Sometimes, you almost feel sorry for the Joint Commission on Accreditation of Healthcare Organizations.
On the one hand, the Joint Commission must deal with consumer advocates, who complain-with justification-that it does nothing meaningful to protect patients. The commission, they argue, is a creature of the hospital and medical establishment. Its primary purpose is to create a Potemkin village of quality improvement-the appearance of doing something while never seriously threatening to change the way things are.
On the other hand, you have hospitals and physicians, who denounce any inconvenience caused by accreditation. To hear these critics tell it, the commission is an ogre, arbitrarily wielding power and placing the community welfare and the livelihood of hospitals and doctors at risk.
A recent suggestion by American Hospital Association President Richard Davidson offers a good example of the latter category of complaints. In an interview in which he was joined by Joint Commission President Dennis O'Leary, M.D., (June 3, p. 6; June 10, p. 17) Davidson told Modern Healthcare that he asked the commission to experiment with teams of volunteer noncommission surveyors drawn from hospitals.
"It would just be part of the whole notion of saying that accreditation ought to be a peer process," Davidson said. "Instead of fully paid, full-time employees of the Joint Commission, we get people to volunteer their time-and be coordinated by a Joint Commission employee, any way they might choose to do that."
Davidson said this would help make the "atmosphere and environment" of accreditation more collegial.
With all due deference to Mr. Davidson, this idea rivals Enron's decision to hire Arthur Andersen as its auditor.
First of all, such an arrangement would likely become what the CIA folks call a "blowback," or an operation that turns against its creators. As some industry officials have pointed out, teams of undertrained volunteer surveyors running around hospitals haphazardly enforcing standards would spawn a nightmare for hospitals. If executives think the current system is a pain, wait until they have to cope with an army of amateurs.
Secondly, such an arrangement would only increase the perception that the Joint Commission is a puppet of the institutions it is supposed to police. Critics will charge that the surveyors are industry chums who will wink and sign a positive report while patients are dying in the lobby.
Thirdly, all institutions entrusted with people's lives, including hospitals, need some rigorous supervision by an outside agency. If the tame Joint Commission surveyors cannot make hospitals safe, it is unlikely that Mister Rogers-like peers will succeed.
The Joint Commission has earned a reputation for enforcing dubious standards and diddling with process issues while the industry gets hammered by quality-improvement advocates. Davidson's proposal may make some resentful hospital executives feel better, but it won't solve any problems.
So one is tempted to have a little sympathy for O'Leary and the Joint Commission-until they try to go into quality-improvement organizations contracting to gain revenue and continue building an empire without consulting key people. As we say, you almost feel sorry for them.
A Cleary remembrance
We note with sadness the passing of David J. Cleary Jr., a longtime executive of Crain Communications, the parent company of Modern Healthcare. Mr. Cleary died last week at a nursing home in Southern Pines, N.C., after a short illness. He was 83.
Mr. Cleary spent 30 years with the company before retiring in 1983. He started as a sales representative for Advertising Age, a sister publication, and rose to executive vice president-general manager and group publisher at Crain. He played a key role in making Modern Healthcare a success.
The staff of this magazine extends its sympathy to Mr. Cleary's family, friends and colleagues.