Monday, April 18, 2011

Who's on first?

This story about the Joint Commission in the Boston Globe is disheartening.

The lede:

The national organization that accredits hospitals will tackle the failure of medical staff to respond to patient alarms, making it a top priority this year.

But the real story is the failure of the Joint Commission to address this issue in a comprehensive and thorough manner. Indeed, it seems to have dropped the ball:

In 2004, the commission decided to make improving alarm safety part of its national patient safety goals, which signaled it was a high priority. However, the agency soon dropped the goal, thinking that hospitals had solved the problem.

The Joint Commission seems to need to spend some time getting a focus on things. It makes animated cartoons about avoiding the spread of germs. It refuses to make its library of hospital best practices widely available. Even in this story, it seems to fear transparency: "He wouldn’t release numbers, but Schyve said the Joint Commission is getting more reports of hospital staff not responding to crucial alarms, or alarms being shut off."

This is the group that accredits hospitals for participation in Medicare. How can Congress let an accreditation agency that works for the public be so opaque with regard to clinical information and with regard to its progress in working on systemic change in hospitals?


e-Patient Dave said...

Thanks for posting this.

Speaking from the perspective of patient safety and patients being engaged in improving healthcare, I want to know: what is their higher priority than letting everyone possible do everything possible to stop the (accidental) killing??

What is the higher priority?

nerdse said...

JCAHO has regulations that are so insanely detailed that doing things by their book would take caregivers away from patient bedsides. They do allow comments, starting around Jan or Feb, on what they're going to load hospitals up w/ the next Jan. Do people know hospitals pay JCAHO to accredit them? That in many states a HC facility can't open its doors w/o this accreditation? That hospital personnel often go home sobbing after being grilled by JCAHO, as they focus on minor details & not major patient care? That their demands regarding documentation are so bad that in 2005 it was estimated that every hour of patient care required 5-8 hours of documentation by all HC professionals? They are too busy justifying their existence with overweening regulations to do any real good for patients.

Mike Rocha said...

Hello Dr. Levy ~

Realize this is not health care-related, but happened to espy you at the Dubravka Tomsic concert last Saturday night. I pen reviews for the Boston Musical Intelligencer, an obscure-but-apparently-well-read publication. If interested, here's my [admittedly long-winded] impression of the event:“brrrava-dubrrravka”-for-tomsic/

Wishing you the best of luck! . . . .

~ s k n a h T

e k i M ~
Mike Rocha

Anonymous said...

Paul, your series of posts about the JC has really made me think about what they are (or are not) doing. Woe betide the JC-inspected hospital which finds a problem, institutes a 'solution', then fails to follow up on the effectiveness of the solution and lets it recur, as noted in the comment section of the Globe article. Yet here the JC has done so with impunity. Where is their deficiency in 'condition of participation'? This lack of follow through seems pretty egregious by the very accrediting agency enforcing the rules. As I mentioned before, I fear that they are behaving more as paid hospital consultants than a standard-enforcing advocate for high quality care.
Not to ignore your other primary point - why should any of this be a secret? Are we protecting those 'clients' again?
More on another issue in a second comment.


Anonymous said...

Part II:
This issue also gives the JC an opportunity to implement another of its tools: the root cause analysis. This is a situation that cries out for a uniform analysis and solution, rather than browbeating individual hospitals into their own hasty solutions. Take a look at the number of independent organizations who are going to 'study' this issue - who will coordinate all of them and arrive at a consensus solution? And one Globe commenter notes that the American Ass'n of Medical Instrumentation's committee includes almost all manufacturers, with 2 physicians - no end users or patients (

Let's see the JC show some leadership here, since it purports to have a Best Practices Library, and convene and coordinate a group of all stakeholders, including users and patients, to brainstorm this issue. Who knows, it could serve as a template for other common patient safety issues.

Let's not hear the institutional equivalent of, 'it's not my job'.


Paul Levy said...

Thanks, Mike. I left you a comment over there.

Anonymous said...

We are nearing a long anticipated turn in the evolution of healthcare. I very much doubt that incoming generations of healthcare consumers (they are walking in the door right now) will put up with this too much longer. People can smell diversion. Unlike many consumer purchases, this one is more intimate.

In honor of the Boston marathon, see

Someday, people will be amazed to think that healthcare systems could be allowed to perform with patients as only bystanders.