Joint Commission veers from hard-line approach

Shady Grove retains accreditation after all

Two separate actions taken last month by the Joint Commission on Accreditation of Health care Organizations have some JCAHO-watchers wondering if the organization isn’t already backing away from its apparent get-tough response to last year’s Office of Inspector General (OIG) report.

Until recently, some complained that the Oakbrook Terrace, IL-based Joint Commission had over-reacted to the OIG report and to criticism that the organization had become too friendly with the industry it was set up to oversee. Of particular interest was the organization’s decision in December 1999 to revoke the accreditation of Shady Grove Adventist Hospital in Rockville, MD. Following the preliminary non-accreditation ruling, Shady Grove officials argued publicly that the Joint Commission had judged the hospital too harshly, punishing it for relatively minor infractions in order to blunt recent criticism.

Prior to the Shady Grove ruling, 100 hospitals had been hit with preliminary non-accreditation status over the past three years. Of those hospitals, however, 39 ended up receiving "a different accreditation decision," says Donna Larkin, a JCAHO spokeswoman. Of the remaining 61, Larkin acknowledges that some had simply dropped out of the accreditation process, while others may have merged with or been acquired by another entity. Even considering those "drop-outs," less than 1% of hospitals received non-accreditation status.

In light of those numbers, many interpreted the Joint Commission’s stern handling of Shady Grove as a sign that the gloves had come off. But at a meeting on Feb. 3, the Joint Commission’s Accreditation Committee ruled to upgrade Shady Grove to "conditional accreditation" status, meaning that the hospital must pass a random, unannounced survey within 90 days to keep its accreditation status.

Not surprisingly, Shady Grove officials have backed off their earlier criticism of the Joint Com mission’s motives. "I think as we came together and began to work with the Joint Commission in our appeal, we came away feeling that [JCAHO] worked very hard with us to ensure that we had fair and impartial hearings," says Robert Jepson, regional director for communications for Adventist HealthCare in Rockville, MD. "And we feel that was achieved."

Don Nielsen, MD, senior vice president for quality leadership at the American Hospital Association in Chicago, has sympathy for the Joint Commission and the difficult course it’s trying to steer. "It is a schizophrenic role in some ways that the Joint Commission plays," he says. "They have a regulatory role, but also an accreditation role based on quality improvement, and I think that to a degree there is always some ambiguity, or at least some strain between the two functions that JCAHO performs. It’s not so much that they’re trying to take a tougher role as that they’re trying to make the accreditation survey process be seen as very credible, very effective, very fair, and very valid."

Public information policy revised

A day after the Accreditation Committee voted to conditionally accredit Shady Grove, the Joint Commission’s Board of Commissioners voted to revise JCAHO’s public information policy in order to provide more precise information to the public about hospitals hit with non-accredited status. The policy revision will take effect Jan. 1, 2001.

To some hospital personnel, the decision may raise uncomfortable memories of the initial controversy over potential public access to root-cause analyses of sentinel events. But, according to Harold Bressler, the Joint Commission’s legal counsel, "this is not an analogous circumstance. Nothing in what the board did with regard to the public information policy would in any way suggest that the Joint Commission would disclose anything about the sentinel event root-cause analysis."

Indeed, while the policy revision seems on the surface to address the public’s clamor for more information about poorly performing hospitals, in reality, the public won’t get much more than what’s already contained in publicly available performance reports. The main difference will be in how the information is presented.

"People are talking about having three general categories, which would at least identify the general nature of the decision to deny accreditation," Bressler says. "Again, it doesn’t reveal anything specific about sentinel events [and] it doesn’t reveal anything more than what’s already in a performance report. The reason for doing it is simply to be more understandable to the public."

Bressler also notes that, "The board did not suggest that we would disclose the specific standard results. So what we’re talking about is a description of a standards area that might make more sense and be more understandable that the performance areas now found in the performance report."