Where is JCAHO in all of this mess??

NorthNurse · Feb 16, 2001

Hi Sue,

Some hospitals are more concerned with trying to promote agenda's such as therapeutic touch and bringing prayer to the bedside, not that there isn't a place for alternative therapies, BUT, I think they should spend time/effort/money on meeting the basics of care FIRST, that are substantially lacking ie.. having enough staff to make sure the patients call light gets answered timely and patients get bathed, rather than who can perform TT and pray with the patient. I think they use this stuff to be impressive for JCAHO visits, and somehow hide the real issues. I can't tell you how many home care patients have complained that no one helped them do anything in the hospital, but they did get a tape recorder, headphones, and music tapes to help them relax. This patient came home with crusted betadine all over his back, because no one helped him bathe, and he was in the hospital over a week. Unbelieveable eh?

Originally posted by RNSue:
According to the JCAHO website, their mission statement is as follows..."The mission of the Joint Commission on Accreditation of Health Care Organizations is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations." Now that the public is becoming more aware of the nursing shortage it won't take long for someone(patient,lawyer) to say "Hey,wait a minute! This health care facility where I was just a patient and got terrible care in is accredited by JCAHO and I thought they were supposed to ensure the quality of my care". I realize that not all health care institutions are JCAHO accredited but all the big ones are. If they are so concerned about "quality of care" provided to the public, why aren't they becoming involved with the terrible working conditions that are definitely NOT improving the safety and quality of care given to the public. Maybe if we directed our complaints to JCAHO concerning our working conditions in the facilities that they have accredited, we just might get some solid action. Management would definitely take notice if they lost their accredition. We have to start playing at their(management's)level. They have ignored us for too long. I know that if I'm ever sued for something that short staffing definitely contributed to, EVERYONE is going down with me. It's long overdue for us to do WHAT WE CAN, to GET HEARD! The public also needs to know what and who JCAHO is. I'm surprised the lawyers haven't thought of them by now. Thoughts, anyone?

patmostoi · Feb 16, 2001

you have got to be kidding.i know where u are coming from. i do know that census' are fudged they list resident assistant who only pass water, linen, ect and do not do pt care as staff members. so despite having 37 pts the record looks like we have 5 staff members on the hall the truth is we have me the lpn, 2 regular cenas, one cena on light duty, and one ra. that actually leaves 2 staff members to do pt care on 3-11. so it is not that jhaco does not monitor-it is that there are loopholes that facilities may use for staffing..this also applies to mandated nurse who have to work as cenas.scary huh! i love my work-but somedays i wonder why i got into this profession.between the politics, staffing, lawsuits, and managed care-ugh!

cmggriff · Feb 16, 2001

RNSue,

Go back to the web site and look dowwn toward the bottom of the page "About Us". There you will find a list of the "corporate members". I believe this will answer the question. There are no nursing or nurse friendly groups mentioned. Essentially Joint Commission is a branch of the industry it purports to be inspecting. This is like letting the prisoners run the jail.

**canoehead, BSN, RN** · Feb 16, 2001

Paperwork is easier to review and not as messy. That's why.

Has anyone ever seen a JCAHO official go into a patient room? How about show up unannounced? Even better, do they come to the units without an administration person there to chaperone and smooth over?

Reviews are a joke in my opinion. Paper driven QI reviews don't touch what really drives quality in nursing care.

oramar · Feb 16, 2001

One of the nurses I worked with once complained to me that she thought sending jcaho to the opera and football games represtented conflict of interest. I can't really make this accusation because it was just a rumor, I did not know for sure it went on.

km rn · Feb 16, 2001

JCAHO is a voluntary accredidation agency - hospitals etc. pay money for the luxury of being surveyed by JCAHO.

I agree with the others - it is very easy for focus on paperwork compliance - it is far more tidy, there is less chance of identifying any substantial issues, and the paperwork is far easier to manipulate that what a person actually observes.

I spent 7 years working in a SICU - when JCAHO came around ...only the managers lived in fear. We saw very little of JCAHO - they were too busy with paperwork to explore life in the trenches. That was wrong - they choose to stick with the paperwork because if they explored the trenches, they would discover problems.

My next job was working for my state's Health Department. Although I was hired to survey hospitals and nursing homes, the regulations are set so that hospitals are very infrequently surveyed. The nursing home survey focused on observations of care, interviews with residents and families, observation of medication passes etc. During my 2 years of employment, we surveyed hospitals only twice - both times the focus was soley on Policy/Procedure Manuals and an environmental tour. The state is mandated to survey a certain percent of JCAHO hospitals to ensure JCAHO is conducting honest evaluations and not being swayed by money, perks, etc. But hey - the focus of both is on paperwork compliance.

So frankly, I don't think JCAHO will care if they get complaints re: staffing from nurses, etc. Their response will be to have each hospital develop a staffing protocol for their hospital - you can imagine how management's version of how many staff are needed compares with how staff see the minimum number of staff. In one of the hospitals I worked we had "acuity based staffing" - the only time managment used it was to pull nurses from the SICU to the floor - "Acuity staffing states you have 5 more nurses than you need - send them to these floors". When the acuity staffing indicated that we needed six nurses to provide safe care - we heard " We can send you 1 nurse that is the best we can do".

Sorry for the cynical point of view.

km rn · Feb 16, 2001

JCAHO is a voluntary accredidation agency - hospitals etc. pay money for the luxury of being surveyed by JCAHO.

I agree with the others - it is very easy for focus on paperwork compliance - it is far more tidy, there is less chance of identifying any substantial issues, and the paperwork is far easier to manipulate that what a person actually observes.

I spent 7 years working in a SICU - when JCAHO came around ...only the managers lived in fear. We saw very little of JCAHO - they were too busy with paperwork to explore life in the trenches. That was wrong - they choose to stick with the paperwork because if they explored the trenches, they would discover problems.

My next job was working for my state's Health Department. Although I was hired to survey hospitals and nursing homes, the regulations are set so that hospitals are very infrequently surveyed. The nursing home survey focused on observations of care, interviews with residents and families, observation of medication passes etc. During my 2 years of employment, we surveyed hospitals only twice - both times the focus was soley on Policy/Procedure Manuals and an environmental tour. The state is mandated to survey a certain percent of JCAHO hospitals to ensure JCAHO is conducting honest evaluations and not being swayed by money, perks, etc. But hey - the focus of both is on paperwork compliance.

So frankly, I don't think JCAHO will care if they get complaints re: staffing from nurses, etc. Their response will be to have each hospital develop a staffing protocol for their hospital - you can imagine how management's version of how many staff are needed compares with how staff see the minimum number of staff. In one of the hospitals I worked we had "acuity based staffing" - the only time managment used it was to pull nurses from the SICU to the floor - "Acuity staffing states you have 5 more nurses than you need - send them to these floors". When the acuity staffing indicated that we needed six nurses to provide safe care - we heard " We can send you 1 nurse that is the best we can do".

Sorry for the cynical point of view. But how long do you think that hospitals would continue to utilize JCAHO accredidation if JCAHO started to explore actual patient care, the impact of inadeqate staffing, etc. JCAHO knows who pays their fees - the hospitals.

Tiara · Feb 16, 2001

The best answer I have seen to this situation is, "the fox guarding the henhouse."

bbnurse · Feb 17, 2001

JCAHO accreditation or Dept. of Health visits are a lot of paperwork issues, true. If you read the latest information, however, the JCAHO folks will be looking more at the complete care of a pt. than at a bunch of medical records. They also have issued a release that they are going to focus on staffing. Does that scare administration? You bet it does. It may help a lot of nurses if adm. takes the needs to heart and plan to provide the right amount of staff to get the best care possible. We can look forward to that in 2002 or the last 1/2 of this year. The DOWN SIDE of that, is, if hospitals do not pass accreditation, it will not improve our jobs and make adm. sit up and take notice. If hospitals don't pass JCAHO every three years or the State Health Dept. yearly, they might as well close the doors and we lose our jobs. That won't help the patients nor us. You see, accreditation of some oversight regulatory agency is one of those "conditions of particpation" required by medicare. I don't know about your hospitals, but we run over 65% medicare or medicaid so we would lose funding and the hospital would close.

My point, while long-winded, is that loss of the fox guard at the henhouse, will affect our jobs more than make the administrators have to deal with us. So, that is not the solution.

I have actually been present for a "drop In" survey which gave us 24hrs notice. I have also had surveyors go into pt rooms and talk with patients and to their nurse---me. OMG!! not an easy thing to take. I have seen them talk to entire teams of ancillary care providers and ask what they contributed to this pts' care and wellbeing. I don't know if it was because it was in a smaller hospital or not. It happened this last survey in a larger hospital. So JCAHO is part of the solution but also a part of the problem. As are most things, neither all good, nor all bad.

We have to stop fighting each other and pull together for the best staffing and care we can get and give for our patients. The rest is just wasted effort, placing blame and bitching that no one really knows how awful it is. We have to be the solution. We can not look to these agencies to solve it but we can not hope these agencies close us down either. Patients have to have healthcare. It's that or we lose our livlihoods too.

LOPAIDNURSE · Feb 17, 2001

THANK YOU, TIARA I GREW UP IN KENTUCKY AND HEARD THAT SAYING FREQUENTLY. JCAHO IS NOW ON THE PATIENT CONFIDENTIALITY BANDWAGON. I HAVE NO PROBLEM WITH THAT BECAUSE I WANT MY INFORMATION KEPT PRIVATE. THE MAJOR PROBLEM IS STAFFING AND YOU ARE RIGHT. IF SOMEONE IS PAYING ME TO GIVE A BS "WHAT A GREAT HOSPITAL" LINE AM I GOING TO BITE THE HAND THAT FEEDS ME?

mustangsheba · Feb 17, 2001

It is my humble opinion the money spent on getting accreditation would be better spent on staffing adequately. Patients don't care if a hospital is accredited. They care about their care.