A recent survey of hospitals undergoing accreditation shows that the process is starting to catch on as a means of improving quality rather than just meeting Medicare and payer requirements.
It also shows that the accreditation experience is getting more positive, but it's still not yielding solid value for a six-figure expense.
The December 1995 report is the second in a series of evaluations planned by the American Hospital Association. Surveys were sent to 660 hospitals that underwent the accreditation process between May 20 and Sept. 30, 1995, and 51% responded.
Compared with the first survey conducted earlier in the year (Sept. 25, 1995, p. 25), satisfaction with on-site survey teams from the Joint Commission on Accreditation of Healthcare Organizations has improved significantly, according to the analysis by National Research Corp., the Lincoln, Neb.-based firm conducting the evaluations.
Dissatisfaction with the surveys, including complaints that they were more punitive than consultative, helped push the AHA and other JCAHO sponsors toward creation of an "action plan" early in 1995 to improve JCAHO performance.
Ironically, hospitals now report that they're getting plenty of feedback on what they're doing well but not enough constructive criticism that helps them fix what's wrong.
That's in spite of the fact that 88% of the respondents received "Type I recommendations" for improving serious shortcomings, up from 79% in the first survey.
"The Joint Commission is performing most positively in terms of identifying specific areas of improvement and least positively in terms of accurately identifying problem areas.....and discerning the level of quality of the organization's provision of healthcare," the report said.
Though Medicare certification and requirements of third-party payers are still among the biggest reasons for undergoing accreditation, other factors gained strength between the first and second half of 1995, the study reported.
The hospitals placed more weight on monitoring and improving patient care. And the accreditation benefit showing the biggest jump in importance was consultation.
Those shifts mirror a dramatic change in the reasons why hospitals should seek accreditation.
In the first survey, released in August, 59% said they wanted their quality validated, while only 25% said they wanted to improve quality. The latest AHA survey documents a reversal: 51% now say they want to improve quality through accreditation, while 26% are looking for validation.
That puts the heat on the JCAHO to deliver expert advice, but its accreditation report got "below-average ratings" on nearly all attributes, especially in identifying "authentic opportunities for improvement."
The emphasis on quality improvement comes as hospitals strive to set themselves apart in the marketplace.
In fact, organizational image continues to rank most important among reasons for seeking accreditation, and the importance is getting stronger.
Also gaining in importance is the relationship between accreditation results and participation in healthcare alliances.
Overall, hospitals showed they were trying to get what they could out of the survey process but objected to the cost, which averaged $110,000-two-thirds of that on internal preparations.
"Hospitals are significantly more likely to agree that the survey was of value to their organization than to feel the fees charged were in line with the value received," the report said.