A group of powerful Roman Catholic hospital systems is about to put the squeeze on the Joint Commission on Accreditation of Healthcare Organizations to mend its ways, MODERN HEALTHCARE has learned.
"With the large number of hospitals our organizations represent, we might be able to leverage the Joint Commission into making fundamental changes in the way it does business," said Wayne Wasden, vice president of quality management at Alexian Brothers Health System in Elk Grove Village, Ill. "You're not able to initiate change as an individual. They don't listen."
The Catholic systems join a growing list of hospitals and hospital organizations that are making known their concerns about accreditation.
Commission executives previously have said that they welcome open debate about accreditation and are willing to listen to all providers' concerns.
The American Hospital Association and its nine regional policy boards are debating the future role of accreditation in a reformed national healthcare system (April 18, p. 3). The Healthcare Association of New York State is surveying its members on their accreditation and licensure needs (April 25, p. 22). And an Arkansas hospital that had been accredited for 40 years voluntarily dropped its accreditation because it felt it wasn't worth it (May 2, p. 4).
Those and other hospitals and hospital organizations are questioning the cost and usefulness of the JCAHO's clinical indicator program, the soundness of the JCAHO's public disclosure policies and the quality of the Oakbrook Terrace, Ill.-based agency's accreditation services (March 14, p. 30).
The Catholic systems voicing their concerns are part of an informal group called the Catholic Multihospital System Quality Forum. The forum, which has been in existence for about four years, has 25 active system members representing several hundred Catholic hospitals, said Jan Attridge, vice president of quality services at Sisters of St. Francis Health Services in Mishawaka, Ind. Ms. Attridge chairs the forum.
The group meets twice a year to share information about quality improvement strategies and to develop ways to exchange comparable quality-related data across hospital systems.
Last year, the forum established a JCAHO subcommittee to coalesce the systems' growing concerns about the current accreditation process and the future direction of JCAHO policies.
In February, the subcommittee drafted a two-page proposal or list of demands that it wants to take to the JCAHO. The full forum will meet in September to discuss the proposal and develop a plan for further action.
Subcommittee members contacted by MODERN HEALTHCARE declined to release the proposal because it hasn't been approved by the full forum, but the concerns raised in the plan run the gamut of accreditation issues, said Claudia Markavich, the quality-management program manager at Mercy Health Services in Farmington Hills, Mich.
High on the list is the JCAHO's clinical indicator system, which the JCAHO will require all accredited hospitals to use by 1997. In addition to such logistical issues as data collection and duplication, the usefulness of the indicators in improving care hasn't been proven, Ms. Markavich said.
"We have grave reservations about the cost and utility of the indicators," echoed Ms. Attridge. "We've not found them to be a source of making improvements in patient care."
Several of the nine hospitals operated by Sisters of St. Francis Health Services have served as test sites for some of the JCAHO's indicators for as long as three years.
Diane Denny, director of quality services at Eastern Mercy Health System in Radnor, Pa., another forum member, said several of the system's 14 hospitals also served as test sites, but none have opted to participate in the voluntarily phase of the indicator project that began this year.
Mr. Wasden said he pulled Alexian Brothers' flagship hospital, 381-bed Alexian Brothers Medical Center in Elk Grove Village, out of the indicator testing project in November 1992 because the hospital found no particular benefit in the JCAHO indicator data.
"What we were taking out of the project was nowhere near what we were putting into it," he said.
The Catholic systems also have concerns about the accreditation survey process itself, particularly how the JCAHO's new network accreditation program will affect hospital systems, Ms. Attridge said.
Mr. Wasden also cited the quality of the JCAHO's basic accreditation services as a top concern for the group, specifically the variability in standards, standards interpretation and field surveyors themselves.
But despite its criticisms, the subcommittee stopped short of urging Catholic hospital systems to voluntarily drop the JCAHO, although the possibility was discussed, Mr. Wasden said. He said the group decided that there were too many negatives in dropping accreditation, including the loss of automatic qualification for the Medicare program.
"(Dropping the JCAHO) is always a possibility. But that's not the goal. We want to improve the process for both sides," Ms. Attridge said.
Instead, the subcommittee recommended establishing a formal ongoing communication mechanism with the JCAHO to ensure that the systems' concerns are followed up by JCAHO executives.
"We want a way to learn more about JCAHO initiatives and to provide the JCAHO with input from its ultimate customer, the hospitals," said Jan Commens, director of quality and utilization management at the St. Louis-based Daughters of Charity National Health System.
"I think that we'll get an audience (with the JCAHO) because of the number of people and systems involved," Ms. Markavich said. "But, I can't predict the results."