Is Joint Commission more hindrance than help?

time4meRN · Jan 27, 2008

I agree, I think they are helping to sky rocket medical care cost. I think they take us away from where were need to be to take care of what ever little thing they think is important this year. For example, meication rec. forms. It is very very expensive for hospitals to maintain JCAHO standards and get ready to up to date on everything so they don't get the almighty "ding". I hope they arn't soooo stupid to think that everything is done well all year long, that we don't scurry trying to be sure everyone is up to date and things are where they are supposed to be. The same with state surveyer's with the state.

dream'n, BSN, RN · Jan 28, 2008

I've worked in QA/QI and risk management, and here's what I know about JCAHO (now the "Joint Commission"--same initials as someone famous . . . ).
There is an alternative to JCAHO, it is a subentity of the American Osetopathic Assn. http://www.hfap.org/
The relationship between CMS (Centers for Medicare & Medicaid Services), JCAHO and acute care facilities accreditated by it is somewhat incestuous. CMS tells facilities they have to be accreditated to receive payment for caring for medicare and medicaid patients. Private insurance companies may also require facility accreditation as a condition for covering care.
So JCAHO saw a business opportunity and worked hard to fill it. I've been to JCAHO headquarters outside of Chicago (to check out job opportunities 15 yrs ago). It's a Taj Mahal of a building, fancier than most big banks headquartered in that area (can you say "fancy pink marble?"). Not only does JCAHO charge the facilities HUGE fees for the accreditation process, it also has a good income stream going with its business of selling accreditation reference materials (those wonderful JCAHO books). So JCAHO has managed to maneuver itself into being the "Good Housekeeping Seal of Approval" for healthcare facilities.
But does it really ensure good, safe patient care? Of course not. The old "wink and nod" system of letting facilities know when the accreditation team will arrive has finally been revised (now you get a window of time as to when they're coming), but it's not the "we could show up at anytime" scenario where a more typical picture of what's going on at the facility could be had. YOU and I are paying for this system indirectly as tax payers who fund CMS. CMS has been slow to require more from facilities via better accreditation processes.
So what has changed? Well, other financial players have started to assert themselves. Insurers don't want to pay for sloppy care that ends up costing them more money. And employers that are faced with the ever-increasing costs of health care plans for their employees have come to realize they can champion changes that might help hold down their costs. www.leapfrog.org
JCAHO is now scrambling to try and hold onto its preeminent acceditation position. So yes, you are probably going to continue to see "over kill" standards from them as they try to dance attention away from their real problems. And why won't JCAHO die? Because they're in bed with the facilities that know the true financial costs of the measures that would ensure better and safer patient care--better staffing ratios, a fully integrated physician order, test/procedure results and patient care documentation system, and more accountability from physicians.
Never a dull moment in healthcare . . . .
HollyVK RN, BSN, JD

Thank you. This is a great post, thanks again for the information.

lindarn · Feb 3, 2008

This is sort of an update on the Joint Commission. Last week I received a newsletter from the Joint Commission, with an offer of a subscription, if I liked it. It was OK, but nothing that I would be interested in receiving on a regular basis, and also nothing that I would want to pay for.

Well, they got impatient when I didn't immediately respond to their offer. I got a letter from them today, with a "bill" for a years subscription to "Inside the Joint Comission". You will never guess how much a subscription cost for one year. Are you all sitting down? Drum roll, please- It cost $429.00 for a years subscription. Would anyone out there be willing to pay $429.00 for a subscription to a magazine? Like I have nothing better to do with $429.00! How about you?

Talk about being completely out of touch with the average bedside nurse. Our wages have been flat for a decade. We don't get breaks, meals, any respect from anyone. And the Joint Commission thinks that I would be interested in a subscription to their magazine for that outrageous cost!!

Sorry, I am just venting about the air heads that run our administrative agencies who has so much clout in our professional practice. And this is what they offer me. How about offering me staffing ratios?

Lindarn, RN, BSN, CCRN

Spokane, Washington

hollyvk, BSN · Feb 3, 2008

This is sort of an update on the Joint Commission. Last week I received a newsletter from the Joint Commission, with an offer of a subscription, if I liked it. It was OK, but nothing that I would be interested in receiving on a regular basis, and also nothing that I would want to pay for.
Well, they got impatient when I didn't immediately respond to their offer. I got a letter from them today, with a "bill" for a years subscription to "Inside the Joint Comission". You will never guess how much a subscription cost for one year. Are you all sitting down? Drum roll, please- It cost $429.00 for a years subscription. Would anyone out there be willing to pay $429.00 for a subscription to a magazine? Like I have nothing better to do with $429.00! How about you?

Lindarn,

JC and other reference publishers buy lists of potentially interested professionals from professional associations and other groups. What you received was an offer JC hoped you'd use at your institution and have it pay the cost of it. And the very annoying practice of sending bills for a publication you've not requested is a VERY common practice by healthcare publishers. They're hoping someone won't realize the facility doesn't subscribe to the publication and will just forward the bill to the accounting dept (or wherever) for payment. And the price? That's about average for a healthcare publication aimed at healthcare facilities. And it's cheap by comparison to the databases and other digital/inline reference services facilities can buy the use of, e.g. drug ref programs for the pharmacy, medication reconciliation programs, order sets, pt discharge materials.

HollyVK, RN, BSN, JD

Stringer · Feb 3, 2008

I just thought I would throw this one out there:
Do you think that the activities that floor nurses must do to satisfy Joint Commission requirements are a help or a hindrance to patient care? It almost seems to me that we spend so much time documenting that a lot of patient care has gone out the window.
What do you think?
Oldiebutgoodie

I don't think they are accomplishing what they hope or think they are. I don't think they are pure evil either.

Also, an incidental problem is that health care entities themselves resort to paperwork and other nonsense to fix problems.

"Contempt," I think best characterizes the attitude of the front line nurses toward TJC these days. That physicians formed the original organization to address physician concerns, unfortunately, engineered genuine nurse input out of the system, in my opinion. I do not believe the more global perspective of actual patient care issues nursing can offer is adequately represented.

Another area of concern has to do with TJC methodology. When they shifted to measuring outcomes based on "Indicators", they initiated a symptom based response by health care systems in order to show well with respect to indicators, often not addressing the problems that cause the symptoms. I guess one could argue that if a hospital can't even come up with the dog and pony show required to squeak through survey, there probably really is something wrong.

I believe this has been recognized and TJC is trying to correct this internal deficiency through "tracers" and surprise visits. Of course, they never really are a surprise, we just have less lead time now days; hospitals need to be a little more ready now. Our last survey still seemed like the good old last minute rush, with early warning systems in place to get the staff in who show well, and get the teams running ahead to put on a good face.

Most troubling is the concern that the data that drives TJC is fundamentally flawed in that it does not reflect what is. Again, the people in the front line who have the most at stake, and the most accurate information are usually not even aware of the data collection tools like ORYX, let alone given a voice.

It would be interesting to see direct care givers given more power on the boards and committees that make the decisions for TJC.

IMustBeCrazy · Feb 4, 2008

A few things from JHACO are good, such as med recs. Doing them are often a pain in the butt, but still very necessary for good patient care. Most of the stuff however is a joke, bureaucrats making more rules to ensure their cushy jobs, IMO.

tazzyjo · Feb 7, 2008

My view is that some of their ideas are good in theory, but will little or no regards to implementation from a nursing point of view or standardization for hospitals point of view, we end up with a quagmire of inconsistency and unattainable goals. I find I rely on my CNA's way to much to know exactly what is going on with my patients moment to moment because I'm so busy TRYing to get all the paperwork done correctly, instead of attending to my patients (at least in some hospitals). Even with lower nurse to patient ratios, it is hard to stay on top of the patients condition because of the never ending requirements of JCAHO and hospitals inept attempts to satisfy the beast call JCAHO. As a travel nurse I've noticed that even with JCAHO many hospitals put their own interpretation on the rules which makes it very hard to find any of this a serious endevour. :banghead:

ssakd · Feb 7, 2008

We are almost going Joint Commission ,pray then it doesnt happen !!!!1

moodychick, LPN · Feb 11, 2008

I think they are a hinderance. The only folks that appreciate giving the nurses more paperwork is management. Management sees that "approved by JACHO" as a medal; they aren't the ones carrying it out and taking away from the patients. I so miss the days when we could actually spend time with our patients doing teaching and just finding out about them. I recall as a student actually playing cards with an elderly woman. I learned so much about her and how she was coping with her illness. We just don't have time anymore with all the added JACHO paperwork.

KYnightnurse · Feb 12, 2008

It's so much more of hindrance in nursing today than it is helpful anymore. We literally spend more time during our shift documenting and filling out endless forms.
I'd like to pose a question: How does current day Joint Commission improve patient care? I'm just dying to know. It seems as though each year between The Joint and CMS patients are being stripped of what their in the hospital for....nursing care.
Just my .02

Here's what 'Joint' did to us last year: we now have to lock up our IVF bags, which were in a Staff Only supply room to begin with. Now they are in a locked med room and locked AGAIN in a cabinet, in other words double locked. As are other supplies such as IV tubing and saline. Joint would die if they knew what went on when their back was turned *L*. And it's not just staff nurses, it's mgt too that disagree with what they do.

They (Joint) need to get a real job.

PMHNP10 · Feb 12, 2008

But they have to do something to justify their existence, so if they don't come up with more paperwork, guidelines, and hoops to jump through, they'll become unemployed and we surely don't want that.
What always fascinates me is that they can make change upon change, and have the power to basically shut down a noncompliant hospital all in the name of improving patient care, yet not once have they mandated minimum ratios...has research not justified this change to improve patient care? I'd love to know why they haven't championed such a cause?

Ok, so for what it's worth, I figured I'd at least make an attempt at finding an answer to my question so I went to the source. I emailed JCAHO asking if their "initiatives" are based on empirical data. I used the '04 CA ratios laws as an example of a law that was enacted as a result of empirical findings. Then I asked them if their decisions were not evidence based, what are they based on (i.e., pt. chart reviews; patient feedback; staff feedback, etc.). Then I planted the idea of how wonderful an "initiative" mandating ratios would be for JCAHO.

I got a reply pretty quickly saying my email was forwarded to the Division of Standards and Survey Methods, and would you believe...I got no further response. I'm shocked and amazed. Because I'm stubborn, I'll probably call the individual who emailed me and see if I can get an answer. If I get anywhere, I'll be happy to share.

twotrees2 · Feb 22, 2008

I agree. I also think they would be better served by not announcing their visits. Most of their "requirements" go out the window after they leave (my experience). While some of their requirements may be well founded, they DO take the staff away from nursing care by focusing on miniscule BS.

i agree - they would do well to not let them know- when they know the staffing magically gets to where you are tripping over each other and everything is set up to accommadate the rules- then when they leave its all back to the crap.