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UPFRONT

Oh, JC, improvement to patient care is where?

“I’ve known for years that the Joint Commission’s hospital accreditations aren’t worth the paper they’re printed on.”

–Rep. Pete Stark (D-Calif.), former chair, House Ways and Means Health Subcommittee in 2007 interview.

So after finishing the “huddle” in the retrobulbar injection area, then repeating the same formation in the “time out” spot in the operating room, I was able to start operating. During surgery, I was annoyed to hear the endless computer button clicks that our circulating ‘scribe’, aka nurse, made while charting the surgical events into our EMR system. In fact, she spent more time clicking on the computer than providing patient care. I asked for several instruments that remained unavailable until she finished charting. What once was an important part of surgery has morphed into a secretarial position, all to fulfill the “patient safety” requirements of the monopoly known as the Joint Commission, formerly JCAHO.

There is no doubt that nothing strikes more fear into a hospital administrators’ heart than the words — “The Joint Commission is here.” This so-called nonprofit organization is considered the official accreditation and certification organization of the more than 22,00 hospitals in the US. Its “mission” is to “improve health care for the public.” Hospitals pay the Joint Commission (JC) for the privilege of being surveyed, and in the off years they pay others to perform mock surveys to prepare for the real thing. Why? They have to. Since Medicare requires accreditation for reimbursement, the Joint Commission enjoys statutory protection to the tune of hundreds of millions of dollars per annum.

Every year, the JC issues more rules, more alerts, more verboten abbreviations, more time-outs/time-ins/huddles et al to follow. In other words, it demands more time the health care professional must concentrate on paperwork and not the patient. Moreover, the rules do not take into account what works in a huge health care system like the Cleveland Clinic versus a tiny community hospital sans the resources to comply with the ever-increasing, arbitrary rules.

It is a self-fulfilling prophecy when an organization that depends on surveying hospitals once every three years to see if they are following “all the rules,” must keep adding rules or face extinction. Why would a business only have a finite number of “standards” that a hospital should follow, when adding more every year ensures they will always have a job? This past fall, I was forced to wear a ridiculous bouffant hat that covered my ears while operating instead of the OR cap that surgeons have worn for eternity. Was this in response to a well-performed study that showed the risk of infection was different? Of course not.

Do all these rules make hospitals improve patient care, improve safety, or reduce complications? I have yet to see one iota of evidence of that being true. In fact the evidence is to the contrary. Some rules often make no sense, but the fact that of the 13 JC officers, only three are doctors and two are nurses, which makes this situation understandable.

As for me, the key to passing any JC interrogation is to flip over my ID badge and find the particular answer posed: my hospital has thoughtfully provided all pertinent answers on its back. I guess that makes the care I provide my patients better. RP