JCAHO-QHR-client form a triangle
Organizations recognize conflict of interest
Quality Healthcare Resources (QHR) in Oakbrook Terrace, IL, is a health care consulting firm and a not-for-profit subsidiary of the Joint Commission on Accreditation of Healthcare Organizations, also located in Oakbrook Terrace.
"QHR adheres to a very strict confidentiality agreement with our clients and with the Joint Commission," says Barbara L. Crystal, the consulting company’s marketing manager. "We don’t request information from JCAHO regarding our clients, and we don’t provide information to them regarding our client list. The only way we receive information regarding a previous Joint Commis sion report is when a client shares it with us."
When a hospital approaches QHR for help in preparing for its survey, a manager of professional services performs a detailed screen over the phone. The consultant assesses the hospital’s structure and needs, and looks at the services the institution offers, such as home care or hospital-based long-term care. The consultant also looks at timing when the Joint Commission’s survey is expected. "This way, we get a feel for the complexity of an institution’s problem," says Crystal.
Once QHR and the institution reach a preliminary agreement regarding what needs to be done, the consultant gives the client an idea of what a consultation and mock survey will cost. along with an approximate agenda. (See sample generic survey agenda, p. 127.) The company sends out a proposal that typically goes to a hospital committee.
QHR has upward of 70 consultants, and tries to match appropriate consultants with a facility’s needs. If, for example, the hospital has a strong surgical unit, a surgeon would be among its physician consultants. If ambulatory care is a major part of what the facility offers, a consultant with intensive experience in that area is sent. In any case, a team consists of a physician, a nurse, and an administrator.
In choosing a company to perform a mock survey, you might start with one of the "Big Six" national consulting firms with health care divisions, such as Arthur Andersen in Washington, DC, or Ernst & Young in New York City. Compare what they have to offer with smaller firms or even individual surveyors from the Joint Commission who do consulting on the side. Mock surveys don’t come cheap, but you may decide having one is worth your time and money. What a hospital can expect to pay for this service depends upon the size of the facility, as well as the customized scope of the consultation.
"There are always ways to work with an institution regarding cost," Crystal says. "Sometimes a facility doesn’t need or can’t afford a full integrated mock survey and prefers to customize the consultation to save money. A hospital might come to us and say, We have such and such amount of money to spend. Please tailor an assessment for us that best fits our needs.’"
Working from that cue, QHR provides advice on what patient units the Joint Commission might visit and what else the upcoming survey will likely include. The hospital ultimately chooses what it wants the assessment to cover. "We work with them to pare down their consultation," says Crystal, "but of course we caution them that there’s no guarantee the Joint Commis sion won’t look at those areas we didn’t touch upon."
Prior to the consultants’ on-site visit, they do an extensive document review board and bylaw papers, environment-of-care plans, information management plans, and so on. They get a feel for where there might be gaps. The process also serves to familiarize the consultants with the organization before they arrive.
"Generally," says Crystal, "hospitals are familiar with Joint Commission surveys and their requirements, so they don’t need much background information. In other settings, such as home care or long-term care, where accreditation could be relatively new, there’s more hand-holding."
During the engagement, consultants may see gaps or places where extra work is needed. They’re picky about the same things the Joint Commission is going to be picky about. Each standard is analyzed: Is the facility meeting the standard? Is there a gap? Is there a possible Type 1 recommendation?
The consultants submit a written executive summary report when they leave. The report highlights some of the most important recommendations so there aren’t any surprises when the full integrated report is issued 30 days later. "One of the consultants stays at the site an extra day for implementation planning," says Crystal. "That day, the consultant jump-starts organizing work plans, assigning responsibility and accountability for tasks, setting deadlines, and so on."
There can be intensive follow-up, as well. "We keep in touch with the institution to see how it’s doing," says Crystal. "Sometimes the client may engage QHR to come back to check on progress."
"Our consultants are generally booked two months out," says Crystal, "so the amount of lead time clients give us in arranging an assessment works to their benefit. After a contract is drawn up, the engagement is set in motion, and a lead consultant goes over details of what is hoped to be achieved."
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