI standards and quality were “the way we do business.” They had moved this to the next level, beyond accreditation, and internalized the intent of the standards. I was like a proud father – very, very pleased.

Question: I ask this question a lot, because it seems to be important. How do you think medical tourism is affecting the healthcare infrastructure of countries like India and Thailand? They're spending more on ramping up the facilities, improving standards, etc. But does the change spread out, or is it limited to the few major hospitals who are able to attract international patients? And how is this affecting the U.S. healthcare system? You deal with both national and international healthcare providers. And we're in the middle of a period of massive changes. Where do you see this going to? What's it going to be like ultimately?
Brian Gooch: The future is always hard to predict, but I think what COULD happen is that something like medical tourism could help spur Indian’s infrastructure development (modernized airports, improved roads, etc.) to better compete with Thailand and Singapore, for example. What I have seen happen elsewhere is that patients will start to notice that there is a difference between two hospitals, e.g., one touting JCI accreditation and the other not, and will say or think something like ‘the first hospital did this accreditation thing, when they did not have to and the second hospital has not, maybe I should go to the first hospital.’ So then other hospitals will start seeking accreditation just to keep up with the ‘first movers.’

Question: Anything else you wish to add?
Brian Gooch: No, I think you have covered the most salient issues. Thank you for the opportunity to talk with you.

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That was Brian Gooch, of Gooch & Associates. I'd like to thank Mr. Gooch for taking the time to answer these questions and share his knowledge and experience about JCI accreditation planning and preparation. We hope he keeps intact his track record of 100% success. Stay tuned for more blockbuster interviews.