The Joint Commission on Accreditation of Healthcare Organizations last week launched a reorganization centering on a more streamlined approach to the survey process, which will eliminate 45 positions mainly in middle management.
Thirty of those positions will be trimmed from the division of accreditation operations, where "service teams" will handle the survey routine from application to final score, replacing a department-by-department handling that diffused responsibility and accountability, said Charles Bair, the division's executive vice president.
The $3.5 million saved by cutting the 45 positions, half of them currently filled, will be shifted into establishing and maintaining closer contact with hospitals and other accredited organizations, Bair said.
Within the accreditation division, teams of survey schedulers, standards interpreters, surveyors and survey-report analysts will be matched up in an all-inclusive group instead of being separated according to their singular role in advancing the survey process, he said.
Bair said he found that the previous departmental organization spawned interruptions and impeded communications at the handoff between job responsibilities. For example, after surveyors did their work and filed their report, the system called for the final decision to be made by an accreditation analyst, where it was "possible for an analyst and surveyor to see the issue differently," Bair said.
An accredited organization sometimes didn't know where to turn for answers or to air disagreements because no one at the JCAHO was accountable for the entire relationship, he said.
Applications were handled by one department; then another would handle scheduling and pre-survey preparations. A surveyor wouldn't necessarily be aware of what give-and-take went on with JCAHO contacts beforehand.
The department setup also contributed to higher overhead by maintaining separate support staffs to handle mail, forms processing and other duties necessary for each department's operation. A single "utilities team" will now handle those duties companywide, Bair said.
In short, the JCAHO is implementing much the same reorientation around functions, instead of insular departments, that it has been requiring of accredited organizations for the past few years as part of its Agenda for Change.
The integrated service teams will be organized into three broad groupings. One will support hospitals, another will deal with home healthcare, and the third will encompass the remaining accreditation programs in mental healthcare, long-term care, ambulatory care, healthcare networks and clinical laboratories.
Outreach teams will be set up for the individual accreditation programs, each headed by the current program director. The teams will act as liaisons between accredited organizations and the service teams.
It's the second reorganization for the JCAHO since the leaders of its sponsoring provider organizations imposed an "action plan" in January listing improvements to be made in response to industry dissatisfaction over the commission's day-to-day performance.
In February the JCAHO reorganized its senior management to split responsibility for operations among three executive vice presidents instead of one chief operating officer (Feb. 13, p. 4).