The Joint Commission (previously known as the Joint Commission on Accreditation of Healthcare Organizations, and still informally called "JCAHO" or "Jayco") has for years assessed quality and safety in hospitals. Previously conducting a somewhat bureaucratic review of files and written rules, Jayco recently enhanced its survey procedures to complete much more thorough investigations of actual clinical procedures and the medical staff's understanding of patient care guidelines.
Also, the Joint Commission now does unannounced surveys, in contrast to the previously scheduled visits. So, a team shows up on a Monday morning and spends the week in your hospital conducting an extensive and intensive review. If they find things wrong, they issue "requirements for improvement", and the hospital must show a detailed plan for making the improvements in a set period of time. If they find enough things wrong, the ultimate sanction is a loss of accreditation, which is bad in many respects, not limited to losing the right to be paid by Medicare.
This is all to the good. Notwithstanding great intentions by well-meaning medical staff and effective supervision by a board of trustees, independent external reviews are helpful in many respects. Our slogan is, "If Jayco didn't exist, we would want to invent it." That is not to say that a visit doesn't make us sweat, and that the prospect of their unannounced arrival doesn't keep people awake each Sunday night. It does.
One of the medical standards currently being enforced by the Joint Commission is something called "medicine reconciliation". Part of this standard means that we are supposed to to discuss with all patients the medications they were taking before entering the hospital, and review their medications again upon discharge. This is supposed to apply to both inpatients and outpatients.
This makes tremendous sense, of course. How can you give thorough and proper care to patients without knowing what medicines they are already taking? But, frankly, it is not always carried out to the full extent. Things happen: A busy clinic, a confused patient, a missing note from the referring physician. But clearly, the goal is full compliance.
This is just one example. It would be the truly extraordinary hospital that gets a perfect score from a Jayco surprise visit on the wide range of patient care standards. But that's just the point, isn't it? Even the finest institutions can improve, and sometimes we all need an objective outside observer to tell us where we should focus our efforts.
The job of hospital management is to use those findings as positive challenges for the institution and help it achieve ever better results for the public. Having talked with my colleagues in the other Harvard hospitals and in the other Boston-based hospitals, I know they share that view. The public should feel good about that shared perspective -- while still holding us accountable for better and better performance.