If there were accreditation standards for maintaining the status quo and covering your backside, the Joint Commission on Accreditation of Healthcare Organizations and its president, Dennis O'Leary, M.D., would exceed them with commendation. After 15 years of doing very little to make hospitals and other healthcare facilities safer for patients, the time has come for O'Leary to step down.
The JCAHO must put someone in charge who would place patient care ahead of his or her job preservation and the protection of the self-interests of the Joint Commission's sponsoring organizations, including the American Hospital Association and the American Medical Association.
Since 1986, O'Leary skillfully has kept the nation's largest voluntary healthcare accrediting agency one step ahead of HHS and consumer organizations but not so far ahead as to draw the ire of hospitals and physicians. He has turned a cottage operation with a little more than $28 million in annual revenue and a few floors in the John Hancock building in downtown Chicago to a massive organization with $111 million in annual revenue and a sprawling corporate office complex in the upscale Chicago suburb of Oakbrook Terrace, Ill.
The only people who seem to have really figured out what the JCAHO is doing are the commissioners of DuPage County, Ill., and the local school district board, who successfully challenged the Joint Commission's property-tax exemption for its headquarters building. The DuPage County Circuit Court ruled that the organization operated more like a for-profit business than a tax-exempt public charity.
O'Leary and the Joint Commission have tried but repeatedly failed at initiatives designed to judge hospitals and other healthcare providers based on their performance-how well they take care of sick people. The projects always are announced with much fanfare and heady names such as "Agenda for Change," "IMSystem," "Orion Project" and "Oryx." And they're invariably scrapped, watered down or delayed.
That's the apparent strategy: Hide behind some mind-bending jargon, act like you're doing something but really do nothing. That way, the Joint Commission keeps its "deemed status" relationship with Medicare, which means any accredited hospital automatically qualifies for the program, and avoids alienating hospitals and other providers that pay its hefty accreditation survey fees. Keep executive salaries growing, and hire and fire at will dozens of well-meaning staff members depending on which way the healthcare quality-improvement winds blow.
Consequently, O'Leary has turned the Joint Commission into little more than an ambulance chaser. Modern Healthcare was the first to disclose the organization's public relations strategy of showing up at a hospital after a horrible patient tragedy. Surveyors conduct a detailed inspection of the hospital after the so-called "sentinel event," demanding a "root-cause analysis" to find out what went wrong. And when the local newspapers and TV stations go away, the hospital often maintains its previous accreditation status.
Last year, after 49 years in operation, the Joint Commission issued its first-ever patient-safety and medical-error reduction standards. They came 19 months after the Institute of Medicine issued its eye-popping report on patient deaths caused by medical errors. Earlier this year, the JCAHO said it was going to overhaul its hospital accreditation standards. That announcement came three months after a second IOM report called for an overhaul of the healthcare delivery system to improve patient care. Hmmm. There may be a pattern here.
So, what does the Joint Commission really do? Not much, if improving patient care is the yardstick. Having a hospital pretty itself up every three years for the surveyor visit is like the college kid who cleans his dorm room only before his parents visit: His room is cleaner, but he doesn't become a better student.
Now it's time to clean house at the JCAHO. Patients deserve better. HHS should demand better. And hospitals, physicians and other healthcare providers should know better.
