Do you need more than one accreditation?
January 1, 2002
Do you need more than one accreditation?
The introduction of the ISO 9000 standards and certification process to the U.S. health care industry raises an intriguing question: Does the industry need two certifications? Can two accrediting organizations — the International Organization for Standardization (ISO) and the Joint Commission on Accreditation of Healthcare Organizations — peacefully coexist?
"A couple of years ago, I sat on an International Board for Health Care Quality," recalls Judy Homa-Lowry, RN, MS, CPHQ, president of Homa-Lowry Healthcare Consulting in Canton, MI. "There was a discussion about how ISO is being applied in Europe and its possible applications in the U.S. I also work with the Joint Commission, and we have been exploring the question of whether we could set up an international standard for health care," she says. "I really think there was an attempt to show how they complement one another. The interesting thing is that the Joint Commission requirements really talk about a process being designed well or measuring the process to see if it’s working. The ISO 9000 piece is a mechanism to do that."
Sandra L. Abnett, RHIT, CPHQ, director of quality management at WellSpan Health System in York, PA, says ISO 9000 may offer the Joint Commission some stiff competition.
"Hospitals are becoming disenchanted with commission [accreditation] costs, even for medium-sized or small hospitals," Abnett notes. "They have a base fee and then additional costs according to volume, lab tests, and so on. In a middle-sized hospital with, say, 300 beds, you’re looking at a five-digit bill — $20,000 to $40,000. That’s why ISO 9000 came into the picture," she continues. "It’s not as costly. The cost is probably a couple of thousand dollars, or $5,000 or $10,000 at most." The reason hospitals go with the Joint Commission is "deemed status" from a Medicare reimbursement standpoint, Abnett asserts. "[The Centers for Medicare & Medicaid Services] kind of lets you alone if you are Joint Commission-accredited."
But Leelanau Memorial Hospital in Northport, MI, holds both certifications. "The Joint Commission, as I see it, tends to be very involved in clinical outcomes, while ISO is much more process-oriented," says Jane Bull, RN, BSN, MBA, the facility’s CEO. "ISO folks, by and large, are not clinicians. Can they come together? At some point, it would be really nice if they would," she says. (Leelanau has pioneered in ISO certification for U.S. hospitals. See "Hospital pioneers ISO certification" in this issue.)
Homa-Lowry contends the two initiatives can coexist. "I think that the Joint Commission has an initiative now where it evaluates its standards and make decisions as to which ones have an impact on patient care."
"If [that agency] used ISO, it would really help . . . develop good processes, instead of just stressing being in compliance, which has more to do with outcomes. The Joint Commission really does care about that," she says. The bottom line, Homa-Lowry says, is that some facilities will continue to stress accreditation, some will stress reimbursement, and others will stress process. "It all has to do with the culture of the organization," she concludes.
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