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Seeking
Approval By
Valerie
J. Nelson Getting a stamp of approval from the Joint Commission on Accreditation of Healthcare Organizations is time-consuming, nerve-wracking, and pricey. But every three years, most hospitals commit time, energy, and money to the survey process, hoping their efforts will be validated with an accreditation from the organization. Why? The easiest answer is that accreditation makes a hospital eligible for Medi-Cal and Medicare payments. It also lends credibility in the eyes of other insurers and health plans and consumers. And the underlying goal, says the JCAHO, is to ensure that the hospital provides quality care. But is accreditation worth it? To plan or not to plan? Few people would say the process is perfect. One criticism centers on the planned nature of the site visit that’s part of the accreditation process. For example, nurses in New York who were interviewed about JCAHO accreditation called it a "charade" because supplies suddenly became readily available during a site visit, said Glen Von Nostitz, research director for the Public Advocate for the City of New York. Earlier this year, the group published a blisteringly critical report of JCAHO accreditation of New York hospitals. And surprise visits can be different from planned ones. Last year, one hospital’s rating fell after complaints from the Service Employees International Union prompted the JCAHO to make two unannounced visits. Infractions that can be prevented during a planned visit—like overcrowding, chronic understaffing, and equipment shortages, which the hospital was cited for—were obvious enough to prompt the Joint Commission to take away its "accreditation with commendation." But focusing on the three-day site visit misses the point, says a spokesperson for the American Hospital Association (AHA). That’s because it ignores the self-examination it took to get there. "It would be a mistake to invest too much of your expectations in the survey process itself," said Tom Granatir, director of quality initiatives for the AHA. "It’s a private, voluntary accreditation program. They want the interchange to be as productive as possible, which means planned surveys." Too much cheerleading? But preparing for the on-site review has a downside, according to critics: The teamwork that goes into preparing gets in the way of honesty. "When a hospital has gone through all of this rah-rah preparation that’s handed out in seminars and meetings, it creates a whole football game attitude," Von Nostitz said. "It’s ‘We are going to win this game.’ Are you as a nurse going to stand there and say something critical? It doesn’t elicit honest information." It comes back to the significance of preparation in the assessment process, said Kurt Patton, executive director of the JCAHO hospital accreditation program. Calling the preparation for the survey "very valuable for a hospital" because of the self-examination it requires, Patton said the Joint Commission has procedures in place that enable workers to speak confidentially, if needed. Hospital staff are encouraged to report problems to their managers and help find solutions. If regular channels fail, they can request a public information interview without management or file a complaint via a telephone hotline. But on the other hand … Still, the Joint Commission does attempt to respond to criticism, and the process is improving. Mary Dee Hacker, MBA, RN, vice president of patient care services at Childrens Hospital Los Angeles, said in 1997 the surveyors from the Joint Commission were better than in the past, and the accreditation survey was the best the hospital has undergone. "The surveyors are more current in understanding health care than in years past," Hacker said. "They served more as educators." The No. 1 comment from hospital CEOs is that they like the "consultative nature" of the process, Patton said. "Surveyors have traveled to hospitals throughout the country and come back with ideas and approaches on ways to do things that the chief executives find particularly valuable." The goal of the JCAHO accreditation process is to improve, not police, Granatir said. Making the on-site element random would not improve it, he added, because the preparation to meet the hundreds of standards is such an integral part of the experience. "Do you want to catch people doing something bad, or do you want to find out what they are doing good?" Granatir said. "The accreditation process takes steps to make it better. It doesn’t begin with the survey. That’s just a blip." The evolution of value Eyebrows also can be raised over an accreditation process that can cost anywhere from $7,200 to $90,000—and has to be repeated every three years. "It’s a very expensive service," Hacker said. "It’s an inappropriate use of hospital dollars. It needs a major overhaul." Another example of the need for change is in standards meant for acute care hospitals that make no sense in the pediatric world, she said. While saying there is "real value" in having an outside agency checking hospital safety and quality, Hacker called the Joint Commission’s approach "really burdensome." The accreditation process is evolving. "Organizations that do accreditation like ours are beginning to look more at performance measurement activities," Patton said. For example, instead of only examining policies, the impact of policies on procedures and training activities would be assessed. The JCAHO is under pressure to be more responsive to the public, patients, and staff, Von Nostitz said. He points out the commission is in a "little bit of a balancing situation" because the hospital industry it is judging makes up 80 percent of its budget. Only 1 percent of hospitals fail to earn JCAHO accreditation. "They have customers, and they have to make them happy," Von Nostitz said. "At the same time, people like us apply pressure from the patient consumer perspective in order to counterbalance the hospital perspective." |
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