The era of healthcare reform is about change-change that is enveloping all of the participants in this nation's healthcare system.
The two-part series and editorial on the Joint Commission on Accreditation of Healthcare Organizations and its new Indicator Measurement System (IMSystem) that appeared in this magazine last month is a portrait of the challenges facing one of the more prominent players in this environment.
Setting aside certain misinterpretations in the articles, we believe they underline the obvious continuing need for the JCAHO to serve as a credible, competent and forceful leader in promoting quality healthcare for the public.
With the national debate on healthcare reform focused so squarely on cost and access, quality issues seem to have received short shrift. Because of this, we have stepped forward as a champion for a sound quality program that is drawn from the expertise and commitment of the private sector. We have assumed this role not as a matter of right, but rather as a matter of conscience and obligation.
This country is on the verge of a radical restructuring of its healthcare delivery system. That's the prerogative of a venturesome society. But if Congress enacts such sweeping changes, these must include quality oversight mechanisms that truly protect the interests of patients and the public during and after this transition. That's what the JCAHO is calling for.
In Washington, talk is anything but cheap, but even expensive talk can be meaningless unless the speaker has credibility. In the case of the JCAHO, that credibility is based on the Agenda for Change, the new healthcare network accreditation program, and the careful initial preparations to make specific performance information about healthcare organizations available to the public later this year.
Although we are sometimes chastised for the time and expense necessary to transform the JCAHO and its accreditation process, launching the initial work products of the Agenda for Change, including the IMSystem, in the year of healthcare reform approaches exquisite timing, in our view.
The credibility at stake isn't ours alone. What we are talking about, literally, are the interests of hundreds of health professionals and healthcare organizations in creating meaningful, efficient quality evaluation systems that permit them to meet their public accountabilities.
That's why the involvement in and support for the Agenda for Change have been so broad and strong. Even though the new accreditation process will pose new challenges for healthcare organizations, it's been designed to be rational, fair and meaningful.
No cutting-edge activity is without its travails, and the three Agenda for Change initiatives (new standards, a new survey process and the IMSystem) have been no exception. In particular, the research and development process used to identify sound indicators for the IMSystem was known to have the potential for frustration. The fact that there are detractors of the indicators that underwent testing is hardly unexpected.
However, we were surprised that MODERN HEALTHCARE, in focusing solely on the negative aspects of the research and development process, chose to ignore the variety of positive experiences many hospitals have had with the indicators.
The fact is, a large number of participants found the testing process to be constructive and extremely open. The JCAHO listened to the suggestions, requests and recommendations from participating hospitals and integrated many of these ideas into the planning for the IMSystem.
Now, the IMSystem is beginning. Built on the successes and lessons learned during the testing of specific indicators, the IMSystem now will be evaluated and refined in preparation for its eventual integration into the accreditation process. That will occur when its worth and value can be demonstrated.
All early signs are positive. Even with initial indicators (obstetrics and anesthesia-related perioperative care) that deal with healthy patients or infrequent events, we have been pleasantly surprised by how often opportunities for improved care are being identified. The next indicator sets to enter the IMSystem in 1995-those for trauma, cancer and cardiovascular care-are expected to enrich significantly the utility of the IMSystem to participating hospitals.
Conceptually, the IMSystem is unlike any other data base. It is the only quality-related, non-commercial data base that's national in scope. The modest number of data elements required have been carefully selected to maximize overlap with those already being collected by hospitals while still providing important performance information. The IMSystem approach remains keenly sensitive to the need to assure that collecting performance data doesn't create undue burdens for healthcare organizations.
Notwithstanding the special characteristics of the IMSystem, it is being created as part of the JCAHO's overall accreditation process. As such, it's not in competition with any other data base. In fact, our intent has been to identify common elements among other data-gathering activities and to forge agreement on future performance measures.
Where the desired public objective is good provider performance that continues to improve over time, provider organizations need to have a clear fix on what's expected of them. Competition among accrediting bodies and data base purveyors is more likely to undermine this need than to satisfy it. And if we are ever to have useful, understandable national "report cards," agreement must be reached on one set of standards and one set of performance measures for each type of provider entity.
If a rational quality measurement framework emerges from the reform debate in Washington, the next great challenge will be the coordination of major healthcare accrediting bodies and other would-be measurers. The JCAHO has extended the hand of collaboration to most of the major accrediting bodies, and we're encouraged by the receptive responses.
This initiative to improve coordination and reduce duplication is uncharted territory. But it's ultimately a win-win-win scenario-for provider organizations, for patients and purchasers, and for all the measurers, big and small.