A new Joint Commission standard, which took four years to develop, has gained acceptance from hospital industry groups after clarifying that a hospitals board of trustees has the final say on a hospitals decision making.
The revised Joint Commission standard MS.1.20 appears to have addressed the concerns of the American Hospital Association and the Federation of American Hospitals. Both groups had aggressively criticized previous drafts of the revision and had accused the Joint Commission of overstepping its bounds and stripping hospital boards of their authority.
That issue came up several times, and were in agreement that were not in the business of messing around with how a hospital is governed, said Robert Wise, the Joint Commissions vice president in the division of standards and survey methods. This new standard really only focuses on the issues that deal with quality and safety.
The standard was approved by the Joint Commission board of commissioners early last month, but just released last week. It contains 33 elements of performance that it mandates must be contained in hospital bylaws.
For some, the standard dictates that procedural details for the elements must also be contained in hospital bylaws while others can be included in policy manuals.
Some of these elements include the structure of the organized medical staff, processes for granting and suspending hospital privileges to independent physicians, the process for selecting and removing medical staff executive committee members, the processes for terminating medical staff membership or clinical privileges, and an appeal process on corrective actions. This was a passionate topic among medical staffs and governing bodies, Wise said. The medical staff side was concerned that they would lose control on a lot of issues of self-government.
Because implementation of the standard will require hospitals to review their current bylaws, assess how they relate to the new standard and then most likely approve new sets of bylaws, the standard will not go into effect until July 1, 2009. The long latency period being granted has pleased some industry representatives, who also praised the new documents clarity.
Hospitals have a clearer sense of what to expect when surveyed on this, said General Counsel Jeff Micklos, FAH senior vice president, who said previous versions of the standard were more subjective and harder to audit.
Last May, the FAH sent a letter to the Joint Commission stating that the proposed revisions will greatly hinder efficient and effective hospital operations, and commented that the FAH fails to see how this significant intrusion into hospital operations is even arguably appropriate under (the Joint Commissions) historical accreditation function.
Micklos said the final version is a vast improvement. From the Federations standpoint, they started to muddy the lines between leadership components, he said.
Nancy Foster, AHA vice president for quality and patient safety policy, agreed. In earlier drafts, it did not as clearly as necessary state the ultimate authority and responsibility of the board of trustees of the hospital for quality and patient safety, Foster said. Its a collaborative process and the medical staff has a critical role, but the communitys expectation is that the board will oversee quality and safety.
While medical staffs and boards can collaborate, the AHA did want to have the details of how this collaboration should work codified by the Joint Commission. Foster said the virtue of the final standards language is that it offers clarity on whats expected and provides a framework to meet those expectations.
Wise noted that since the AHA and FAH were so vehemently against the standard before and are now at peace with it, the Joint Commission must have given the groups all that they asked for.