The Next Joint? Regulator or Consultant

My first experience with the Joint Commission was as an administrative resident. I was responsible for organizing all the materials for the reviewers. I remember how proud I was the survey went well and we received our accreditation. Everyone seemed relieved that we wouldn’t see the Joint Commission for another 3 years. Several years later I remember my friend’s hospital did not receive one Type I recommendation; in other words a perfect score. Were they indeed perfect? Finally I decided to voice my criticism. My organization had again been surveyed and again we received accreditation. What bothered me most were my discussions with the Joint Commission at the outset of the process. Did we have any issues of concern that were quality related? We responded yes and proceeded to ask their help and to even cite us. I am sure many of us have used the line with our staff that we must do it because the Joint Commission says we have too. My last experience that I dare talk about was a few years back in another hospital, we had 17 Type I recommendations. I told our team Pass /Fail was good enough and we passed. Of the 17, several were significant, but most were trivial and corrected within several minutes.

Most of my colleagues in the field, if asked, probably would not invite Joint Commission as a consult, nor pay for their services.Sounds like I am going to recommend we only use them because we have too, but that is not the case.

A recent article in Modern Healthcare discussing Mr. O’Leary’s retirement and all the recent problems attracting national attention in Joint Commission Accredited hospitals certainly raised a lot of eyebrows. It is certainly not the Joint Commission’s fault. Could some of the stories been avoided, possibly and if only one then there is value. Of the 4 recommendations I remember how a critical crash bar didn’t work on an emergency exit. We, as hospitals and physicians, do need to keep raising the bar and change the way we practice. I believe more than ever we need both a stick and a carrot or in this case both a regulator and a consultant. If history serves me right it was the College of Surgeons and others that originally founded the Joint Commission. Several years back when continuous quality improvement became popular the Joint Commission backed off on pushing process (CQI) because of many voices from the field or at least that is the way it appeared. We hospitals and physicians need a partner and advocate who understands healthcare. Having selected Dr. Mark Chassin it seems the Joint Commission believes the same thing. Consumers need better information and knowledge and until we figure out ways to increase our transparency those of us within the field need to push even harder regarding safety and quality.

The following is from Modern Healthcare, cover story, by Andis Robeznieks; Dr. Chassin said he hopes to accelerate change by wider and more aggressive dissemination of proven methodologies for quality improvement. “To help accelerate improvement, you can’t have each individual hospital and health system invent it’s own improvement programs one after another”. Even if successful, there’d be a lot of wasted and duplicated effort.

A good read is Wall of Silence by Rosemary Gibson and Janardan Prasas Singh. Telling the stories is not enough. Let’s partner with Dr. Chassin and his colleagues to keep the things about the accreditation process that make sense and really help, drop the things that don’t and accelerate the sharing process.

-Stan