Wouldn't you have loved to be a fly on the wall last week as leaders of major healthcare organizations met in Chicago to begin thrashing out the future mission and role of the Joint Commission on Accreditation of Healthcare Organizations? By all accounts, last week's summit meeting didn't result in much concrete action. What it did offer was a welcome opportunity for a high-level face-to-face parley allowing industry representatives to vent frustrations that have been building for months over their inability to get the JCAHO to take their grievances seriously.
Their complaints have been numerous and diverse, but they fall into three major areas of concern:
Should control of the JCAHO rest with its officers or the board representing the major healthcare organizations that fund it?
Is the JCAHO trying to wear too many hats?
Is there a better way to guarantee high-quality performance by healthcare organizations than a captious, often inconsistent accreditation system that requires administrators to jump through bureaucratic hoops?
After insisting for months that its policies and procedures were serving the best interests of the healthcare community, JCAHO leaders last week unveiled an experimental plan to establish a regional service office to work with hospitals in an ongoing coaching process rather than appearing once every three years when it's accreditation time. The JCAHO leadership deserves credit for taking a positive first step to improve the accreditation process. But we fear it may be too little too late.
The debate over the JCAHO is about more than making the cost of survey compliance more reasonable, eliminating discrepancies between what surveyors say at exit interviews and what appears on final survey reports, or simplifying its accreditation manual. These are all worthy goals, but in today's fast-changing environment they equate to little more than rearranging the deck chairs on the Titanic.
The JCAHO needs to adopt a fresh approach that focuses on improving the performance of those roles it is uniquely qualified to provide instead of trying to be a boutique of accreditation and quality-measurement services.
For starters, the agency should separate its consultation/education services from its regulatory activities and spin off each into an individual organization. Even though such a move might entail added costs, it would decrease the likelihood that provider organizations feel pushed to use educational services.
If its goal is to be more responsive to public concerns about quality, the JCAHO should expand the number of consumer and nonprovider representatives on its governing board. This will require it to discard or reduce its reliance on provider funding and to compete in the marketplace with other organizations developing comparative databases.
The organization should abandon its misguided plan to require accredited hospitals to participate in its indicator measurement system. The program has not demonstrated that it's a useful source of information for improving quality outcomes. Instead, the JCAHO could fuel a push to more innovation in healthcare quality initiatives by encouraging hospitals or systems to develop their own quality processes, then providing a stamp of approval recognizable to consumers, providers and payers alike.
