Hospitals Face Shorter Notice for Inspections

Copyright © 2009 National Public Radio®. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

ALEX CHADWICK, host:

When you walk into a hospital, you assume it meets certain standards. But what are they, and who's keeping track? This year, for the first time, U.S. hospitals are facing accreditation inspections that come without any advance notice.

From member station WBUR in Boston, Allan Coukell has the story.

ALLAN COUKELL: At 7:00 on a Monday morning, officials at the Massachusetts General Hospital learn that today will be the day. Ten minutes later, the inspectors are standing in the hospital's main lobby.

Unidentified Woman #1: (Unintelligible). May I help you?

Ms. CAROL BLUM(ph): Hi, this is Carol Blum from nursing, and I have the JCAHO Survey with me.

COUKELL: The five inspectors - or surveyors, as they're properly called - are from the Joint Commission on the Accreditation of Healthcare Organizations, or JCAHO. The surveyors ask for a list of all the patients in the hospital, and then they quickly fan out. Sarah Shaheim(ph), a nurse by training, elects to visit a patient on the psychiatric unit.

Ms. SARAH SHAHEIM (JCAHO Surveyor): The nurse, I need her.

Unidentified Woman #2: OK. She went to give her medications.

Ms. SHAHEIM: Wonderful. Let me shadow her.

Unidentified Woman #2: Oh, OK.

COUKELL: The stakes are high. U.S. hospitals can't be paid by Medicare without JCAHO accreditation. And 47 states use their stamp of approval as part of the state licensing process. But in the past, critics have charged that these surveys are toothless tigers. Surveyors tended to focus more on policies and procedures than on patient care. And knowing the schedule gave hospitals months to prepare. Now the surveyors come in unannounced, and they focus on real patients.

Ms. SHAHEIM: Okay, very good. So, where is the prednisone?

COUKELL: In the medication room on the psych unit, Shaheim has discovered that one of the patient's medications seems to be missing.

Unidentified Woman #2: No. I know. But it's not here, so.

Ms. SHAHEIM: So, you don't have it. It's like the process of delivering the medication to you needs to be tighter. Okay. You are giving me a bone in my mouth to go follow through.

COUKELL: With that bone in her mouth, Shaheim will soon visit the pharmacy. It's called tracing. The surveyors follow the patient through the system, visiting the operating room, the lab - any part of the hospital that's been involved in that patient's care.

On the psych ward, Shaheim interviews the patient's doctor and social worker, checks the fire extinguishers, the defibrillator, the temperature of the kitchen refrigerator - even, at one point, the screws on the hinges of the door.

Ms. SHAHEIM: Because there have been incidents of a patient harming themselves.

COUKELL: With a screw?

Ms. SHAHEIM: With a screw. They unscrew it and then they cut themselves.

(Soundbite of banging sound)

COUKELL: The survey seems both incredibly detailed and weirdly arbitrary. But over the week, the surveyors will trace about 35 patients across three-quarters of the treatment sites in the hospital. At Mass General, it's Maryanne Spicer's job to ensure the hospital meet standards. She says the inspection is thorough enough to identify any important problems.

Ms. MARYANNE SPICER (Director, Massachusetts General Hospital Compliance): The things that seem to be singular drop off and the things that seem to be more systematic really do emerge after a few days.

(Soundbite of paper rustling)

Dr. BRETT ELLIOT (Part-time Surveyor, Joint Commission on the Accreditation of Healthcare Organizations): Okay. Could we speak to the patient for a minute or two?

COUKELL: Dr. Brett Elliot(ph), a part-time surveyor and part-time ophthalmologist from Delaware, visits David Holloman(ph), who's on the orthopedics floor for a hip replacement.

Dr. ELLIOT: All right. And so you had your surgery. And you're pretty comfortable?

Mr. DAVID HOLLOMAN (Patient): Yes. I'm quite comfortable.

Dr. ELLIOT: Have you been to PT yet? Physical Therapy?

Mr. HOLLOMAN: Just got through with it.

Dr. ELLIOT: Just got through. All right.

COUKELL: The survey will result in full accreditation for Mass General. At the end of the week, the hospital gets what amounts to a report card. JCAHO officials say their new approach of unannounced surveys and patient tracers means they catch more problems and put more than twice as many hospitals -about 4 percent - on warning compared with a few years ago. But can patients be confident that this process is effective?

Dr. ARTHUR LEVIN (Director, Center for Medical Consumers): There's always been the problem of the fox guarding the chicken coop.

COUKELL: Arthur Levin directs the Center for Medical Consumers, a New York-based health care advocacy group. He criticizes the accreditation process, because JCAHO is not a government agency, but an independent body that's funded by the industry it regulates. Despite that, Levin says, the new system likely does give a much better snapshot of day-to-day operations.

Dr. LEVIN: I think having surveyors walk in unannounced is a big improvement. And the new system of following a number of patients throughout their hospital stay probably gives a more accurate picture of the quality and safety of care in the hospitals.

COUKELL: Mass General and large hospitals like it now devote a great deal of time to trying to systematically improve patient care. But does knowing about the surprise inspection make orthopedics patient David Holloman feel more confident?

Mr. HOLLOMAN: Oh, of course, because I think everybody has to be on his toes.

COUKELL: For NPR News, I'm Allen Coukell in Boston.

Copyright ©2009 National Public Radio®. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to National Public Radio. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.