Serious errors can put you on accreditation hot seat
The Joint Commission is watching you
The Joint Commission has come up with a new way to threaten a hospital’s accreditation by targeting hospitals that receive bad publicity after a serious medical error. In addition to the bad press and investigations from local authorities, the Joint Commission may get involved and demand an explanation, all under the threat of revoking your facility’s accreditation.
The new program from the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, involves putting facilities on "accreditation watch" status after a particularly egregious error that suggests there may be a systemic problem threatening the health and safety of patients. Once placed on accreditation watch, the facility must present a report on the error, explain why it happened, and how the systemic problem will be corrected.
In announcing the initiative, the Joint Commission described it as a way to address serious medical errors. The announcement came at the same time the American Medical Association announced the formation of the National Patient Safety Foundation, an effort to collect information on medical errors and use the database to improve patient care.
While the Joint Commission’s spin on the accreditation watch program is that there is nothing punitive about it, some risk managers see it differently. Grena Porto, RN, MS, DASHRM, director of clinical risk management at VHA East in Berwyn, PA, sees the program as punitive and unnecessary.
"It sounds bizarre to me to say that it’s not punitive but on the other hand they’re putting your accreditation in jeopardy," Porto says. "The only thing the Joint Commission is empowered to do is bestow accreditation or take it away. That’s pretty punitive."
Events in news might be catalyst
Porto sees the accreditation watch program as an unnecessary burden to hospitals that already are under fire for a serious patient injury or death. Because their accreditation is in jeopardy, they will be forced to jump through the Joint Commission’s hoops, she says.
Another concern is how the Joint Commission is defining the "sentinel events" that can result in a hospital’s accreditation being threatened: "an unexpected occurrence, involving death or serious physical or psychological injury or risk thereof." The last two words make the definition too broad and vague, Porto complains.
The Joint Commission’s vice president for accreditation services also uses a vague explanation of what sort of event might trigger accreditation watch status. Richard J. Croteau, MD, tells Healthcare Risk Management that the event must be a "serious adverse outcome, such as death, the loss of a limb, loss of function." The adverse outcome must be sufficiently unexpected to suggest that there is an underlying deficiency at the health care facility. An example would be a surgical mistake in which the wrong leg is amputated, he says.
For the Joint Commission to initiate accreditation watch status, the adverse outcome must come to the agency’s attention, "and we typically find out through the media," Croteau says. In most cases, accreditation watch status will be in response to an adverse outcome that attracts widespread media attention, he says, not an event that remains a secret within the hospital.
"A lot of adverse events happen and it’s not our intent to put organizations on accreditation watch in all cases," he explains. "We need to be practical. This is a new policy and we’re looking for ways to conduct this without being punitive."
Thirty days to respond
Once a facility is placed on accreditation watch, it must submit a report to the Joint Commission within 30 days. The report must include a root cause analysis and a plan for correcting the problems that led to the error. If necessary, the Joint Commission will provide assistance to the hospital during the investigation. If the initial report is not satisfactory, the Joint Commission will allow another 15 days for a second report.
"If they do a root cause analysis in good faith and we find it acceptable, we will arrange for any follow-up within six months to check on improvement," Croteau explains. "If the root causes are corrected, that can be the end of the accreditation watch. But if they’re not proceeding in a true improvement mode, they could lose accreditation."
Croteau stresses that the Joint Commission’s intent is to help hospitals correct systemic problems that threaten patients. Ideally, every accreditation watch status would result in improvements at a targeted hospital, not a loss of accreditation.
But Porto sees the program differently, suggesting that it will be only another unnecessary bureaucratic burden. By the time a hospital is put on accreditation watch, it already will have recognized the sentinel event and probably will be under investigation by local and state health authorities, she notes.
Porto also questions the Joint Commission’s motives, especially since it seems the accreditation watch program will target health care facilities that receive media attention for noteworthy medical errors. Porto suggests that the Joint Commission may have been embarrassed by past events when the media reported that there was little Joint Commission involvement with obviously troubled hospitals.
"Events that wind up in the media are not indicators of quality of care. If they’re using the media to determine the events that wind up being reported under this new regulation, that is an imperfect system," Porto says. "There is no correlation between the seriousness of the event and what gets attention in the press. You’re letting the press determine whose accreditation is targeted."
Risk managers will be left with little choice but to comply with the Joint Commission’s requirements, no matter how superfluous the investigation or disingenuous the motivation, Porto says.
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