Change is in the air for the nation's notoriously lax hospital inspection system.

For years, nurses and other health professionals have complained that the inspections of the Joint Commission on Accreditation of Healthcare Organizations are a sham. Now the federal government's chief health inspector has issued a scathing report that confirms what they've been saying. The report, from June Gibbs Brown, inspector general of the U.S. Department of Health and Human Services, calls for fundamental changes in the system that provides accreditation, and therefore federal Medicare dollars, for 80 percent of American hospitals.

In the wake of the report, the Federation of Nurses and Health Professionals and two other AFL-CIO health care unions are stepping up their effort to turn JCAHO inspections into genuine assessments of patient care.

The three unions--FNHP/AFT; the Service Employees International Union; and the American Federation of State, County and Municipal Employees--are pressing JCAHO on what should be the most basic elements of a hospital inspection system: getting a true picture of what happens in hospitals and making the results public.

The unions met with JCAHO executives immediately after the inspector general's report and pressed them to make four specific changes:

• Stop announcing inspections ahead of time;
• Let health care workers provide information to inspectors at confidential, off-site interviews;
• Protect whistleblowers;
• Publicly disclose findings.

FNHP program and policy council vice chair Ann Twomey was one of the FNHP leaders at the meeting. "They're not there yet, but they are trying to be responsive. We can't let up on the pressure. The problems are fundamental. They won't be corrected until JCAHO truly acts as an oversight body, not an arm of the hospital association," she said.

After the meeting with union leaders, JCAHO announced that from now on, its "random unannounced" hospital surveys--follow-up, surprise return visits to previously inspected facilities--will really be unannounced. Previously, "unannounced" meant a hospital had at least 24 hours advance notice. However, only 5 percent of the hospitals JCAHO surveys are subject to these follow-up inspections. The regular inspections conducted every three years will continue to be scheduled long in advance.

Even this relatively small move provoked an angry outburst from the American Hospital Association. Modern Healthcare magazine reported that the AHA is "furious" and quoted AHA communications advisor Richard Wade as saying, "We're upset about the outcome and very disappointed in the process [of] how they got to it." The magazine said an AHA senior vice president complained that JCAHO had reneged on a promise to discuss and pilot test any changes.

But JCAHO is distributing a video to its member organizations and accredited hospitals that explains the need to get real about inspections. In the video, half a dozen health care leaders warn that if the industry doesn't clean up its act, the public will make the government come in and do it.

Inspector General Brown's report calls for action by the federal Health Care Financing Administration. HCFA controls the vital flow of Medicare dollars. Under current law, hospitals accredited by JCAHO are assumed to be good enough for Medicare. Brown suggested that if JCAHO does not mend its ways, HCFA should consider asking Congress to change the law. Currently, she said, "Joint Commission surveys are unlikely to detect substandard patterns of care or individual practitioners with questionable skills." She pointed out that HCFA inspects nursing homes much more stringently.

The inspector general's report follows a 1998 investigation by New York City public advocate Mark Green who concluded that JCAHO is not capable of keeping New York hospitals safe.

FNHP Program and Policy Council chair Candice Owley was interviewed on 10 radio news programs around the country after the new report was issued. Owley said reporters were surprised that hospitals know in advance when inspectors are coming.

Owley welcomed JCAHO's recent moves but said the industry should be regulated by government, not by itself. JCAHO's inspection system may improve as long as health professionals and consumer groups keep it in the spotlight, she said, "but eventually people will move on to something else unless a real tragedy brings this issue back. I would hate to see a tragedy be the way legitimate regulation gets put in place."