The Failure of the Joint Commission

Nurses Safety

Published

I want honest opinions here. I consider myself one of the many that think the Joint Commission has outlived its usefullness. Every year more National Patient Safety Goals, Sentinel Event alerts and more Do Not Use abbreviations. While the Joint Commission does have some very important safety goals and patient safety recomendations, To me its seems that it is an organization that turns a blind eye and a deaf ear to the obvious and focuses on the irrelevant.

For example, A few year back a Sentinel Event alert was issued abour MRI safety. Although MRI incidents may occur, the number is relatively low - However Patient care in hospital up and down the country continues to suffer due to short staffing or over-burdened nurses.

In every Sentinel Event alert or National Patient Safety Goal, workplace recomendations are issued by the Joint Comission - In nearly every instance, Better nurse staffing is recomended.

How come with each new Patient safety goal or Sentinel event alert - nursing paperwork/charting increases and time for actual patient care is diminished?

If the Joint Commision was serious about patient safety, NATIONWIDE NURSE TP PATIENT STAFFING RATIO'S would be implemented.

What is the hold up?

I believe that the MRI safety Sentinel Event Alert, for example was bogus to begin with. Joint Commission with a task force and recomendation all about MRI safety? Come on - What about safety instructions from the machines manufacturer. Personally, I think Jont Commision should focus more on the realities of healthcare and not the isolated RARE incidents that the news media (and JCAHO) sensationalize.

Having already stipulated to the fact that there aren't enormous numbers of MRI patient injuries, I would also say that the numbers of close-call and minor-injury events is far from rare. Here's a blog post identifying a few of the most egregious MRI accidents from the first 3/4 of 2009, as reported to the FDA (Can We Still Call Them MRI Metal Detector Blog).

It should be noted that most MRI accidents occur because the machine is working properly (generating massive magnetic fields and washing patients in large amounts of RF energy). As long as the device is working as designed and approved by the FDA, as a medical device contemporary law provides some very substantial protections to the manufacturer of the MRI. As such any standards that the manufacturers wish to put forward are (a) voluntary on their part, and (b) without any means of enforcement.

It is estimated that thousands, perhaps 10's of thousands, of MRI accidents and near-misses occur annually in the US. The vast, VAST, majority of these are 'pilot error' which could be avoided had someone, anyone, required that industry best practices be followed. For all the regulation, licensure and accreditation oversight for ionizing radiation modalities, there has not been a single physical environment safety requirement for MRI at any level. It is only by grace or luck that we've failed to seriously injure more people, though the trends suggest that 'injuring more people' is the direction MRI is currently headed ( MRI Metal Detector Blog).

I won't dispute that a 95% handwashing rate, as an example, would do more to save lives than an MRI Sentinel Event Alert, but through just a handful of changes to MRI safety, bringing contemporary expectations in-line with best practices, we could virtually exterminate some of the most common forms of MRI injury.

Specializes in Health Information Management.

So if you consider JCAHO a failure, how would you fix it? Or what would your ideal be (understanding that just getting rid of it isn't really a viable option) for a completely new agency with a similar mandate?

So if you consider JCAHO a failure, how would you fix it? Or what would your ideal be (understanding that just getting rid of it isn't really a viable option) for a completely new agency with a similar mandate?

I don't think there's a need for a new agency -- every state has an existing healthcare licensing agency and surveyors who are responsible for enforcing the state rules/regs related to different types of healthcare facilities/services. In every state, those surveyors are also "contract" surveyors for CMS (the Feds) -- since it is impractical (and expensive) for CMS to have surveyors in every state, they have a few offices in different regions of the country, and they contract with the state licensing agencies to "borrow" the state surveyors when needed and then reimburse the states for the cost of the surveyors' time/travel when they do Federal surveys (I was a surveyor for my state (and CMS) for several years earlier in this decade, so I'm v. familiar with how this works). That system seems to work pretty well, and I don't see that there would be a big difference noted if JCAHO just ceased to exist (except that hospitals wouldn't be hanging big "JCAHO" banners and giving away "JCAHO" mugs and pens to all their employees :D). The state agencies could hire some more surveyors and do some more surveying than they currently do, to pick up the slack, and it would accomplish the same ends. Joint Commission isn't doing a v. good job, anyway (in my opinion and the opinion of every state surveyor (from many states) that I've met ...)

Specializes in Health Information Management.
I don't think there's a need for a new agency -- every state has an existing healthcare licensing agency and surveyors who are responsible for enforcing the state rules/regs related to different types of healthcare facilities/services. In every state, those surveyors are also "contract" surveyors for CMS (the Feds) -- since it is impractical (and expensive) for CMS to have surveyors in every state, they have a few offices in different regions of the country, and they contract with the state licensing agencies to "borrow" the state surveyors when needed and then reimburse the states for the cost of the surveyors' time/travel when they do Federal surveys (I was a surveyor for my state (and CMS) for several years earlier in this decade, so I'm v. familiar with how this works). That system seems to work pretty well, and I don't see that there would be a big difference noted if JCAHO just ceased to exist (except that hospitals wouldn't be hanging big "JCAHO" banners and giving away "JCAHO" mugs and pens to all their employees :D). The state agencies could hire some more surveyors and do some more surveying than they currently do, to pick up the slack, and it would accomplish the same ends. Joint Commission isn't doing a v. good job, anyway (in my opinion and the opinion of every state surveyor (from many states) that I've met ...)

But having things maybe be a hodgepodge of state regs, a few federal regs, etc. - doesn't that kind of spell trouble for patients? I'm just thinking out loud, not necessarily advocating for JCAHO or anything. I do think a centralized national agency for surveying, monitoring, and certification makes sense, but I'm more than willing to hear arguments to the contrary. It just seems as though when you leave something up to individual states to regulate, you end up with fifty different versions - a few good, some average, and many awful versions.

Specializes in icu/er.

our hospital has just fired jcaho and hired a new accreditation group called dnv healthcare accreditation. after two full mock surveys by them and reading the reports they seemed to be much more levelheaded in their approach to surveying. unlike jcaho who only informed you of the problem & tells you to fix it, dnv informs you of the problem and reccomends how your facility can fix it based on the inherrited facilities structure. dnv understands that hospitals are not the same size, same staff and treat the same communities. they understand that a local community 125 bed level 3 hospital dont have the resources that a 600 bed level 1 medical center has and realize that whots works for one hospital wont or cant work for another so they try to individualize certain aspects of the survey when they can. unlike jcaho who thinks everyone should be the same no matter what the situation is. its like when we had our last exit jcaho survey i told the surveyer that i always felt "jcaho was just another money grubbin company since they will not address the pt:nurse ratio with the same vigor that they do for a med. rec. form." they just looked at me like i was crazy & stated they would note that. what a bunch of fakers.

But having things maybe be a hodgepodge of state regs, a few federal regs, etc. - doesn't that kind of spell trouble for patients? I'm just thinking out loud, not necessarily advocating for JCAHO or anything. I do think a centralized national agency for surveying, monitoring, and certification makes sense, but I'm more than willing to hear arguments to the contrary. It just seems as though when you leave something up to individual states to regulate, you end up with fifty different versions - a few good, some average, and many awful versions.

But that's what the system is now (and has been all this time), with JCAHO -- each state has its own rules/regs for the different types of healthcare facilities/services, and JCAHO is supposed to be enforcing the CMS federal/national rules/regs (which are certainly not "a few" regs -- they are a comprehensive system of rules/regs that cover all of healthcare, and you must be in compliance with them to receive Medicare/Medicaid funding), plus its own JCAHO standards (many of which seem extremely bogus to many of us in the "real world" at this point :D). Taking Joint Commission out of the picture would not change much -- just save hospitals a lot of $$$$ (states and CMS don't charge you out the wazoo for the "privilege" of being surveyed, and don't strongarm you to buy a bunch of crap to celebrate having passed your survey, and don't strongarm you to hire their friends to help you "prepare" for your survey ...).

There IS a "centralized national agency for surveying, monitoring, and certification" -- that's CMS. Joint Commission is just another layer of bureaucracy and hassle in addition to that.

Specializes in ER, Urgent care, industrial, phone triag.

The Joint Commission is a membership club with heavy dues. They do inspections and all of the facilities managment teams get in a twit about perfecting things while the inspectors are there. So, all's well while they are being inspected only to return to normal after. In reality, JCAHO does very little to regulate or punish hospitals.

The fact that they give warnings to their "members" about the dates they will be there to inspect a facility kind of negates the effectiveness of the organization.

Surprise inspections would tell JCAHO what really goes on in their member hospitals, but I have my doubts if they would do much for real change.....ie, recommend safer nursing staff levels.

Specializes in Critical Care Nursing AKA ICU.
I want honest opinions here. I consider myself one of the many that think the Joint Commission has outlived its usefullness.

JACHO is the most ridiculous thing ever!!! I had the privileage to sit with an auditor for 2hrs while he audit my patients chart, that just came out of the OR for a TAAA and my other patient was on CVVHD. He had the nerve to ask me if i was having a good day. :mad: what do you think? you idiot...i thought in my head

Specializes in Telemetry, Med-Surg, ED, Psych.

You've heard the term "security theater" (search the TSA and security theater)....In my opinion JCAHO is "Healthcare Safety Theater". I makes consumers, hospitals, insurance companies, nurses, doctors, and everyone else THINK they are safe when in reality it is all a front.

Joint Commission visits are like watching a bad movie....Its fake acting and tons of butt-kissing.

In fact, when Joint Commission comes I feel relaxed....its all a big show-n-tell party.

However, when CMS or the state health dept come - those are the big guys who can shut you down overnight. At least when the state comes, they know what to look for and how to do it. Most state officials I have seen don't have time for hospital administrators "Dancing around the point". The state is where real change happens.

A hospital in my area was inspected by the state recently. The hospital was put on "Critical Alert" status for some major patient safety related issues - all of which could have been avoided with proper nurse staffing, better ratio's, Amnesty incident reporting, evidence based practice, and proper hand hygiene education. The state made direct rec's to said hospital to improve their staffing matrix, nurse ratios, incident reporting and administrative communication or face still fine and possible closure.

Specializes in Critical Care Nursing AKA ICU.
My fear is that with all the documentation standards, facilities are becoming more concerned that everything is DOCUMENTED as a priority...... instead of actually done:eek:

i have been told by managers to "just check the boxes" or during chart audits "just make the numbers look good"

Specializes in ER, ICU, Administration (briefly).
You've heard the term "security theater" (search the TSA and security theater)....In my opinion JCAHO is "Healthcare Safety Theater". I makes consumers, hospitals, insurance companies, nurses, doctors, and everyone else THINK they are safe when in reality it is all a front.

Joint Commission visits are like watching a bad movie....Its fake acting and tons of butt-kissing.

In fact, when Joint Commission comes I feel relaxed....its all a big show-n-tell party.

However, when CMS or the state health dept come - those are the big guys who can shut you down overnight. At least when the state comes, they know what to look for and how to do it. Most state officials I have seen don't have time for hospital administrators "Dancing around the point". The state is where real change happens.

A hospital in my area was inspected by the state recently. The hospital was put on "Critical Alert" status for some major patient safety related issues - all of which could have been avoided with proper nurse staffing, better ratio's, Amnesty incident reporting, evidence based practice, and proper hand hygiene education. The state made direct rec's to said hospital to improve their staffing matrix, nurse ratios, incident reporting and administrative communication or face still fine and possible closure.

I'm not generally one to pick on any specific political party, but the state inspection teams (under ACHA here in Florida), have been disempowered by the republican administraiton and specifically under Jeb Bush. Only minimun salaries are offered, to even very experienced RN's. WHen I applied, that was $35,000, vs the $80,000 I was making as a clinical nurse. I heretell Jeb personally got this done.

Interestingly, Jeb Bush, when he left office, started working at TENET healthcare on theri Board of Directors for $450,000 per year.dollarsign.png

Now, THAT's reward power. Hmmmm, sort of explains a lot of weird CON decisions over the years.

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I find it interesting the way we chart is not to show what happens to the patient but to make it easier for all the bean counters to do their jobs, both in hospital management and with JCAH.

Our place had the pleasure of putting on a show for JCAH when they came to inspect a month ago. Most days we don't have enough staff, but when JCAH was there, they mandated that people be at work. Our head nurse was seen more that day than we had seen her in the whole previous month.

To me it's like a lot of other certifications that hospital acquire. Its what you are willing to pay for.

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