JCAHO appears to be addressing deficiencies

Quality of surveyors has improved recently

A New England quality director who prefers anonymity says she’s seen both good and bad Joint Commission surveyors in her years as director of quality improvement. "They vary," she says. "We were last surveyed in November 1997, and I couldn’t help but notice a change in the surveyors." She says they were a little more knowledgeable, a little more continuous improvement-oriented, and a little more education-oriented.

"Every opportunity he had, our administrative surveyor gave us advice about data collection, continuous improvement, and continuous monitoring," says the quality director. The nurse surveyor, on the other hand, got too deep into areas where the director says she had no expertise. She quickly lost her credibility. "For the sake of the survey’s outcome, we got into a Yes, ma’am’ mode."

For example, says the director, when the time came to explain and justify how they were working with leaders at the state or national level, or how they might have been chairing a national initiative, she challenged their approach. "It wasn’t a matter of, That’s interesting. Did you ever think of A, B, or C?’ Or From my experience, I’ve learned that if you question this, that will happen.’ She went too deep."

This surveyor had respect for QI

The director from the New England facility has nothing but praise for the facility’s last physician surveyor. "He was superb — the best I’ve ever seen. He was a retired surgeon, and he knew hospital care. He very nicely went back and forth between his experience and the standards — where he felt we needed to make some improvements."

The director says he was respectful. "He’d say, You need to get your expert groups together to figure out how best to do this. I can’t tell you how to do it, but I can tell that your physician profiling needs strengthening.’ He had the perfect, practical background experience." She says he had respect for QI and could move in and out of administrative, clinician, and medical staff executive sessions skillfully. "He asked the tough questions and pushed the tough issues in a way that was very credible. If I had a videotape of our medical staff exec session, I’d hold it out as a model of how that should go."

Another quality professional who prefers anonymity says she heard resounding praise for a survey conducted by a group of impressive educational surveyors. "Both nursing leaders and administrative leaders said that was the first time the Joint Commission felt value-added to them," she says. "For the first time, they felt they had learned something or understood something better because of a survey. And isn’t that what it’s supposed to be all about?"

Your colleagues want value added, and they want to be respected and told they’re doing a good job when they are. The quality professional says, "I’ve been amazed at how disappointed even physicians are when they’ve spent 40 minutes with a surveyor, and the surveyor gives them no positive feedback or no feedback at all." She says she’s told surveyors it would be valuable if they gave some good feedback to the team when they are impressed with a program. "I say, The team wants to hear from you what you think.’ At least two surveyors have said to me, Well, that’s not our job. Our job isn’t to give kudos.’ That’s unfortunate when that happens."

Some of your colleagues tell stories that seem to indicate surveyors’ behavior changes according to different incentives. The same surveyor came for two purposes to Monsour Medical Center in Jeannette, PA, because the facility is involved in Pennsylvania’s pilot Orion Project.

"Our Orion surveyor was the same individual who had come for our regular survey," says, Wilma McCullough, RN, CPHQ, quality assurance manager at Monsour. "But there was a distinct difference in his personality when he came for the Orion survey — he presented himself in a nicer manner. He was friendlier and more personable. My guess is that the Joint Commission works more with surveyors when they go out on Orion projects because that’s a voluntary pilot program."