At a recent hospital board meeting, a judgment was made that the current chief executive officer was "no longer relevant." Executive turnover has become commonplace as management dogma taught in years past has proved insufficient for today's demands.
"No longer relevant" applies to organizations, too. Unable to compete or remain financially viable, many hospitals are no longer with us. Whether eaten by competitors, merged or simply shuttered, they were unable to stand alone.
This law of corporate Darwinism now has come to call at the Joint Commission on Accreditation of Healthcare Organizations. Evidence is extensive of the JCAHO's poor adaptation to the new realities in the jungle. Some points to consider:
Questionable impact on quality. Does accreditation by the JCAHO-or any outside agency-guarantee or significantly affect quality? Public Citizen's Healthcare Research Group recently petitioned HCFA to review the authority of the JCAHO to judge hospitals qualified to participate in Medicare and Medicaid. The watchdog group disclosed that one-third of accredited hospitals failed to meet minimum standards during follow-up federal surveys. This parallels an earlier expose by the Wall Street Journal showing that numerous JCAHO-accredited hospitals failed state and federal inspections.
Longstanding and widespread hospital customer dissatisfaction. The Arkansas Hospital Association's consideration of mass withdrawal from the accreditation program last year-and the more recent decision by St. Mary-Rogers (Ark.) Memorial Hospital to do just that-illustrate the growing disaffection. St. Mary estimates savings of $170,000 a year by substituting annual Medicare surveys for the JCAHO process.
Pent-up consumer demand for quality information. The new Consumers Guide to Hospitals (Center for Study of Services) shows hospital-by-hospital death rates for major surgical procedure. Highlighted in publications by the American Association of Retired Persons, the book represents the voice of consumerism. The public wants to know relative quality and cost data by hospital and procedure. Consumers see as arrogant the efforts of health professionals who fight disclosure, debating the data's accuracy or the public's ability to understand it. The public is less interested in accreditation than in performance outcomes.
Erosion of political support. The decision earlier this year by the American Hospital Association to review its position on the role of private accrediting agencies in a reformed healthcare system suggests that the AHA isn't sold on the policy directions pursued by the JCAHO. Its action reveals a response to growing political pressure as well as open-mindedness on the question of what is best for hospitals.
Industry dinosaurs?An analogy for the JCAHO, and for other healthcare organizations, too, can be found in a recent Forbes article detailing how full-service airlines are becoming obsolete in the face of Southwest Airlines' service concept, which the industry is now rushing to copy ("A Sixties Industry in a Nineties Economy," May 9). The airline industry is described as technologically advanced, but a structural dinosaur. According to the article: "In short, the airline business is going through much the same trauma as older industries-such as steel, autos, even retailing-have: Fundamental changes in the business requiring entirely new ways of doing things. Unlike these other industries, the airlines have yet to face up to a total restructuring. But the moment of truth is now upon them."
It is important to realize there's nothing inherent in the JCAHO as an organization that gives it eternal life. If it cannot reinvent itself and find "entirely new ways of doing things," and if it cannot be relevant in the eyes of its customers, then the normal extinction of the organization is both a natural and desirable outcome. Other approaches can and will take its place. For those charged with examining the problem, the objective should not be how to preserve the JCAHO. Rather, it should be to determine the best approaches to improve healthcare quality at the most affordable price. That might mean no accreditation approach at all. A question from Re-engineering 101: If we were starting over today, would we design a JCAHO, or would we go in a totally different direction?
Should the JCAHO be allowed to pass away? When a loved one is facing death, caregivers often find themselves confronted by family members urging heroic measures. Unable to face the reality of death, their anxiety drives them to the conclusion that life must be preserved at all costs, regardless of how empty it may be. To some degree, that may be where we are with the JCAHO. Not sure of what life would be without it, we use artificial support, keeping it going no matter how poorly it functions or how little we believe in it.
It might be useful to take a longer management view of the issue. Organizations and industries have life cycles. They are born and, if they survive the traumas of each age, they go through infancy, childhood, adolescence and finally reach peak performance referred to as prime. At prime there is strength, energy, clarity of purpose and high-performance functioning. But remaining at prime is difficult to do, as the JCAHO illustrates. It is not unusual for organizations, as they begin to age, to become bureaucratic and rigid. The JCAHO is a classic case of an organization past its prime, showing the symptoms of advanced age, still trying to control by fiat, but unable to perform. Maybe it's time to let it go.
Looking in the mirror. Perhaps what we really mourn is that we see in our own organizations the same seeds of defeat. Perhaps the anger we voice at the JCAHO is really a reflection of our anxiety as we struggle to fix what's wrong in each community hospital and in the healthcare system overall. In our minds, we sense the JCAHO is living on borrowed time, and we sense our own operation's mortality, too.
This is not gloomy thinking. The troubles of the JCAHO can serve as a wakeup call to all in leadership. It is the prime directive of management to never defend the status quo but to renew and reform, re-engineer and resurrect. While the industry decides on the future of the JCAHO, the more important question is how to keep our healthcare organizations vital and effervescent. In the end, it comes down to the test of our own commitment to excellence and whether we are willing to pay the price of change. In the end, are we relevant?