Hospital report cards come from all kinds of sources these days, online and in news headlines. But the criteria for judgment vary, and scores can be wildly different, even for the same hospital, depending on who’s doing the inspection. When I was a reporter, I was wary of basing news stories too heavily on data from accreditation agencies like the Joint Commission on Accreditation in Healthcare Organization, which recently cited the state’s new psychiatric hospital in Berlin with 44 violations.
The words “Joint Commission” might suggest it’s an arm of government, but it isn’t. It’s a non-profit evaluator of nearly 5000 hospitals nationwide, with little or no competition for its services. Accreditation can be a powerful marketing tool and qualify a hospital for Medicaid and Medicare certification without a government inspection.
It’s worth noting, though, that member hospitals pay to be evaluated, and some critics say this creates a conflict of interest. In fact, a 2004 report by the U.S. Government Accountability Office blasted the Joint Commission for finding fewer than three quarters of the major deficiencies and errors in hospitals that were uncovered in other ways.
This doesn’t mean the Commission’s reports are useless. They do tell us something about whether a hospital has policies that safeguard patient’s health and safety, and, to a lesser extent, whether those policies shape practice. But inspectors spend, on average, only about three days in a hospital, which usually knows in advance that they're coming. They tour the place, read policy documents, look at a sample of patient records, and talk to some staffers. They usually don’t observe care directly; that would violate patient confidentiality.
Hospitals do have to report serious medical errors to the Joint Commission, and if they can’t prove that they’ve at least a system for disclosure, they could lose accreditation. But that doesn’t mean that every clinician is going to fess up.
So while accreditation may be necessary and useful, it doesn’t tell us nearly all we need to know about a hospital. Which is why comparison shopping for health care is pretty hard to do. It’s also why it’s important for health care journalists to do leg work as well as data dives, to learn for themselves what’s behind all these rating systems vying for our attention.
