What is a JOC?

A JOC is a collaborative multi-disciplinary meeting to facilitate communication and teamwork among emergency medicine, hospital medicine, nursing, quality, case management, and other key stakeholders that interface with EM and HM services.

Its primary purpose is to optimize patient care by identifying opportunities for improvement, implementing patient care protocols, and facilitating rapid-cycle changes through an iterative approach.

Bringing this combined group of clinical leaders together helps develop solutions that fulfill each team member’s needs. Think of it as an “all for one, one for all” approach where everyone involved benefits.

Why Have a JOC?

At many hospital facilities, no formal forum exists for sharing ideas and formulating processes. A JOC provides a structured model for teamwork that fosters collaborative EM/HM communication and multi-disciplinary perspectives on challenges faced by clinicians and patients alike.

What Are the Benefits of a JOC?

At least three benefits accrue from the formation of a JOC: •

  1. Performance Improves. Facilities that set up a JOC and make a concerted effort to synergize their EM and HM programs typically see improvements in financial and patient experience performance within 90–120 days.
  2. Accountability Increases. The JOC opens communication lines, standardizes processes and procedures, and increases accountability. This results in improved metrics, such as EM LWOT, Door-to-Provider Time, and LOS for Admissions, as well as HM LOS and Sepsis compliance—not to mention improving VPB bonuses and reducing readmission penalties.
  3. Care Becomes Standardized. JOC meetings can help establish standardization of care while still providing more personalized care for patients—critical factors that contribute to high-value service delivery, cost reduction, and patient experience satisfaction.
How Often Should the JOC Meet?

Facilities that institute a new process to formalize a JOC and make a concerted effort to align their EM/HM programs typically see performance improvements within 90-120 days. Example improvements seen within the first year (from actual experience using established methods) include:

What Should Be On the JOC Agenda?

A JOC meeting should follow a standardized agenda. Otherwise, accountability can wane, and momentum can grind to a halt. We recommend including the following as part of every JOC agenda:

  1. Review the status of action items from the previous meeting. Every meeting should begin and end with progress updates. All action items should be assigned to an accountable party, with a deadline and an expectation to report on status at the next meeting.
  2. Review shared metrics and goals. Review status on a standard set of measurements your JOC identifies as integrated EM/HM metrics. Discuss trends and high and low points.
  3. Share successes and challenges. Talk about what’s working and what’s not. Discuss strategies to improve processes and shared metrics. If new issues arise, substantiate them with objective data.
  4. Define and assign action items for the next month’s meeting. Document follow-up steps and tie them to an accountable person, measure, and deadline.

Performance Impact of an Aligned EM/HM

Facilities that institute a new process to formalize a JOC and make a concerted effort to align their EM/HM programs typically see performance improvements within 90-120 days. Example improvements seen within the first year (from actual experience using established methods) include

Setting Standards to Bridge the Communications Chasm

Even the best laid plans will not execute unless the teams carrying them out buy into the message. That is why seeking feedback from team members, documenting processes, and educating all involved on the “why” behind the processes is vitally important. During joint EM/HM leadership meetings, we recommend establishing a shared set of EM/HM handoff standards.

To establish joint standards, stakeholders from the EM and HM service should work together to review the following questions and agree upon joint protocols. Though flexible in extenuating circumstances, a mutual code of conduct will defuse disagreements as they arise and set the tone for a culture focused on achieving the most efficient, cost-effective, and optimal solution for the patient.

Key Questions EM and HM Services Should Answer Together to Establish a Standard Practice

Defining the EM service’s commitment to the HM service:

  • What is the standard procedure for determining the correct level of care for a patient?
  • What conditions warrant patient transfers?
  • What reasonably excludes a patient from being transferred?
  • What conditions or situations warrant a consult request being initiated in the ED?
  • What workups will be completed in the ED before calling HM?
  • What specific conditions require a standard procedure before handoff to HM?

Defining the HM service’s commitment to the EM service:

  • What time frame is acceptable to return ED pages/calls/texts?
  • What time frame is acceptable to complete a consult?
  • What is standard procedure for a consult? (What should be done if there is a disagreement?)
  • What is a reasonable time span between page/call received and admit order time?
  • What should happen if there is disagreement about the disposition of a patient?
  • When is it reasonable for the hospitalist to see a new admission in the ED? • Who is responsible for the care of admitted patients being held in the ED (if facility is at capacity)?

JOC Success Story: Real-life Example

Diverse group of medical professionals reviewing information.
Identifying the Problems & Crafting Plan
JOC Strategy
Performance Results
Key Success Factors