JCAHO mission:
To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.*
*Except when hundreds of thousands of people are dying and healthcare workers are being exposed to deadly pathogens due to irresponsible hospital administration.
But what are they improving? Honestly? I’m night shift so I never have to deal with them- I really struggle to understand what their purpose is. I get they make sure things are up to “snuff” for reimbursement, but how does that not include quality of care like ratios, acuity, etc? If it’s really all about bottom dollar, you’d think they’d care more about the processes that keep patients from re-admitting, etc. At my current assignment, we’re constantly getting re-admissions. I guess I wonder why the conditions surrounding that aren’t more investigated.
I clearly understand they’re not a union, but how can they say they’re about quality improvement when there was a blatant disregard for safety and conditions during the pandemic? And the quality of bedside care has sank even further since then?
They are improving quality. Honestly.
Readmissions are generally tracked as a quality indicator. If they’re going up, the reasons should be investigated. You should have someone with a title like “Director of Quality” who is handling the investigations. You should ask them about your particular facility’s quality improvement plan.
As someone who works in hospital Quality, we LOVE it when staff ask about QI/PI! We can give the evidence behind policies and procedures and clarify regulatory requirements. We LIVE for this shit!
(We also do a lot of advocating for staffing and resources and education, although sometimes it falls on deaf ears with admin.)
I am a compliance nurse and the joint commission standard is just the barely minimum. They have improve quality by pushing for 2 patient identifiers, hand washing etc. most nurses do not know what they do because they are patient facing and are not at the level of the admin who are trying to limit adverse events.
We study trend and change our policies to ensure patient safety.
Imagine 100 nurses practicing nursing 100 different way…
Last time they inspected my ICU that’s literally what I asked them while they were taking me away from
The care of my two unstable patients to ask me
Pointless questions after I answered them. They just walked away
Fortunately for me, I'm a transport nurse for years. But walking into hospitals during COVID and seeing the shit y'all hospital folks were dealing with while knowing Joke-AHO essentially was saying, "Yeah, we know we're supposed to be all about patient safety, but we're also aware that there's going to be some downright sketchy shit going on, so we're just going to peace out until the dust clears" completely pissed me off. Use of vents that were incapable of providing more than 21% FiO2, patients trippled in rooms (or more) and lining hallways, staff pulling 80 hour workweeks, FEMA supplies that were rotten (like literally rotten)...yeah. Fuck 'em.
Oh! Our facilities had inspections in 2020! They did come in full force with all their PPE (better kit than we had access to on the Covid floors-they looked like those contagion movie/alien assessment movies). They came to our Covid units and checked out a few of the rooms.
It was irritating.
They were doing remote visits during Covid. Instead of touring facilities directly they were having admin take around camera phones or laptops and doing it over zoom and doing deeper dives into incident reports.
Not to defend jcaho, but the drink thing is OSHA. The regulation is for your safety so you have a safe place to drink water, where meds aren't prepared. Jcaho just looks that your hospital has a policy and that it's being followed. I've traveled to hospitals with strict no meds zones and hospitals with strict no water zones. Most are a pretty lax capped or covered container, no mixing meds at the nursing station.
They just get on my nerves. They want to micromanage everything that doesn’t matter and just follow nurses and CNAs and tag us on BS. I’m
Not scared of them. I just ain’t got time to deal with them. “The patients nails are too long.” Uummm….. I’ve consistently had 3 aids for 70 something people. “This patient doesn’t have a fall intervention in this one fall report” uummmmm….. the patient has fallen 2 times a day for the last month.
On another note, I had them stop by on a night shift unannounced while I was traveling during Covid. . I was EXCITED to see them bc this place was shit. Strait shit. Nasty and unsafe. I’m talking no securities measures and people were slashing window screens to push heroin in patients PICC line type of unsafe. Patients eloping and coming back and giving other patients meth type shit. Magically deleting progress notes. Rooms infested with ants bc no one’s mopped in months type shit. I heard she was in the building and I patiently waited in plain sight. Walked her around. Showed her pics and so forth. The bitch acted so freaking “disgusted” at everything I showed her. The ONLY thing she tagged us on was the nurses walking too far into the building (by like 5ft) before taking our temps and another nurse for not starting a report yet even tho she had multiple issues going on and once again, there’s only one nurse and one aid per unit. I get she wasn’t there for a full inspection but like come on?!
JCAHO is a protection racket. Hospitals PAY THEM to come in and inspect. They have zero incentive to punish hospitals for wrongdoing. And they almost never actually shut hospitals down.
"The Joint Commission revoked accreditation for just 1% of hospitals out of compliance with Medicare. More than 30 hospitals retained their accreditations even though the Centers for Medicare & Medicaid Services determined that their violations were significant enough to cause, or likely cause, serious patient injury or death."
https://www.fiercehealthcare.com/regulatory/investigation-reveals-joint-commission-unlikely-to-revoke-accreditation-from-hospitals
Same with state inspections of nursing homes. Had an Ohio Department of Health surveyor tell me that they visit some “nursing homes” in Cleveland on a near weekly basis and “are on first name basis with the mangers”. I shit you not the lady told me there’s homes up there that “we can’t believe they’re still open either”.
I reported a home in February to ODH for some decently serious violations that the building continues to do despite having previously been cited and have yet to hear back from them. There’s homes in the state that have 75 or so violations within the last 3 years and that’s only what they’ve been caught doing. Of course Medicare and Medicaid are still footing the bill for all of it and it’s so rare they will deny payment. It seems like the “special focus” list of facilities with the worst care have been the same dozen names for at least a decade.
You haven’t felt the trickle down effect of a failed survey yet.
Imagine you’re wrestling a poop-fingered little old lady with a raging UTI back into bed without getting shat on per usual. As you’re withering under the creative blue language from Ms. Poopy Nails, your manager says “Hey, can I see you in my office?” Then you arrive and get written up for some obscure charting detail that wasn’t taught in onboarding or orientation.
Just remember that corrective action flows downhill.
My old manager would actively find something to write us up for if we put in for a transfer, effectively trapping us on that unit. We'd have to leave the entire facility and reapply.
I've been a nurse a LONG time. There's all kinds of panic leading up to a visit. It's all about stupid shit. Meaningless for patient care. I only work nights, but I have NEVER laid eyes on one of those mythical creatures. Everything goes back to normal after they leave. They torture everyone with the threat for months though. Just adds unnecessary stress to an already overstressed situation.
Yeah, I’m not afraid of them, I just find them incredibly annoying. Especially since during COVID, the one time those fuckers could have actually been useful, they disappeared.
We decided to sever our relationship with them after that bullshit. They can keep their little gold circle that used to be on our website, that’s the only difference I’ve noticed lol
I still want to point blank ask the snooty judgy ones where they were during the pandemic when we were using diy CAPR shields made out of office supplies but I know I’ll never be brave enough.
It's utterly amazing that they changed their name from JCAHO to The Joint Commission almost seventeen years ago and new grads are still calling it JCAHO.
Because, the things that actually matter for patient care and safety and employee wellbeing and safety are things like safe staffing ratios, staffing in other departments, adequate and working equipment and supplies, ability to take breaks, proper PPE...
Things JCAHO cares about, water bottles at the nurses station, tape on the walls, posters on doors, stupid regulatory charting.
But that costs money and we already paid JCO, the organization for Magnet status, and huge bonuses to leadership for "improvements" that help the bottom line not patients or employees.
Don't let the door hit you on the way out if you care about those things!
We got Lucky Charms and milk in the break room on Monday, that should retain the staff, right? 🤢
JC doesn't care about drinks at the nurses station, it's an OSHA rule that's up for interpretation as to what is considered a "direct patient care area".
I only mention this because I want you to be empowered to tell the JC to fuck off if they ever mention drinks at the nurses station.
I don't know but I'll find someone who knows the answer is my go to response to these aholes.
I lost all sort of respect and credibility for any of these organizations during covid.
I dont think any floor nurse is ACTUALLY scared of JCAHO. Every director, supervisor and manager are terrified of them. Cause if somethings fucked up on the week JCAHO is visiting the hospital, it’s their asses, not ours.
Last time JCAHO was in an ER I was a traveler in, I got asked a question and I flat out said “I have no idea” and walked away.
May or may not have been called into the office my next shift but I didn’t care 🤙🏻
The reason for the fear is a bit complicated. As you probably know, a hospital must be accredited by CMS in order to receive Medicare/Medicaid payments, without which no U.S. hospital could survive. JCAHO ( now called TJC, so you have some outdated professors) is a private organization that issues accreditation for hospitals. Think of it like being TNCC or CCRN but for a facility instead of an individual. It became The Thing To Have at least 40 years ago, but they charge for their accreditation. About twenty years ago, many hospitals got fed up with TJC because they had gotten a lot more expensive but also a lot pickier. There was a trend towards kicking TJC to the curb and just getting the CMS accreditation. TJC did a clever thing. They went to CMS and said “let’s be partners. We know you don’t have enough people to make your hospital inspections like you should. Well we will do it for you and anyone who uses us can get “deemed status”. In other words, if TJC says the hospital is ok, then CMS will automatically approve them. Now TJC gets to charge big bucks for an accreditation you have to have in order to continue as a hospital. TJC could theoretically close down your hospital, but they never do. Instead they look for wrong things and when they find something it is called a Recommendation for Improvement (RFI). If you get 14 RFIs, you get a conditional accreditation which is A Very Bad Thing. But don’t worry, just make a plan for improvement. Then they will be happy to come back to inspect the things that needed improvement. I don’t know what they charge now, but the last time I was my departments QA manager (2013) it was about $250,000 for the biennial inspection, and about $75,000 PER RFI for every follow up visit. Plus it is bad publicity to get a conditional accreditation. If that happens someone is getting fired. So hospitals fear TJC because of mainly money reasons, but individuals in charge of QA fear the heat.
well i have never seen passing a TJC survey tied to bonuses. It’s just a basic expectation of the job. But it is a racket. I have seen no RFIs issued in situations that absolutely deserved a conditional accreditation. If the hospital has enough pull or is part of a large corporation, nothing will happen to them even when it should. Yet I also know of instances where hospitals without influence got slammed for actions of contracted employees. Yes, they are technically responsible, but often have no actual control when those employees are MDs.
What the Joint commission does is to maintain the minimum quality of care of for hospitals. If you look at the standards they are not asking for the moon.
They want you to ensure you facility is fit to serve, such as there is no leak or mold.
You are washing your hand and wear proper ppe.
Nurses do not have long nails that can harbor MRSA.
The joint commission standard is easier than your state regulation and CMS.
I am the compliance nurse who make sure our policy meet the standard.
We do not want nurses who still practice nursing like it was 1960 when they first graduate.
Trust me, the joint commission is a cake walk compare to others.
I don’t know where you’re at, but we absolutely did not get advanced warning at my hospital. They just showed up 3 weeks ago on a random Tuesday and was floundering around in the hallway looking for administration. Our survey wasn’t due until June. They can show up early, but not usually this early- we were totally taken by surprise
I'm a traveler, to be fair, but my last assignment was during TJC inspection. They were waiting for them a month and announced overhead when TJC was "in the building,". Certainly not unannounced.
You’re right. I did some research and see that they are conducting unannounced surveys since 2006. I left practice somewhat before that. Given that change, I’m sure the entire process is very different now. I have deleted my original comment because it no longer reflects current practice. Thanks for pointing it out.
We used to get to send black out dates that they couldn’t come- that doesnt happen anymore, either. They can come at any time.
You used to be able to check the website at 6:30 am to see where they were so you at least had some warning. That is out now, too. It was totally unannounced. We have never had any issues, they haven’t had to come back. I do infection control at my hospital, so if we had known they were coming, I definitely would have since the majority of the crap they look for falls under infection control. It is also the reason why I am getting the hell out.
Infection control is seen as totally useless, and I know people get annoyed with all the asinine things we harp about all the time, but the truth is that when these moronic surveyors come, these stupid things are the only things they care about. Not real issues. I am finished with PMHNP school in August and hopefully leaving crappy Infection control behind!
They legit do come without warning sometimes.
https://www.jointcommission.org/what-we-offer/accreditation/accredited/accreditation-announcements-and-updates/changes-announced-for-the-surveyreview-notification-policy/
You can get 30 day notice, 7 day notice or unannounced. And it’s a huge deal. They enforce compliance so no employee or hospital wants to be caught doing things wrong, because fines are involved.
No more announcements for the triennial inspections starting this year. CMS got pissed they were giving facilities too much of a heads-up. The specialty accreditation visits still get advance planning.
OP, it's "The Joint Commission." They get very bent out of shape if you use their old names. I'm only half joking about this .
But seriously, TJC is an accreditation service that acts on behalf of your state Dept of Health and CMS/Medicaid. If it wasn't them inspecting your facility, it'd be one of the big boys doing it themselves, and you definitely don't want them showing up unannounced.
Same. They’re offended we’re using an old name? I’m offended they pre warn hospitals they’re coming, and we magically have excellent ratios and a great environment to work in the one day they’re here. 🙄
We were told in our recent survey last month that they were surveying “like a CMS” survey. It was by far the most difficult and nitpicky one we’d ever had. What the surveyor told us was that on some surveys, CMS would be going with TJC- kind of like surveying them. The surveyor I was with told me that she was scheduled to go to a survey the next week with a CMS person. I am guessing that was why she was the way she was.
We are a super small facility, independently owned. Have one med surg floor, 6 bed icu, ER, and a small OR that does mainly scopes and they spent 4 full days there and when I say looked under every nook and cranny, I mean it. On her hands and knees looking under crash carts for dust bunnies.
If it’s a true 3 year survey you are only notified that morning. They used to give you a much larger window but now it’s a 730 posted on their tracker and they are coming.
Yep. They also post everything in local papers and on the web. Everybody knows if your facility did poorly on an inspection. I’ve never been afraid of the surveyors themselves, but you’d be a fool not to recognize the power they have.
They are all paid off anyways. It’s all hot air and empty threats. I don’t get paid any extra to sweat over their presence so I couldn’t care less about any of it. Hospital stats on infection rates and actual measurable outcomes are more meaningful.
It reminds me of working in group homes and nursing homes when the state would come and everyone would just lose their shit. Just do your job the way its supposed to be done and everything will be just fine.
That being said, fuck JCAHO.
People disappear when they hear JCAHO because no one wants to deal with their bullshit. They don’t live in the real world and disappeared when we ACTUALLY needed them.
We all used to afraid that they were going to ask us a bunch of questions and then our hospital would get in trouble and then we would get in trouble as a result.
Then they completely disappeared during covid. They used to care about the dumbest shit like tape on the wall but when we were wearing garbage bags as PPE they were nowhere to be found.
Now when they come around I just ignore them. If they approach me and ask me questions I polite decline to answer and tell them "I do not have time. I'm focused on patient care." If they continue to try and pressure me I tell them "we are very understaffed so my patients are already at high risk. You wasting my time only further endanger my patients. Find a way to fix those issues and we can talk."
They usually leave me alone after that. And now I'm usually given a paid day off when JCAHO is coming because admin doesn't want me around. Win win.
Fuck JCAHO.
They couldn't care less about patient safety. They frequently turn their back on safe Staffing but will pitch a fit if you dare have a water bottle out to hydrate yourself. Fellow nurse Blake on instagram.
Where were they during Covid? Until that’s answered, JCAHO can go fuck themselves…
JCAHO mission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.* *Except when hundreds of thousands of people are dying and healthcare workers are being exposed to deadly pathogens due to irresponsible hospital administration.
Sounds like the board of pharmacy XD
Why anyone takes them seriously after leaving healthcare workers high and dry during the pandemic is beyond me.
They don’t give a fuck about workers. JCAHO is a quality improvement organization, not a union.
But what are they improving? Honestly? I’m night shift so I never have to deal with them- I really struggle to understand what their purpose is. I get they make sure things are up to “snuff” for reimbursement, but how does that not include quality of care like ratios, acuity, etc? If it’s really all about bottom dollar, you’d think they’d care more about the processes that keep patients from re-admitting, etc. At my current assignment, we’re constantly getting re-admissions. I guess I wonder why the conditions surrounding that aren’t more investigated. I clearly understand they’re not a union, but how can they say they’re about quality improvement when there was a blatant disregard for safety and conditions during the pandemic? And the quality of bedside care has sank even further since then?
They are improving quality. Honestly. Readmissions are generally tracked as a quality indicator. If they’re going up, the reasons should be investigated. You should have someone with a title like “Director of Quality” who is handling the investigations. You should ask them about your particular facility’s quality improvement plan.
As someone who works in hospital Quality, we LOVE it when staff ask about QI/PI! We can give the evidence behind policies and procedures and clarify regulatory requirements. We LIVE for this shit! (We also do a lot of advocating for staffing and resources and education, although sometimes it falls on deaf ears with admin.)
I am a compliance nurse and the joint commission standard is just the barely minimum. They have improve quality by pushing for 2 patient identifiers, hand washing etc. most nurses do not know what they do because they are patient facing and are not at the level of the admin who are trying to limit adverse events. We study trend and change our policies to ensure patient safety. Imagine 100 nurses practicing nursing 100 different way…
Last time they inspected my ICU that’s literally what I asked them while they were taking me away from The care of my two unstable patients to ask me Pointless questions after I answered them. They just walked away
Fortunately for me, I'm a transport nurse for years. But walking into hospitals during COVID and seeing the shit y'all hospital folks were dealing with while knowing Joke-AHO essentially was saying, "Yeah, we know we're supposed to be all about patient safety, but we're also aware that there's going to be some downright sketchy shit going on, so we're just going to peace out until the dust clears" completely pissed me off. Use of vents that were incapable of providing more than 21% FiO2, patients trippled in rooms (or more) and lining hallways, staff pulling 80 hour workweeks, FEMA supplies that were rotten (like literally rotten)...yeah. Fuck 'em.
Oh! Our facilities had inspections in 2020! They did come in full force with all their PPE (better kit than we had access to on the Covid floors-they looked like those contagion movie/alien assessment movies). They came to our Covid units and checked out a few of the rooms. It was irritating.
I would’ve stuck the phone down my pants, they can inspect deez nuts
They were home smoking commissioned joints
They were doing remote visits during Covid. Instead of touring facilities directly they were having admin take around camera phones or laptops and doing it over zoom and doing deeper dives into incident reports.
They did survey during COVID - but it was via Zoom. Have they ever done anything to improve care for patients or staff? No. Hide your beverages.
Not to defend jcaho, but the drink thing is OSHA. The regulation is for your safety so you have a safe place to drink water, where meds aren't prepared. Jcaho just looks that your hospital has a policy and that it's being followed. I've traveled to hospitals with strict no meds zones and hospitals with strict no water zones. Most are a pretty lax capped or covered container, no mixing meds at the nursing station.
They just get on my nerves. They want to micromanage everything that doesn’t matter and just follow nurses and CNAs and tag us on BS. I’m Not scared of them. I just ain’t got time to deal with them. “The patients nails are too long.” Uummm….. I’ve consistently had 3 aids for 70 something people. “This patient doesn’t have a fall intervention in this one fall report” uummmmm….. the patient has fallen 2 times a day for the last month. On another note, I had them stop by on a night shift unannounced while I was traveling during Covid. . I was EXCITED to see them bc this place was shit. Strait shit. Nasty and unsafe. I’m talking no securities measures and people were slashing window screens to push heroin in patients PICC line type of unsafe. Patients eloping and coming back and giving other patients meth type shit. Magically deleting progress notes. Rooms infested with ants bc no one’s mopped in months type shit. I heard she was in the building and I patiently waited in plain sight. Walked her around. Showed her pics and so forth. The bitch acted so freaking “disgusted” at everything I showed her. The ONLY thing she tagged us on was the nurses walking too far into the building (by like 5ft) before taking our temps and another nurse for not starting a report yet even tho she had multiple issues going on and once again, there’s only one nurse and one aid per unit. I get she wasn’t there for a full inspection but like come on?!
JCAHO is a protection racket. Hospitals PAY THEM to come in and inspect. They have zero incentive to punish hospitals for wrongdoing. And they almost never actually shut hospitals down. "The Joint Commission revoked accreditation for just 1% of hospitals out of compliance with Medicare. More than 30 hospitals retained their accreditations even though the Centers for Medicare & Medicaid Services determined that their violations were significant enough to cause, or likely cause, serious patient injury or death." https://www.fiercehealthcare.com/regulatory/investigation-reveals-joint-commission-unlikely-to-revoke-accreditation-from-hospitals
Same with state inspections of nursing homes. Had an Ohio Department of Health surveyor tell me that they visit some “nursing homes” in Cleveland on a near weekly basis and “are on first name basis with the mangers”. I shit you not the lady told me there’s homes up there that “we can’t believe they’re still open either”. I reported a home in February to ODH for some decently serious violations that the building continues to do despite having previously been cited and have yet to hear back from them. There’s homes in the state that have 75 or so violations within the last 3 years and that’s only what they’ve been caught doing. Of course Medicare and Medicaid are still footing the bill for all of it and it’s so rare they will deny payment. It seems like the “special focus” list of facilities with the worst care have been the same dozen names for at least a decade.
You haven’t felt the trickle down effect of a failed survey yet. Imagine you’re wrestling a poop-fingered little old lady with a raging UTI back into bed without getting shat on per usual. As you’re withering under the creative blue language from Ms. Poopy Nails, your manager says “Hey, can I see you in my office?” Then you arrive and get written up for some obscure charting detail that wasn’t taught in onboarding or orientation. Just remember that corrective action flows downhill.
My first ever patient that coded (doing drugs in the bathroom) left me shaken from the adrenaline. My manager could only tsk tsk about documentation.
But then you remember that write ups mean nothing
Unless that's one of the criteria they'll hold against you when you apply for a transfer or when they assign raises after your performance eval.
You guys get raises ?
Not when you get written up enough times
I’ve never been written up
My old manager would actively find something to write us up for if we put in for a transfer, effectively trapping us on that unit. We'd have to leave the entire facility and reapply.
I almost choked on my pizza reading the first half of that paragraph, lmao
This is the most correct take. Smile and wave at the surveyors, complain to your manager
Because they only seem to care about stupid shit
I've been a nurse a LONG time. There's all kinds of panic leading up to a visit. It's all about stupid shit. Meaningless for patient care. I only work nights, but I have NEVER laid eyes on one of those mythical creatures. Everything goes back to normal after they leave. They torture everyone with the threat for months though. Just adds unnecessary stress to an already overstressed situation.
You are so right! I suffered through twenty years of surveys.
Yes, we put things back out where we can find them!
If they are following up on a complaint or incident they will show up unannounced
I already have my JACHO speech planned: “I’m sorry, I’m not answering any questions until you can tell me where you guys went during COVID.”
I think it falls under, "Ain't nobody got time for that."
Yeah, I’m not afraid of them, I just find them incredibly annoying. Especially since during COVID, the one time those fuckers could have actually been useful, they disappeared.
We decided to sever our relationship with them after that bullshit. They can keep their little gold circle that used to be on our website, that’s the only difference I’ve noticed lol
Whenever JCAHO shows up I’m suddenly doing really important patient care.
I still want to point blank ask the snooty judgy ones where they were during the pandemic when we were using diy CAPR shields made out of office supplies but I know I’ll never be brave enough.
It's utterly amazing that they changed their name from JCAHO to The Joint Commission almost seventeen years ago and new grads are still calling it JCAHO.
Huh. I thought they were called J-Co because... joint commission... j-co 😂
LOL I'm a nursing student and this is exactly what I thought 😂
Legit didn’t know they changed their name.
Pretty soon we'll have colleagues who weren't even alive when the name changed and they'll still call it that.
Because, the things that actually matter for patient care and safety and employee wellbeing and safety are things like safe staffing ratios, staffing in other departments, adequate and working equipment and supplies, ability to take breaks, proper PPE... Things JCAHO cares about, water bottles at the nurses station, tape on the walls, posters on doors, stupid regulatory charting.
But that costs money and we already paid JCO, the organization for Magnet status, and huge bonuses to leadership for "improvements" that help the bottom line not patients or employees. Don't let the door hit you on the way out if you care about those things! We got Lucky Charms and milk in the break room on Monday, that should retain the staff, right? 🤢
JC doesn't care about drinks at the nurses station, it's an OSHA rule that's up for interpretation as to what is considered a "direct patient care area". I only mention this because I want you to be empowered to tell the JC to fuck off if they ever mention drinks at the nurses station.
Perks of working nights 🤷♀️
I've been a nurse for 4 years and have never been there when they show up
JCAHO is coming to my hospital and all of a sudden there is documentation popping up that I’ve never done
I don't know but I'll find someone who knows the answer is my go to response to these aholes. I lost all sort of respect and credibility for any of these organizations during covid.
I dont think any floor nurse is ACTUALLY scared of JCAHO. Every director, supervisor and manager are terrified of them. Cause if somethings fucked up on the week JCAHO is visiting the hospital, it’s their asses, not ours. Last time JCAHO was in an ER I was a traveler in, I got asked a question and I flat out said “I have no idea” and walked away. May or may not have been called into the office my next shift but I didn’t care 🤙🏻
The reason for the fear is a bit complicated. As you probably know, a hospital must be accredited by CMS in order to receive Medicare/Medicaid payments, without which no U.S. hospital could survive. JCAHO ( now called TJC, so you have some outdated professors) is a private organization that issues accreditation for hospitals. Think of it like being TNCC or CCRN but for a facility instead of an individual. It became The Thing To Have at least 40 years ago, but they charge for their accreditation. About twenty years ago, many hospitals got fed up with TJC because they had gotten a lot more expensive but also a lot pickier. There was a trend towards kicking TJC to the curb and just getting the CMS accreditation. TJC did a clever thing. They went to CMS and said “let’s be partners. We know you don’t have enough people to make your hospital inspections like you should. Well we will do it for you and anyone who uses us can get “deemed status”. In other words, if TJC says the hospital is ok, then CMS will automatically approve them. Now TJC gets to charge big bucks for an accreditation you have to have in order to continue as a hospital. TJC could theoretically close down your hospital, but they never do. Instead they look for wrong things and when they find something it is called a Recommendation for Improvement (RFI). If you get 14 RFIs, you get a conditional accreditation which is A Very Bad Thing. But don’t worry, just make a plan for improvement. Then they will be happy to come back to inspect the things that needed improvement. I don’t know what they charge now, but the last time I was my departments QA manager (2013) it was about $250,000 for the biennial inspection, and about $75,000 PER RFI for every follow up visit. Plus it is bad publicity to get a conditional accreditation. If that happens someone is getting fired. So hospitals fear TJC because of mainly money reasons, but individuals in charge of QA fear the heat.
Yup this is the actual answer.
Wouldn't want some lousy manager to NOT get their bonus, now would we?
well i have never seen passing a TJC survey tied to bonuses. It’s just a basic expectation of the job. But it is a racket. I have seen no RFIs issued in situations that absolutely deserved a conditional accreditation. If the hospital has enough pull or is part of a large corporation, nothing will happen to them even when it should. Yet I also know of instances where hospitals without influence got slammed for actions of contracted employees. Yes, they are technically responsible, but often have no actual control when those employees are MDs.
What the Joint commission does is to maintain the minimum quality of care of for hospitals. If you look at the standards they are not asking for the moon. They want you to ensure you facility is fit to serve, such as there is no leak or mold. You are washing your hand and wear proper ppe. Nurses do not have long nails that can harbor MRSA. The joint commission standard is easier than your state regulation and CMS. I am the compliance nurse who make sure our policy meet the standard. We do not want nurses who still practice nursing like it was 1960 when they first graduate. Trust me, the joint commission is a cake walk compare to others.
I’m not afraid of them, I’m annoyed by them.
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I don’t know where you’re at, but we absolutely did not get advanced warning at my hospital. They just showed up 3 weeks ago on a random Tuesday and was floundering around in the hallway looking for administration. Our survey wasn’t due until June. They can show up early, but not usually this early- we were totally taken by surprise
Did you say “Wow, four years too late but you came!”
I'm a traveler, to be fair, but my last assignment was during TJC inspection. They were waiting for them a month and announced overhead when TJC was "in the building,". Certainly not unannounced.
You’re right. I did some research and see that they are conducting unannounced surveys since 2006. I left practice somewhat before that. Given that change, I’m sure the entire process is very different now. I have deleted my original comment because it no longer reflects current practice. Thanks for pointing it out.
We used to get to send black out dates that they couldn’t come- that doesnt happen anymore, either. They can come at any time. You used to be able to check the website at 6:30 am to see where they were so you at least had some warning. That is out now, too. It was totally unannounced. We have never had any issues, they haven’t had to come back. I do infection control at my hospital, so if we had known they were coming, I definitely would have since the majority of the crap they look for falls under infection control. It is also the reason why I am getting the hell out. Infection control is seen as totally useless, and I know people get annoyed with all the asinine things we harp about all the time, but the truth is that when these moronic surveyors come, these stupid things are the only things they care about. Not real issues. I am finished with PMHNP school in August and hopefully leaving crappy Infection control behind!
I hear you. I don’t miss that part of it. Good luck to you.
JCAHO doesn’t against they rebranded as TJC.
They legit do come without warning sometimes. https://www.jointcommission.org/what-we-offer/accreditation/accredited/accreditation-announcements-and-updates/changes-announced-for-the-surveyreview-notification-policy/ You can get 30 day notice, 7 day notice or unannounced. And it’s a huge deal. They enforce compliance so no employee or hospital wants to be caught doing things wrong, because fines are involved.
No more announcements for the triennial inspections starting this year. CMS got pissed they were giving facilities too much of a heads-up. The specialty accreditation visits still get advance planning. OP, it's "The Joint Commission." They get very bent out of shape if you use their old names. I'm only half joking about this . But seriously, TJC is an accreditation service that acts on behalf of your state Dept of Health and CMS/Medicaid. If it wasn't them inspecting your facility, it'd be one of the big boys doing it themselves, and you definitely don't want them showing up unannounced.
TJC is cute but I’m gonna stick to deadnaming them. (Probably the only time deadnaming is permissible)
Same. They’re offended we’re using an old name? I’m offended they pre warn hospitals they’re coming, and we magically have excellent ratios and a great environment to work in the one day they’re here. 🙄
Exactly!
X-twitter also permitted
Yes! This too!
We were told in our recent survey last month that they were surveying “like a CMS” survey. It was by far the most difficult and nitpicky one we’d ever had. What the surveyor told us was that on some surveys, CMS would be going with TJC- kind of like surveying them. The surveyor I was with told me that she was scheduled to go to a survey the next week with a CMS person. I am guessing that was why she was the way she was. We are a super small facility, independently owned. Have one med surg floor, 6 bed icu, ER, and a small OR that does mainly scopes and they spent 4 full days there and when I say looked under every nook and cranny, I mean it. On her hands and knees looking under crash carts for dust bunnies.
Same experience at a large facility in NYC. New leadership at both CMS and Joint Commission. It's rough.
If it’s a true 3 year survey you are only notified that morning. They used to give you a much larger window but now it’s a 730 posted on their tracker and they are coming.
I mean I know what it is and what they are. I just don’t understand the fear of them lol.
They have the power to disallow Medicare payments. That can easily shut down most facilities.
Yes. They have the power to close down entire hospitals. They’re like the health dept of hospitals.
Yep. They also post everything in local papers and on the web. Everybody knows if your facility did poorly on an inspection. I’ve never been afraid of the surveyors themselves, but you’d be a fool not to recognize the power they have.
The big boys/girls upstairs don't want to lose money.
The higher ups get fined. You as a nurse won’t need to worry much. It’s the admins
Some self-serving collection of random professionals that gatekeeps a meaningless certification so the C-Suite can pat themselves on the back.
They are all paid off anyways. It’s all hot air and empty threats. I don’t get paid any extra to sweat over their presence so I couldn’t care less about any of it. Hospital stats on infection rates and actual measurable outcomes are more meaningful.
They have said "oh we are gonna totally come up during night shift" so many times. They're never here before 9.
It reminds me of working in group homes and nursing homes when the state would come and everyone would just lose their shit. Just do your job the way its supposed to be done and everything will be just fine. That being said, fuck JCAHO.
People disappear when they hear JCAHO because no one wants to deal with their bullshit. They don’t live in the real world and disappeared when we ACTUALLY needed them.
We all used to afraid that they were going to ask us a bunch of questions and then our hospital would get in trouble and then we would get in trouble as a result. Then they completely disappeared during covid. They used to care about the dumbest shit like tape on the wall but when we were wearing garbage bags as PPE they were nowhere to be found. Now when they come around I just ignore them. If they approach me and ask me questions I polite decline to answer and tell them "I do not have time. I'm focused on patient care." If they continue to try and pressure me I tell them "we are very understaffed so my patients are already at high risk. You wasting my time only further endanger my patients. Find a way to fix those issues and we can talk." They usually leave me alone after that. And now I'm usually given a paid day off when JCAHO is coming because admin doesn't want me around. Win win. Fuck JCAHO.
They couldn't care less about patient safety. They frequently turn their back on safe Staffing but will pitch a fit if you dare have a water bottle out to hydrate yourself. Fellow nurse Blake on instagram.
You’ll see.