Respiratory Therapy 101: Just Keep Breathing

911Doc over at  M.D.O.D. has an excellent piece on how JCAHO (the Joint Commission on Accrediting Healthcare Organizations) and their evil companion Press-Ganey are really little more than modern-day protection rackets that prey on hospitals.

Back when I was a “newbie,” I used to believe in the mission of organizations like JCAHO and Press-Ganey. I thought that the idea of making organizations meet certain standards to ensure that patient outcomes would improve was a good idea. And on some level I still believe that making hospitals and healthcare providers meet certain standards of care is an excellent idea. And in theory, this is what JCAHO is all about.

However! What JCAHO actually does is very, very different from that. What JCAHO does is generate paperwork and foolish policies that have little to no impact on patient care. JCAHO misidentifies problems and then demands vast oceans of paperwork to prove that the problem is going away. They are a complete and utter failure of an organization.

The problem of inadequate care is simple, really. Inadequate patient care is a result of providers having too much work to do and not enough resources to do it with. My hospital is an excellent example: we routinely send RTs out to the medical floors with 60 to 70 treatments to complete in 12 hours, which if the RT follows our P&P manual would result in a 15 to 18 hour workday with no breaks. There is simply no way to complete that assignment. Treatments will be missed, patients will not be seen, and it adversely affects patient safety.

A normal human being looks at that scenario and quickly identifies the problem: too much work, not enough staff. The solution is to either reduce the workload (in theory our protocols do this) or to increase the number of RTs (a complex problem to solve).

A JCAHO-oriented person would look at that same scenario, but instead of recommending ways to reduce workload or increase staffing, they will implement a new tracking system that means that every time an RT misses a treatment, they must notify the supervisor and complete a piece of paper. This means that the supervisor spends hours each day writing down who missed what treatment, and the already overworked RTs must take time away from patient care to document missed therapy. This actually happened here. RTs have been having to fill out papers for months, which solves no problems and inconveniences everybody.

To summarize: JCAHO is a humongous waste of time. They do very little to help improve care while going out of their way to make the jobs of those of us in the trenches more mired in paperwork and foolish policies. Managers have less time to focus on problem solving and operations because they are spending more time making sure that JCAHO won’t fine them. The Joint Commission is a great idea that’s been badly misapplied, and I for one have a low opinion of that particular organization. They misidentify problems, contribute to the worsening of real problems, and suck money out of hospitals in return for shoddy services. We’d all be better off without them, and I for one hope that hospitals and providers start to tell them that.