JCAHO – The Borg?
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.
Technorati tag: JCAHO
Aggravated DocSurg says:
December 22nd, 2005 at 4:05 pm
Actually, the incident you described above showed a failure of that institution, on numerous levels, that have nothing to do with JCAHO. Credentialling must always go through a credentials committee, made up of physicians who are interested in ensuring that any potential applicant has the capability of caring for patients in their institution. Approval of said credentials committee should then go through the medical exec. committee, as a further check. Finally, the head of the OR has the responsibility to ensure that a new surgeon on staff has received their credentials via the above process before allowing him/her to schedule cases.
The administrator in the instance you described above should not have been able to override those committees (at least that’s the way things work in every institution I have heard of).
Thanks for your comments — I think you might change your views when unannounced surveys start taking place!
Rita says:
December 22nd, 2005 at 5:21 pm
To Aggravated Doc -
Yes, it will be interesting to see whether the stress levels go up or down based on unannounced surveys. At least we won’t experience the same six-month pre-survey frenzy that is so common now. The day the team shows up however, will probably equal at least one month’s frenzy all rolled into 8 hours.
Whatever you think of the Joint Commission, you’ll no doubt get a chuckle out of the truthfulness of this Brigadoon reference from an April 2004 post by A Chance to Cut is a Chance to Cure:
Are the inspectors so dense that they think the hospital looks and runs like this all the time? What the surveys create is some sort of medical-based Brigadoon where the ideal hospital only appears every three years.
CardioNP says:
December 22nd, 2005 at 9:14 pm
I recently left a facility that volunteered for an unannounced survey last year. It was nearly a year of stress as everyone was thinking the survey was going to be “next month”. When the grapevine indicated that other local institutions were being surveyed, the mgt thought we were next. We weren’t.
So it was continual month after month of being told JCAHO is coming in the next couple weeks, and then they didn’t. IIRC, they ultimately came at the end of summer and I had the pleasure of not encountering any of the surveyors. So my guess is that unannounced surveys may not lower the stress level. Management will just make sure that you are minding your Ps and Qs more often and have more frequent JCAHO readiness memos, meetings, emails etc.
plb says:
December 23rd, 2005 at 2:02 pm
Been through JC surveys from healthcare admin perspective for many years. The ongoing readiness coupled with continuous improvement etc. vision makes sense from an operational standpoint to a certain point. However, the layering on of compliance standards, esp. the safety goals, are breaking the camel’s back. Like the drive for EMRs for healthcare, including small MD practicies and small community hospitals, the same expectations from JC for smaller hospitals is impractical and unrealistic. We can chase people (and facilities) from healthcare with this inordinate amount of standards that are approaching a checklist and audit for every step of care. There must be a better way. How can the same number of staff and a shrinking margin cope with all this?
Mary Baker, MS, CPMSM, CPCS, CPHQ says:
January 1st, 2006 at 4:51 pm
I have thought for a long time that unannounced surveys should be performed. I have been in the Medical Staff Services field for many years and have witnessed the facility trying to get ready (get things cleaned up) just before JCAHO comes in for the scheduled survey, only to go back to the bad habits (Temporary Privileges without verifying credentials is only one example).
It would serve us all (including medical staff, administrators, etc.) to remember who we are protecting….the patient, the public from the Michael Swango’s (and yes there are still some Michael Swango’s out there). It only takes one bad doctor for Medical Staff and Administration to question “How did this doctor get on staff and how do we get them out of our facility.”
Mary Baker, MS, CPCMS, CPCS, CPHQ
President
Medical Staff Plus Consulting, LLC