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Well Sourced: Think of the Joint Commission as a friendly beat cop

Well Sourced: Think of the Joint Commission as a friendly beat cop

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It’s hard to imagine, but there was a time about a decade ago when one of the few sources for detailed information on hospitals making mistakes was a self-policing organization that had a reputation for doing little and saying even less. As I have described in multiple posts in this series, there are now many more options for finding facts about health care organizations, and the Joint Commission has responded to this competition by becoming a more forceful public voice for health care improvements.

SOURCE: Joint Commission on Accreditation of Healthcare Organizations

WHAT IT DOES: The commission is a nonprofit, peer-review organization that is the main accrediting body for hospitals. Teams from the Joint Commission inspect hospitals to see if they are meeting a set of criteria deemed by the commission and Medicare as important factors for good patient care. If a hospital can secure accreditation from the Joint Commission, it becomes eligible for Medicare funding.

WHAT IT DOES NOT DO: The Joint Commission tends to focus on processes, not specific patient outcomes. For example, it will look at records for a subset of patients on a measure such as “Patients not in intensive care units who have community-acquired pneumonia who received the appropriate medicine (antibiotic) that has been shown to be effective for community-acquired pneumonia.” But it won’t examine all the patient intake and discharge data to find out whether the hospital has an inordinately high rate of patients dying from pneumonia.

RECORDS: When you are starting to write about a hospital for the first time — and on a regular basis after that — you should download and read your hospital’s Joint Commission report. You can search for it on the Quality Check page of the Joint Commission’s website. This will tell you whether a hospital succeeded, failed, or performed in the average range during its last inspection. Hospitals generally win accreditation and generally receive the Joint Commission’s “National Quality Approval” rating, but you can see how they performed against state and national averages.

You also can see whether there are areas where they didn’t hit the marks and areas where they performed particularly well. If a hospital really flubs it, it can lose its accreditation. This is an event so rare that you should not let your local hospital administrator downplay it. And if your hospital did not perform well on a particular area, you should ask what happened and how the hospital is addressing the problem.

DRAWBACKS: The Joint Commission keeps its detailed inspection reports secret. You can try to fight to get access, but there are laws on the books in many states that carve out exemptions for the Joint Commission. The commission does not like to punish hospitals and so usually works with them to improve performance. If you’re looking for a lot of details on your hospital’s problems, you’re not going those details here.

SUGGESTION: Use JCAHO as a first step to understand the basic outlines of how your hospital is performing. It can be especially useful if your hospital is bragging about something when it turns out they are merely average or even underperforming by Joint Commission standards.

Photo by Irekia via Flickr.


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I hope you realize that hospitals are notified about the approximate timing of Joint Commisiion site visits years in advance. This gives hospitals ample time to cover up any deficiencies, buff their paperwork, paint over cracks, and rehearse their staffs before the visit. The day after the JC inspectors leave, it's back to business as usual. The whole process is theater. If it is so worthwhile, why are so many errors still occurring in hospitals? We in the profession know of hospitals we would never allow a family member to set foot in. Yet as you mentioned, hospitals rarely fail a JC site visit. Until things change and real inspections take place (I don't expect the JC to lead the way), no progress will occur. Meanwhile, the JC makes money on the inspections and selling manuals on how to prepare for them, and everyone is happy.

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You are absolutely correct, Skeptical. Not only do hospitals know the approximate timing of Joint Commission visits years in advance, they are notified of the exact inspection dates weeks - or more - in advance of the visit. During those weeks, patient care is delivered, but absolutely nothing else gets done as the hospital prepares. Standards and protocols are written, re-written, or buffed up. Every wall posting (like a "cheat sheet" that a nurse might use for quick reference to determine the IV rate for a mg/Kg/min medication) - Gone! Running around a busy ER? Don't be surprised if someone in a suit carrying a clipboard starts following you around. Oh, and if you want to educate yourself on exactly what the Commission has determined to be a patient care standard - you have to purchase their very costly standards manual. If they were as concerned about patient safety as they profess, you would think that they would want to disseminate information as to how to improve patient safety. I will never really understand how a private corporation - one with no legal mandate - became so powerful.


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