Massachusetts Nurse :: October 2004

Government report finds JCAHO more 'lap dog' than 'watch dog'

By David Schildmeier

As hospitals continue to promote their "quality care" based on accreditation by the Joint Commission on Accreditation of Health Care Organizations (JCAHO), the Government Accounting Office (GAO) has released a report that found that JCAHO regularly failed to identify "serious deficiencies" at hospitals—problems later found by state inspectors that could "potentially compromise patients' safety."

In response to the GAO report, a bipartisan group of lawmakers introduced a bill under which Medicare could restrict or remove the authority of JCAHO to accredit hospitals. "Congress expects the Joint Commission to be a watchdog," said Sen. Charles E. Grassley, an Iowa Republican and one of the bill's sponsors. "It looks like the Joint Commission is instead a lap dog."

JCAHO is a private nonprofit organization that has been granted the authority to ensure that health care organizations meet the patient care and safety standards that are required in order to receive Medicare payments—a monetary figure that totals more than $109 billion annually. Here in Massachusetts, the Department of Public Health accepts JCAHO accreditations, which occurs every three years, as deeming a hospital "safe." The DPH will only investigate the quality of care at a facility after something terrible has occurred.

The organization has long been criticized for its lax system of oversight, and in 1999 a Department of Health and Human Services report issued a scathing indictment of the JCAHO process of accreditation, saying it failed in its mandate to protect the safety of patients and was too closely aligned with the industry it was charged with overseeing.

Nurses are among those who have long criticized JCAHO and the system of oversight for the hospital industry as a complete joke and an utter failure.

"Every front-line nurse knows that JCAHO is a total joke," said Karen Higgins, RN. "The hospitals are given notice of pending surveys, and they spend months preparing to get ready. Staffing always improves around the time of a JCAHO visit, and it goes right back to normal (usually bad) immediately after. What good is a voluntary system?"

The credibility of a voluntary process of accreditation takes on added significance for nurses as many hospitals are moving to the "Magnet Program," which is a JCAHO-like process that was created by ANA and that applies a similar process to nursing.

Based on a survey of 500 hospitals inspected by JCAHO between 2000 and 2002, the report found that the organization failed to identify 167 of the 241 deficiencies state inspectors later found at the facilities, or 69 percent of the total. Deficiencies that JCAHO failed to identify included a Texas hospital that failed to manage a serious infection control problem; a California hospital that had no system to ensure sterilization of medical instruments; and a another Texas hospital that administered medication without a physician's orders and gave a double dose of narcotics to an ED patient who later died.

These reports are highly troubling given that they fall on the heals of numerous reports in the most prestigious scientific journals that show patients are suffering greatly and many more are dying because of poor care, particularly due to chronic understaffing at hospitals.

Here in Massachusetts, the DPH reported a 76 percent increase in the number of patient injuries, medication errors and patient complaints in hospitals over the last seven years. A survey of the state's nurses found that two thirds reported an increase in medication errors, and more than half reported an increase in patient injuries, harm to patients and readmissions due to poor care. One in three reported an increase in patient deaths due to poor care.

Yet, nearly all Massachusetts hospitals have glowing reports from JCAHO, and as a result, DPH does nothing to address the problems nurses have so readily identified.

"That is why we need a safe staffing law that makes safe RN-to-patient ratios a condition of licensure," Higgins said.