In the wake of a visit to Arkansas by representatives of the Joint Commission on Accreditation of Healthcare Organizations, an uneasy calm appears to prevail among hospitals dissatisfied with expenses of accreditation and the way surveys are conducted.
But though the JCAHO's appeal for patience with unfolding accreditation improvements made an impression, its lasting impact will depend on how long the hospitals have to wait for the accrediting body's promises to pan out, said James Teeter, executive vice president of the Arkansas Hospital Association.
"The message to Dr. O'Leary was, `We think you're sincere, but out here in reality-land we have not seen evidence that what you're saying (about improvement in survey procedure) is happening here.'*"
Of the 65 hospitals in the state accredited by the JCAHO, about 40 attended the June 17 town-hall-style meeting in Little Rock, which lasted about three hours.
Following a presentation on accrediting initiatives from JCAHO President Dennis O'Leary, M.D., and two other representatives, hospital executives "left feeling just a bit easier about it," Mr. Teeter said. "Whether that feeling will continue, we'll see."
JCAHO executives had no comment on the meeting at press time.
The session came just as a second Arkansas hospital, 89-bed Stuttgart (Ark.) Regional Medical Center, announced it would forgo JCAHO accreditation. The hospital's administrator was not available to confirm or expand on the decision, but Mr. Teeter confirmed it.
In April, St. Mary's Hospital of Rogers, Ark., said it would drop JCAHO accreditation after 40 years of being surveyed every three years.
"There's a hemorrhage," Mr. Teeter said. "There are four or five others that are on the brink."
Some were at the meeting and told Dr. O'Leary of their leanings during a period where "some very searing questions" were asked, Mr. Teeter said.
"(Dr.) O'Leary stood there and took 'em one after the other for two-and-a-half hours," Mr. Teeter said. "We were not a bashful group."
The most penetrating questions concerned what hospitals saw as high survey fees and mounting expenses involved in preparing for the surveys. Those expenses were prominently mentioned by St. Mary's as factors leading to its decision to drop out (May 2, p. 4).
Other concerns centered on the frequency of change in accrediting standards and a perceived inconsistency of performance and priorities among surveyors, Mr. Teeter said.
The gathering produced its most favorable news about the JCAHO not from its representatives but from a handful of recently surveyed hospitals that reported the experience "was the best they had in years," Mr. Teeter said. The reviews emphasized education and assistance rather than being punitive, he added.
The news was well-received, he said, but it didn't resolve complaints that the eventual accrediting decision can focus on serious problems that were never brought up during the on-site survey. "We'll see 90 days from now, when that report comes in, whether that is consistent with the exit interview," Mr. Teeter said.
The visit to Arkansas is the latest development in a yearlong series of exchanges between the JCAHO and the state's hospitals that at one point had the association considering a mass withdrawal of its members from the accreditation program (April 18, p. 12).
Dr. O'Leary also was to meet late last week with the Tennessee Hospital Association's section for small and rural hospitals over the same concerns about the cost and benefit of JCAHO accreditation.