The recent contradictory statements from Joint Commission President Dennis O'Leary regarding his retirement plans pretty much typify his management of the private healthcare accrediting body during his 19-year tenure. Pretend to do or say something important but really do or say nothing.
In case you missed it, O'Leary, 67, has told staffers at the Joint Commission on Accreditation of Healthcare Organizations that he plans to retire at the end of 2007, when his current employment contract expires. The public affairs office at JCAHO headquarters in Oakbrook Terrace, Ill., confirmed O'Leary's retirement plans. But now, as reporter Joseph Conn disclosed in last week's issue (April 25, p. 12), O'Leary is backpedaling on his plans, saying he's in no rush to leave. With a total compensation package worth $860,185 in 2003, we can understand why. O'Leary finished sixth on our annual ranking of the highest-paid healthcare association executives (March 28, p. 26).
As we've noted many times in this space, O'Leary's management of the Joint Commission has been a disaster if you measure success as taking the lead in improving the care and safety of sick people. His nearly 20 years at the helm have been marked by one glamorous and curiously named initiative after another, each replacing its predecessor as the so-called cutting-edge approach to quality improvement. The problem is, the JCAHO is never first with these brilliant ideas. O'Leary only jumps in after others have tested the water. And on the few occasions when the JCAHO dared to lead, like when it proposed a star-rating system for hospitals or tough emergency room-crowding standards, it quickly backed down under pressure from those who pay its accreditation fees.
All the while, the JCAHO has continued to grow into this huge bureaucracy, so huge that -- like a high-flying Wall Street stock -- it had to split to avoid calling attention to itself. It now functions as two organizations: the JCAHO and Joint Commission Resources, its not-for-profit subsidiary. Combined, the two generated more than $118 million in annual revenue in 2003. And if that's not enough, the Joint Commission in March announced plans to create an international patient-safety center. The center has three full-time staff members and no budget. But given O'Leary's green thumb, its annual revenue surely will be in the millions in no time, with healthcare providers footing the bill for the international travel of JCAHO executives.
While O'Leary fiddled, others burned up the path toward quality improvement, often out of frustration with the JCAHO's do-nothing approach. In this issue's special report, reporter Mark Taylor writes about providers who have embraced other quality-improvement and patient-safety strategies such as Six Sigma, Lean Manufacturing, ISO 9000, Toyota Way and Baldrige (p. 32). Entire organizations have been formed to make patient care better, organizations like the Leapfrog Group, the National Quality Forum, the National Patient Safety Foundation and the Institute for Healthcare Improvement. The federal government has gotten into the act with Medicare pay-for-performance demonstration projects and a Web site that publishes hospital-specific performance data on 17 quality indicators.
Years ago, I attended a JCAHO conference at which O'Leary sarcastically poked fun at groups trying to develop clinical indicators to measure hospital performance. He told the crowd that it takes years to develop a good indicator and those who thought differently were fooling themselves. At the time, the JCAHO was developing its own set of clinical indicators, a project it later scrapped as it got bogged down in detailed clinical debates in the various task forces O'Leary had set up. The anecdote stands as a testament to the JCAHO's failure to take the lead on quality improvement. Rather than healthcare providers forging new ground to make patients safer, O'Leary through his arrogance and political survival skill has abdicated that position largely to payers.
The only remaining question is: Why wait until 2007?