Joint Commission Voted 'Least Popular' for Fifty-Fifth Year

Until I joined the medical blogosphere I had no idea how strongly many clinicians feel about the Joint Commission on Accreditation of Healthcare Organizations. 

I've seen them referred to as the Borg, the Deathstar of American medicine, and most recently as Nazi storm troopers.

If you don't work in a JCAHO-accredited setting and wonder what all the fuss is about, the concept of hospital inspections that led to the Joint Commission was started in 1918 by The American College of Surgeons.  In 1951 The American College of Physicians (ACP), the American Hospital Association (AHA), the American Medical Association (AMA), and the Canadian Medical Association (CMA) joined with the ACS to create the Joint Commission. (Canada has since dropped out to start it's own organization.)

Over the years I've been involved in a number of surveys, some with excellent findings, some not so great.  From my experience I can attest that:

1.  The process is far from perfect
2.  Some surveyors are (much) better than others
3.  Knowing that a JCAHO survey is imminent is a huge stress for both clinical and non clinical staff.  Now that surveys are unannounced the stress is different, but certainly not less.
4.  Surveyor bias can affect your "score."  (Note that actual number scores are no longer given.)
5.  American hospital care is better because of the work of the Joint Commission.

Truly, for all the angst and expense a survey generates, US hospital care is better than it would be without a "big brother" looking over our shoulders.

Example:
I have served as a consultant for a number of hospitals. (Translation - for reasons soon to be obvious, I'm not revealing where this occurred.)

During a JCAHO survey I noted that posted on a bulletin board (directly outside of the conference room the surveyors were using no less) was a newspaper advertisement encouraging people to come to this particular facility for a wonderful new high-tech procedure that Dr. X was now performing. 

Being the suspicious sort (a job requirement) I immediately went to the Medical Staff Office and checked Dr. X's credentials file. Sure enough, no documentation about wonderful new high-tech procedure at all.  No training, no request for the privilege, no review by peers, no grant by the board.  My best guess is that he went to some sort of weekend training program, called up the PR department and requested an ad, and was ready to begin trying out his newly acquired skills in the hospital's OR.

Scary, very scary.

I ran (okay I walked pretty fast) through the hospital ripping that ad off every wall on which it had been proudly tacked up.  I went to Administration with my collection, advising them it would be a wise idea not to mention wonderful new procedure while surveyors were lurking about.  I also informed the physician that he had to immediately stop scheduling this procedure until the proper steps for requesting and granting privileges had been taken.

Healthcare is complex; most hospitals employ a thousand or more people and collaborate with hundreds of physicians in dozens of specialties.  It's a real challenge to keep everyone safely moving together.

So Dr. Schwab (no relation as far as I know) as a surgeon, you want to know that the implantable device you're tucking into a patient is of the finest quality.  In order for that assurance to be given, the manufacturer must have a good quality control inspection program in place.  As a potential patient in a big, not-so-user-friendly hospital, I want that same assurance.

That having been said, I love your memo from the Surgical Utilization Committee (SUC).  I've also taken minutes at a few medical staff meetings over the years and have used that all-encompassing "discussion ensued" phrase myself.  If silverware was thrown I made it "lively discussion ensued."

    

Comments

[LeAnne]

Ha! Lively discussion ensued, I'll have to remember that one!

LeAnne

[Kim]

I can certainly understand the credential surveys, MDs AND RNs.

But locking doors? No hydrogen peroxide in the rooms? No betadine in the rooms? Making a complete list of all the patient's medications, dosages, times taken and last dose taken so that all the MD has to do is check a box?

On every patient that comes through the ER whether they have meds or not, allergies or not, we have to fill out a separate form.

JACHO seems to have nothing better to do than to find minutae in the clinical setting and make new rules and PAPERWORK that make nurses' lives on the floors and in the ER hell on earth.

On the other hand, one of the best things they did was institute the "pain scale" and focus on the relief of pain as a major issue (the Fifth Vital Sign). That was productive and improved patient care immensely. That worked seamlessly into our nursing practice as a pertinent, patient-related goal.

So while JACHO serves a purpose, I think they sometimes have no clue what their "recommendations" actually do to day-to-day nursing functions.

[Rita Schwab]

Kim,
I agree that JCAHO sometimes creates rules and standards that increase the work of doctors, nurses, and administrative staff, without an equivalent benefit. One of these days healthcare is simply going to collapse under the weight of its own paper!

[Don]

Has anyone done cost/benefit analyses of the JCAHO survey process, as well as adapting an institution to JCAHO standards, etc.? While it makes sense to say that one life saved is value enough, the realities of medical care today is that we do not immediately perform MRI's on anyone who has complaints of a headache (not yet one of their safety goals, thank heavens) and that with health care costs already skyrocketing, the truth would seem to be that a bureaucracy like JCAHO should not be given free rein over what is and is not allowed in the direct patient care setting. It seems clear to me that JCAHO has as its primary purpose to continue to exist, to keep coming out with new goals, and to consider the day to day practicality and costs of their recommendations as secondary.

[Concerned]

JCI is about as transparent as pea soup when it comes to how much they charge, especially for hospitals outside of the USA. They will be contributing to higher health costs outside of the USA as well as within, and they could also be seen as "asset stripping" poorer countries. Surely the competition needs to be encouraged, both within the USA and outside, and some openness about what is charged is surely justifiable on moral gounds. Please check out the "JCI - how much do they cost?" blog spot. Thanks.