JCAHO - Out of Control!

Cockatoo - Hamilton Island, Australia. Photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

“In any bureaucracy, paper work increases as you spend more and more time reporting on the less and less you are doing”

JCAHO web site: http://www.jointcommission.org/

Health care facilities are periodically inspected by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) which determines whether the center is authorized to deliver health services to patients. JCAHO's mission statement stands out like a banner on the home page of their web site, “Helping Health Care Organizations Help Patients.” The goal is commendable, but with rare exception a visit by JCAHO means more paperwork, added expenses, nervous administrators, and little benefit for patient care.


Most hospitals operate at a steady state level. Efficiencies and good patient outcomes are primarily the result of competent physicians, nurses and support staff, who attempt to do their jobs despite burdensome administrative requirements. When a JCAHO inspection is imminent, hospital administrators, whose jobs depend on the results of the inspection, prepare by demanding the medical staff and employees complete more forms. Even if the hospital has a history of providing exemplary care to its patients, a lack of documentation or failure to adhere to guidelines set by the government can expose the facility to fines and probation. Consequently, in the weeks leading up to a JCAHO visit every spare piece of equipment is hidden from view and administrators, who usually are cloistered in their offices, are in full view of their employees.

There is a standing joke that JCAHO and California State Inspectors work in these jobs, because clinical medicine is not their strong suit. Officials working for these organizations wield capricious power and find themselves in a position where their rulings are virtually incontestable. Knowledge of medicine becomes secondary to the ability to find minor problems in an organization and to exaggerate their importance. It is not uncommon to see a hospital administrator groveling before an inspector to try to achieve a more favorable rating.


Inspectors' ability to find fault in a hospital requires imagination and the ability to foresee potential problems that most mortals never grasp. Not long ago JCAHO paid a visit to our hospital, and evidently after the first day the hospital was performing too well. The followoing day an inspector visited the neonatal nursery and discovered the bottoms of the plastic bassinets where the newborns are kept did not have holes drilled in them. The potential problem, apparent to only the inspector, was in the event of a fire the automatic sprinklers located in the ceiling would deluge the nursery and fill the bassinets with water and drown all the babies. As ludicrous as this may sound, at the debriefing later that afternoon the chief inspector proclaimed the finding as “brilliant,” and new holes were drilled before the next morning.


If a reader looks in the history section of the JCAHO web site (go to “about us” then select “history”) and examines noteworthy occurrences over the last fifty years, it is impressive how responsibilities have mushroomed. The amount of oversight and the detail into which the organization can effect health care centers is stifling. Those of us working in clinical medicine are well aware of this phenomena. We are overwhelmed with paperwork that in appearance and detail is closer to a legal document than a medical record. Soon every sentence will begin with the word “whereas.” Nurses spend an inordinate amount of time functioning as data input clerks rather than caring for patients – all at a time when there are more patients and fewer people to take care of them.


There may have been a time when JCAHO and its sister organizations provided an unambiguous benefit to the public, but their scope has morphed into a monster satisfied only by more rules and regulations at the expense of common sense and efficiency. Legislation is needed to curtail their power and allow high functioning health care facilities the freedom to conduct operations in a more independent manner. It is time to tip the scale to the side of patient care and away from forms and impractical dictates. For this to transpire JCAHO's role must be redefined as advisory rather than adversarial. This means defanging the inspectors, so their far fetched accusations and preposterous interpretation of regulations can be challenged by hospitals. As it stands, they act with impunity and make paltry efforts to develop healthy, working relationships with hospital personnel.


JCAHO visits are lost opportunities, since inspectors are quick to criticize and slow to praise or offer helpful suggestions. In all the years our hospital has been subjected to these idiosyncrasies, I remember how few worthwhile ideas have been implemented as a result. The only certainty is more red tape and the hope of earning a passing grade, so we will not be bothered for a few more years.