Aug 28, 2008

JCAHO: The "Big Brother" of Medical Practice


I remembered a few months back when my brother told me that one of the major hospital in the city here in Cebu was threatened by an immediate drop in hospital admissions. Something very unusual for them since they are always flooded with patients at any given time. All of a sudden, as what my brother described the phenomenon, the emergency receiving area became a "ghost town". Orderlies are lining up outside waiting for patients!

What brought about this phenomenon? As it turns out, many of their hospital doctors has somewhat "unionized" and started referring their patients to other hospitals of their affiliation. What sparked the sudden outrage of these doctors was due to the hospital's initiative to adopt JCAHO practices. As a consequence, other hospitals within the city suddenly had an unexpected surge of patients while the said hospital had very few. So what is JCAHO? Why are doctors in that hospital intimidated and even caused outrage to move their patients out?


What is JCAHO?

JClogo JCAHO is an independent, not-for-profit organization, The Joint Commission accredits and certifies more than 15,000 health care organizations and programs in the United States alone. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

What is JCAHO's Mission?

To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.

What is the scope of JCAHO?

The accreditation programs of JCAHO includes: Ambulatory Care, Assisted Living, Behavioral Healthcare, Critical Access Hospitals, Home Care, Hospitals, Laboratory Services, Long Term Care, Networks, and Office-Based Surgery.


Isn't this good for all of us?

The answer is a resounding yes! However, (in my opinion) doctors are threatened because of the following reasons:

1. Standards: When doctors work in a JCAHO accredited hospitals, part of the policies that they are expected to adhere is the set standards by JCAHO. This means that doctors cannot just confine patients, request lab workups or procedures unnecessarily. Thereby, controlling healthcare cost incurred by he patients. This significantly controls the doctor from having malicious agenda of giving so many procedures and confining them unnecessarily just to earn more. This is true and this is rampant.

2. Peer Review: This time around, doctors practices are meticulously reviewed for proper patient management. They are under a watchful eye of hospital appointed committee (like the "Big Brother") and reprimand if any violations are made, be it procedurally or behaviorally.

3. Performance Evaluation: With our current healthcare practice, who determines if the doctor is effective in patient management? Does the doctor himself even know he/she is efficient and effective in delivering healthcare? I bet he doesn't. We consider doctors as modern day Shamans and would want to remain that way! JCAHO has toolkit for medical practitioners in the form of performance indicators. It is performance metrics program where all their patient management activities are measured, quantified and analyzed. The output of the report provides a grade. Just like how hospitals under JCAHO are graded from 0 to 100.

4. Full disclosure: Doctors are also expected to fully inform and disclose all activities that will be done to the patient, its outcome, and medical errors (if any) - blag! Doctors are human and they commit mistakes but they are not honest enough to tell you they made a mistake for fear of litigation.

My thoughts:

We don't anymore live in the middle ages where the Shamans are the only people in the know and not even question their authority. Doctors have enjoyed that position for a long time and at most at the expense of patient safety. JCAHO's basic tenet is patient's safety. Nothing more and there are no hidden agenda to this. Bottom line here is, doctors don't want to be controlled or a "big brother" watching over their shoulders. It just annoys them to think that they can be kicked-out of the JCAHO accredited hospitals or worse, sued for medical errors by their patients.

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