Health care quality is a vital issue for every American because all of us will one day need to rely on it. For that reason, private accreditors of health-care providers are subject to enormous public scrutiny even when everything works as it should. Lately, our industry has come under criticism for a perceived lack of transparency and findings that seem to contradict government regulators. But much of that is rooted in a fundamental misunderstanding of what we do and what the public expects.
I have worked in both the public and private sectors to ensure health care quality, first as Commissioner of the New York State Department of Health and now as the head of the nation’s largest private healthcare accreditation organization.
Among the many things I’ve learned over my career is that being a state health commissioner is very different than being a private accreditor. The former has a duty to protect and improve the health of the public while the latter is a means of improving the way health care is delivered.
As a private accreditor, we create evidence-based quality standards; conduct in depth, on-site surveys of hospitals and other health care providers; evaluate compliance with those standards; work with providers to address opportunities to improve care; and inspire them to excel in providing the safest, highest quality care.
The goal of the private accreditation system is to identify deficiencies in care and have the hospitals correct those deficiencies — it is not to find as many deficiencies as possible to justify removing accreditation from those organizations. Denying accreditation is sometimes necessary if hospitals cannot bring their care up to an acceptable level. However, in the overwhelming majority of cases, hospitals do come into compliance once deficiencies are pointed out.
Regulators, on the other hand, are public institutions with the authority to impose penalties and enforce laws, and their activities are therefore subject to public scrutiny and oversight.
Private accreditors have no such authority and need to balance public transparency with the need for candor between surveyor and healthcare provider. In addition, regulators are typically the first to receive complaints from the public, but often don’t share information about what was found to be noncompliant with private accreditors.
This balance is well understood in high-stakes industries that deal with complex risks every day, such as aviation, rail and marine transportation, and commercial nuclear power. All of these industries combine public reporting of important data with systems of confidential reports that contain sensitive information about safety risks, solutions, and uncertainties around potential process failures.
These oversight systems facilitate the identification of safety hazards – real and potential — in a safe harbor that is free from the fear of reprisal, public humiliation, or litigation. The system works. Confidential evaluations such as these are credited with promoting and sustaining a safety culture that reduces harm substantially over time.
By maintaining an open and candid relationship with a broad range of institutions across the country, private accreditors are able to spot overlooked risks that might appear to be singular events at an individual hospital but are actually part of a nationwide issue. Private accreditors, not public regulators, were the first to identify the presence of concentrated electrolyte solutions such as potassium chloride in patient care areas as the reason for accidental injections of these agents. Today, deaths due to these accidents are unheard of.
It is also important to acknowledge an uncomfortable reality. There are no perfect hospitals anywhere in the world. No known methods or procedures have succeeded in abolishing preventable harm to patients. Neither private accreditors nor government regulators can guarantee that such events will not occur in hospitals that have “passed” their reviews.
Critics of the private accreditation system say there is too much confidentiality between healthcare institutions and accreditors and that hospital survey reports should be made public.
We strongly support the goal of putting valid, useful data on quality of care in the hands of the public. In fact, we were the first to create a program that reports publicly a variety of standardized quality measures that assess hospital performance, a program that continues to this day.
But the responsibility for assessing all sources of data and making a judgment on a healthcare institution’s ability to serve the public rests with a publicly accountable regulator, not a private accreditor.
That’s why we and others have called on the Centers for Medicare and Medicaid Services (CMS) to engage in a dialogue with private accreditation organizations to identify a more effective strategy to better educate the public while ensuring necessary protection for health care quality improvement.
In the end, we all want the same thing: a health care system that consistently delivers the best quality of care and exhibits a culture of excellence that inspires institutions to continually improve their performance.
We are ready to work with CMS and other stakeholders to ensure that we achieve that goal in a way that properly balances public data with confidential quality improvement.
Dr. Mark R. Chassin, M.D., is President and Chief Executive Officer of The Joint Commission, nation’s largest health care standards-setting and accrediting organization.