Mark Chassin seems to be an excellent choice as the next president of the Joint Commission. As our Aug. 6 cover story revealed, he is a past critic of the organization, and has worked on quality issues for prestigious institutions most of his career. With such a resume, one could be tempted to ask why he would set himself up for so much abuse, but he apparently views remaking the spectacularly underachieving accreditation body as a mission.
As if he needed any reminding of the scale of that task, the week of his appointment saw another in a seemingly endless series of examples of the commissions abject failure to police bad hospital care.
At 609-bed Rhode Island Hospital in Providence, a neurosurgeon opened up the wrong side of an elderly mans skull to fix intracranial bleeding. It was the second such incident this year at the facility and the third since 2001.
State health department officials didnt wait for the outcome of a post-event analysis, forcing the hospital to bring in an outside consultant to monitor its neurosurgery practices and to have a second doctor verify each surgery plan. They also bemoaned the effectiveness of Joint Commission procedures.
Therein lies part of the challenge. The commission is all about policy manuals and protocols and not enough about what actually happens to patients. Simply put, hospitals with bad track records on medical errors are allowed to stay open. This is why those being policed say the commission is worthless, giving it failing grades in a Modern Healthcare Online poll in April.
Woefully late, the commission has made some changes, and is mulling others. It adopted unannounced surveys and began to track individual patients care from admission to discharge. It is also looking at how to use outcomes in the accreditation process.
The problem is that outcomes remain stubbornly difficult to track accurately, especially for hospitals with low volumes of certain procedures or rural hospitals with low volumes across the board. But there is a growing body of research on how to use quality-of-care measures to evaluate the performance of individual hospitals.
Meanwhile, medical errors are not exactly difficult to trace. If a hospital repeatedly comes up short, it should lose its accreditation and thus its ability to bill Medicare. Having a number of bad hospitals struck off the list would put the fear of God into the rest of the industry, saving countless lives. Instead we see the surveyors show up a day or two after a tragedy, with news cameras in tow, in a fake show of resolve, rarely sanctioning the offending facility.
Similarly, there is no reason for the high nosocomial infection rates found in so many facilities years after a number of concerned health systems nearly eliminated such infections through relatively simple protocols.
That sorry record is why Chassin may face a major hurdle in his new job, which doesnt start until Jan. 1, 2008. Rep. Pete Stark (D-Calif.) has had it in for the Joint Commission for years. The House bill reauthorizing the State Childrens Health Insurance Program has a provision authored by Stark to strip the commission of its unique status as a federally sanctioned accreditor. If it makes it through conference into law, the loss of status would be a catastrophe for the organization, either opening the door to other private-sector groups or having the CMS retain the accreditation authority.
Finally, we strongly urge Chassin to wean the commission from all of its noncore business ventures, which have only served to give critics even more ammunition. Selling data and other services to the very facilities it accredits is a conflict of interest. He should focus all of the organizations research on making hospitals safer places to visit, which should be its one and only job.