Needless anxiety over your next inspection - Health Services Inspections

Few events generate as much organizational angst as an inspection. Health Services Inspections (HSI) are no exception.

Anxiety is defined as an emotional reaction to a threat that doesn't exist in reality. Fear is a reaction to a true threat. Anxiety, while a common emotion, generally causes problems for individuals and organizations and rarely serves any productive purpose.

For most medical units, the reaction to an impending HSI is best defined as anxiety. A few have reason to fear an HSI for the likelihood of its revealing the truth about their inadequacies. This latter group is fortunately very small, and given the fact each already knows its problems, usually has far less anxiety than those in the majority. They know they are likely to be rated poorly, and have resigned themselves to it, often rationalizing their performance instead of accepting responsibility and taking control to fix the problems.

Since it is a small group, and their problems will eventually come to light during an HSI, the rest of this article will deal with the majority--those that having nothing to fear from an HSI, but that often lose sleep worrying that they do.

In 2001 we implemented the short-notice inspection schedule with JCAHO, the Joint Commission on Accreditation of Healthcare Organizations. This was supposed to have been the equivalent of a no-notice inspection, but for the sake of practicality, we give units approximately 30 days' notice, with the caveat that nothing done after notification will be given credit.

Feel free to take leave

We also ask that, in keeping with the no-notice spirit, that leaves and TDYs not be cancelled. Many units have accepted this paradigm and have had HSIs without some of their "key" personnel.

Others, however, have immediately cancelled all TDYs and leaves after notification and also have gone to extended work hours to "polish the books" for the HSI. This does not reflect well on an organization's leadership; the philosophy behind short-notice HSIs is to provide senior leaders with an accurate, real-time assessment of the status of their medical resources in their normal daily routine.

When we assess a unit that has devoted excessive time preparing for an HSI, what we're assessing is how well they prepare for an HSI. This often provides an accurate picture of the health of the unit; if it is able to gear up for an HSI, it is probably able to meet other challenges presented to it. Unfortunately, this mindset also causes a lot of wasted effort in preparation that doesn't serve the mission.

The wasted effort piece is what we were trying to avoid by going to short-notice scheduling. Medical units have enough to do without the Air Force Inspection Agency (AFIA) adding to their list of priorities.

You know not the hour

Many units think they have "oracles" who "know" when the HSI is coming. With this "knowledge," some units go into their preparatory mode, canceling leaves and TDYs and working extended hours, preparing for an HSI that may be a year or more away.

The cost to the Air Force Medical Service of this aberrant behavior, while not easily calculated at the local level, is considerable. Good people, who are already working hard to accomplish the mission, have additional taskings and disruptions in their training and personal lives for no good purpose because the inspection, for all they know, may be far into the unscheduled future.

In Basic Training in 1969, we were given a block of instruction on rumors, their ubiquity in a military environment, and the damage they can do to the mission and the Air Force. This was a revelation for me at the time, and apparently might be likewise for many in the Air Force now.

The Air Force Inspection Agency's Medical Operations Directorate conducts Health Services Inspections (HSIs) of all Air Force medical facilities, both active-duty and Air Force Reserve Command. AFIA is the action arm of the Secretary of the Air Force Inspector General (SAF/IG).

TIG Brief thanks Colonel Geeze, flight surgeon, psychiatrist and deputy director of AFIA's Medical Operations Directorate, for his contributions to this page over the past three years. He retires this summer after 33 years of service.

COPYRIGHT 2003 Air Force Inspector General
COPYRIGHT 2003 Gale Group