Tuesday, February 22, 2011

The dummies' guide to The Joint Commission

I received an email advertisement, and it left me saddened. It is for a book entitled The Joint Commission Survey Coordinator's Handbook. This was the text of the email:

Packed with expert advice, best practices, and sample tools and tracers, this book saves you from having to research and manage Joint Commission accreditation activities on your own.

Now in its 12th edition, this fully updated book by Laure L. Dudley, RN, MS, interprets The Joint Commission’s standards in practical, straightforward language that removes the guesswork for you. Discover what has changed in the past year, what you need to know about the standards, and what you need to do to comply.

So, I figured that this was the dummies' guide to the Joint Commission's standards. I was saddened to think that those standards are so abstruse that there is a need to translate them into "practical, straightforward language."

Then, I clicked on the book's image in the email and was taken to the real advertisement. Upon further review, I figured out that the book is not the dummies' guide only for hospital folk who are about to be surveyed by the Joint Commission. It is as much a guide for the surveyors themselves! The ad includes the following in addition to the text above:

  • Find answers to all of your Joint Commission questions in one resource
  • Remove the guesswork and hunting for the latest Joint Commission changes
  • Gain confidence in your role as survey coordinator
  • Become an effective communicator with staff and leadership
What’s new:
  • Joint Commission Standards and CMS: Much has changed in the Joint Commission standards following the organization’s deemed status application. Find out how this affects survey preparation as The Joint Commission aligns closer to the CMS Conditions of Participation.
  • The clarification process: One of the most nerve-wracking components of a Joint Commission survey is clarifying requirements for improvement. Find tips and suggestions for getting the most out of your clarification process.
  • Insider perspective: This year the Handbook is written by a former Joint Commission employee and contains guest commentary by several other former staff, offering readers a distinct insider’s perspective.
  • Updated Life Safety Code® for the non-engineer: Written by safety expert Brad Keyes, CHSP, discover how the Life Safety Code® is accessible to survey coordinators and other non-engineers.
I don't know if the book is an officially authorized publication of The Joint Commission. That point is blurred a bit, as there is an endorsement in the advertisement from someone putting herself forward as a surveyor. If it is authorized, it should say so. If it is not, it does not seem appropriate for a JC employee or contractor to endorse a publication by a third party.

Beyond this point, though, what does it say about hospital accreditation standards if there is a need for them to be translated or interpreted in this manner? What does it say about the training of surveyors if they need CliffNotes to do their job confidently?

Maybe this is just a clever company trying to make money from both hospital safety and quality folks and from JC surveyors. On the other hand, it is the 12th edition, so the book seems to have some staying power. And the author is a former executive director of The Joint Commission.

For years, I have been proclaiming the importance and value of JC surveys, having great appreciation for the dedication and expertise of the surveyors who visited our hospital, and noting:

I have often said that, if the Joint Commission did not exist, we would want to invent it. An objective outside review of this sort is extremely helpful to a hospital as it strives to provide better and better care to the public.

Each time I said that, though, observers from other hospitals would skeptically respond by saying that the accreditation standards are often recondite at best, but also sometimes in conflict with good clinical practice. Some of that is inevitable, and I am confident the JC is involved in its own process improvement efforts on those fronts. But, wouldn't it be nice if the 12th edition of this book were the last because it just wasn't needed any more?


Anonymous said...

Having served as an inspector for the College of American Pathologists, which serves as a JC 'substitute' for many hospital labs; I can attest that understanding your own organization's standards or checklist questions can be difficult. But it would seem the JC itself should be answering these questions, not letting marketers publish a book about it.

The real tragedy is that hospitals concentrate on the minutiae of what they have to do to pass the inspection rather than on the underlying principles of good care on which it is based. Analogous to 'teaching to the test' in education, I supposed.


Bob C. said...

Maybe I missed something, but I understand the target audience to be survey coordinators (within the hospital/health system); not TJC surveyors.

Mark Graban said...

That "teaching to the test" analogy seems to certainly hold true, nonlocal.

There are parallels, it seems, to ISO-9000 in the manufacturing world. Having the certification or accreditation doesn't seem to be any indicator of quality for the factory or the hospital. It seems that every major high-profile medical error that's in the news comes after a Joint Commission accreditation.

As with ISO, it's all in how you go about it -- just passing the test or a tool to drive improvement.

One example that always comes up - Joint Commission says hospitals are not supposed to store equipment and gurneys in hallways. Also, it just makes sense not to so that you are blocking patient transport or emergency response.

But hospitals almost ALWAYS store stuff in the halls (and store stuff under sinks).... except for when Joint Commission is coming.

It reminds me of a British-ism that the Queen thinks the world smells like a fresh coat of patient. Do Joint Commission inspectors REALLY think these rules and guidelines are really being followed when they are not there?

It takes two sides to be complicit in an effective oversight regime - the overseers and the overseen.

Bill said...

From Facebook:

What struck me most about your observations were these questions:

>"What does it say about hospital accreditation standards if there is a need for them to be translated or interpreted in this manner?"

>"What does it say about the training of surveyors if they need CliffNotes to do their job confidently?"

My world is post-acute (nursing home, outpatient rehab, hospice) care where CMS rules more directly -- no JCAHO deemed status, except for hospices. We have experienced a similar "creep" in the amount of "helpful guidance" on CMS regulations which, in some cases, have actually not changed in many years. But the agencies pile interpretive guidelines on top of interpretive guidelines to the point where the 2010 version of the nursing home regs are over 800 pages long, when they were only 200 pages long less than 10 years ago.

As the demands for more accountability and efficiency are spoken more loudly, this does seem to be an aspect that can't be overlooked. Standards are beneficial and can be the rising tide that brings up (or out) some of the less seaworthy boats, but it also forces us to allocate resources toward compliance that might be better-directed closer to those we are here to serve!

Thanks for bringing this up, Paul.

Anonymous said...

Mark, you make me laugh about the equipment in the hallways. My hospital did that consistently, which always irritated me because it was the same hallway leading to the morgue (I was a pathologist). Just before the JC inspection, it would all disappear like magic! Then literally the day after, it reappeared. Never did find out where it went....


Mark Graban said...

nonlocal, your hospital may or may not have rented trailers or temporary storage space to put all that stuff... I've heard crazier things.

Anonymous said...

I can tell you, as a current Joint Commission employee that:
1) This book is not a publication from The Joint Commission. Several companies are in business specifically to "explain" The Joint Commission's standards. Their business model is based on making it seem that the accreditation standards are more complicated than they really are. Whether they "explain" accurately or not is anyone's guess.
2) The author is a former executive director -- of the marketing department at The Joint Commission, so her expertise on the subject is something to take with a grain of salt. (Why is there a marketing dept, you might ask? Well, The Joint Commission accredits ambulatory care, long term care, behavioral health and other settings, and does not have anywhere near the ubiquitous presence that it has in hospitals.)
3) We know that hospitals have always prepared pretty heavily just before the accreditation survey (getting equipment out of hallways, for example) which is why the on-site surveys are now unannounced.

Anonymous said...

I believe a previous comment to be correct. The book is a prep guide for the survey coordinator role in a hospital that is why it is called "The Survey Coordinators Guide..."