The Joint Commission, which accredits four-fifths of the nation’s hospitals, is being accused of misleading consumers about the quality of care at those hospitals and then ignoring suggestions on how to correct the problem.
“The organization that accredits hospitals around the country, and voices support for transparency about hospital quality, has a Web site that obscures the reality of many hospitals’ performance,” said Charles Ornstein, president of the Association for Health Care Journalists (AHCJ) and a reporter for the public-interest journalism group ProPublica . In a March 1 letter sent to Dr. Mark R. Chassin, the Joint Commission’s president and CEO, Ornstein noted that not only has the group not addressed the “navigational issues” raised by AHCJ more than two years ago, but problems that make the commission’s QualityCheck site even less useful have cropped up.
For instance, that “Gold Seal of Approval” for your local hospital? Perhaps it should be called a Gold Seal of Possible Approval. Says the AHCJ: “[It] is misleading because hospitals with conditional accreditation or preliminary denial of accreditation still receive the same gold seal as fully accredited facilities.”Meanwhile, if you want to find only those hospitals with less-than-full accreditation, you’re out of luck. Says the AHCJ: “To check on a hospital’s accreditation status, one has to open each individual profile. The Joint Commission once had a mechanism to sort hospitals by accreditation status, but that is no longer available.”
Also, “no longer available” is any past record that a hospital flunked its survey. Says the AHCJ: “After a hospital loses accreditation, its past Accreditation Quality Reports are eventually removed from the site, leaving only the facility’s name with no historical record.” The journalists are too polite in their letter to mention that the Joint Commission surveys are paid for by the hospitals, themselves.
The accusations of purged information are particularly troubling given the Joint Commission’s embarrassing history. Its predecessor began life by taking the results of the very first national survey ever of hospital quality and burning them in a hotel furnace at midnight specifically to avoid the poor performance scores falling into the hands of the press. That seminal 1919 event is missing from the official Joint Commission history on its Web site – like other bad news? — although it is publicly acknowledged elsewhere.
As a consultant who has been frustrated by the Joint Commission Web site for years, the general navigational problems came as no surprise. I have had great difficulty using it; I can only imagine what the average consumer experiences. Nor is the lack of responsiveness to complaints surprising. Chassin is a brilliant quality improvement pioneer, but, like many physicians, he believes the best way to help patients is to help make providers better at what they do. When I spoke to Chassin privately about the consumer-unfriendly QualityCheck site last year, he was about as interested in fixing it as a wholesale plumbing supplies dealer would be helping you find the right guy to clear a clogged sink. I think Chassin sees his job as making all plumbers great plumbers so you won’t have to worry about which one to call.
Of course, while the Joint Commission is working on the Exciting Future (see my previous blog on its Center for Health Transformation), you, the patient, are left on your own to cope with the mundane present. OK, not exactly on your own. The Joint Commission does publish a series of pamphlets called Speak Up, as in Help Avoid Mistakes in Your Surgery and (if that doesn’t work) Information for Living Organ Donors. In fact, as part of this year’s celebration of Patient Safety Awareness Week (March 7-13), you can complete an online quiz to test your Patient Safety IQ and be entered in a drawing to win the Joint Commission’s book, You: The Smart Patient.
See? The Joint Commission believes in smart patients. Just not, “too smart.”
One member of the Joint Commission’s Board of Commissioners is a consumer representative, Ilene Corina of PULSE of New York. It’s unclear whether the journalists reached out to her or any other commissioner. Meanwhile, in mid-2008 the Joint Commission received an 18-month grant, partly funded by the Robert Wood Johnson Foundation, “to find new ways to help consumers better understand healthcare quality data and use the information to make informed healthcare decisions.”
I can’t decide whether the answer is going to be “better pamphlets” or “don’t ask, don’t tell.”
Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age”.