It's time to end JCAHO's sham hospital inspections

When you know your in-laws are coming to visit, your first instinct is to wash the dishes, make the beds and clean the bathrooms. You're looking to present a positive image of your home that isn't necessarily typical but likely will pay dividends in countless ways. When hospitals find out when inspectors are coming, the same behavior patterns kick in. Temporary staff are hired; vacations are cancelled; floors are waxed; halls are cleared; and plants, furniture and other items to spruce up the hospital are rented. Like magic, these things disappear when the inspection is over, leaving the real but undetected problems behind.

Federal investigators recently released a crucially important report that lifts the veil on these sham hospital inspections. The inspector general of the U.S. Department of Health and Human Services said the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) inspectors generally are unable to detect substandard care because the organization is too cozy with the hospitals. Two of the biggest contributing factors are that hospitals get advance notice of inspections, and hospitals can choose which patient records inspectors can examine.

Most of JCAHO's funding comes from the hospital industry, and a quarter of its board members are hospital executives. JCAHO considers hospitals, not the public, to be its clients.

Virtually every hospital surveyed by JCAHO passes inspection and receives accreditation. Nurses and other health care workers roll their eyes when hospitals brag about their high marks in full-page ads or in banners over the hospital entrance. National and regional surveys of registered nurses show that, unlike the rosy picture painted by JCAHO, quality of care has declined to such a poor level that many nurses would not feel comfortable having a loved one admitted as a patient to the facility where they work.

The inspector general has performed a great public service by exposing the flaws of the current quality inspection system, but more must be done. It is time to push for changes in the JCAHO accreditation system:

• All inspections should be unannounced.
• The surveyors, not the hospital, should choose the records to review.
• All survey results must be made public, posted in the hospital and available on the Internet.

Front-line health care workers should be given the opportunity to tell surveyors what's really going on in the hospital. And--very important--these workers need whistleblower protection from any retaliation for telling the truth.

Bottom line practices are threatening the quality of our health care system. The Joint Commission can be an ally in the fight for quality but only if it changes. Health care is too important to be left in the hands of the current inspection system. The time has come either to end sham inspections or to put an end to JCAHO. (See feature story.)