Aggravated DocSurg is living up to his name today – he’s really quite aggravated. The target of his wrath is the Joint Commission on Accreditation of Healthcare Organizations. He labels them The Death Star of American Medicine. Medpundit and Bard Parker have joined in the fray.
As a veteran of many encounters with JCAHO surveyors over the years, I feel I must take issue with some of the statements made by my aggrieved fellow-blogger.
Watching hospital administrators lose bowel and bladder control the minute a JCAHO inspection is brought up has always reminded me of Vader’s underlings wilting in his presence..What is most galling to me, however, is that hospitals must fork over a hefty sum for these frequent torture sessions, and the inspections are done not by practicing physicians or nurses, but by folks who long ago gave up the difficulties of actually caring for patients for the safety of a clipboard to hide behind.
We agree; the Joint Commission is powerful. Accreditation is voluntary, but pity the reputation and finances of the poor institution that fares badly on a survey. However, while many surveyors have retired from active practice, a number have not. For those who have, I doubt they’ve forgotten all ‘the difficulties of caring for patients.’
A hospital that wishes to bill federal programs may choose to be inspected by the government, in the form of CMS surveyors, instead of JCAHO. Can’t say I’ve had that pleasure, but some of my colleagues have reported that a JCAHO survey is far less painful. There’s also a potential new player on the horizon in the form of TÜV Healthcare Specialists.
My experience with JCAHO accreditation is based primarily on hospital compliance with Medical Staff and Leadership standards. Understanding and implementing those standards is a challenge; many of them are inconvenient and expensive. It is for that very reason that healthcare needs accrediting bodies. Hospital leaders aren’t overly fond of inconvenient and expensive standards. If no one was “looking over their shoulders” some standards would simply be ignored.
Case in point. Several years ago I did consulting for a number of different hospitals. The first day at one of them an administrator I met told me to work on temporary privileges for a surgeon who was at that very moment, in the OR. No records, no verification of credentials, no screening, but in the OR performing surgery nonetheless. Turns out this was not an isolated occurrence. When I vigorously argued about this practice, the administrator’s response was that it was his job to bring in money to help keep the hospital financially solvent, it was my job to worry about credentials.
Thanks to a team of Joint Commission surveyors, that practice came to an abrupt end, thank you very much.
Joint Commission accreditation is a far from perfect process. My biggest complaint over the years has been that survey focus is often surveyor dependent. Some surveyors have “pet” standards which they focus on to the exclusion of others. That seems to be less of a concern with the recent change to tracer methodology, where patients are “traced” through the facility.
So my Aggravated friend, there is another side to this story. Resistance may not be futile, but sometimes it’s just not healthy.
The JCAHO mantra can really be translated as “Resistance is futile. You will be assimilated!” As a result, I suppose JCAHO is really The Borg.
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