Another Acronym to Strike Fear in Your Heart?

Maureen Larkin, for HealthLeaders Media, October 2, 2008

JCAHO. Until The Joint Commission changed its name early last year, that acronym was enough to strike fear in the hearts of hospital employees at all levels. When a JCAHO surveyor arrives, everyone from executives to front line managers scrambles to make sure that supplies are stored in the right places and medications are delivered properly. Survey time at a hospital is serious business.

Now another acronym has made its way to the accreditation scene, and it remains to be seen if this one will have the sheer power that JCAHO held for so long. The Centers for Medicare and Medicaid Services announced last week that it has granted DNV Healthcare, Inc. deeming authority for U.S. hospitals. DNV is the first organization to receive deeming status in more than 30 years.

JCAHO hasn't been the only deeming authority over the past 30 years, but it may seem that way. In fact, I'm sure there are a lot of healthcare workers out there would be hard-pressed to tell you the names of the other accreditation organizations out there. The Joint Commission is the accreditation authority, and any hospital that wishes to be seen as one that provides quality care works to meet its standards.

So why after 30 years has CMS decided to grant another organization deeming authority? Surely it has something to do with CMS' increased focus on quality and patient safety. By creating a growing list of "never events," and an emphasis on transparency, CMS has made it clear that it wants hospitals to not only improve on certain key outcomes, but also make the quality of hospitals something that consumers take into consideration when they're selecting a hospital. DNV's accreditation process combines CMS Conditions of Participation with ISO-9001, a collection of standards for quality management systems. DNV's process is called the National Integrated Accreditation for Healthcare organizations and was designed to streamline the accreditation process, identifying ways to make continual improvements.

It sounds good, but will hospitals really abandon The Joint Commission for another agency? I think it's possible. The Joint Commission's accreditation process isn't perfect—just ask anyone on the hospital staff who is involved with accreditation. They'll tell you that the JC's standards change too frequently, and that JC staff members, though good at pointing out needed improvements, often aren't helpful to hospitals that are implementing changes or process improvements.

DNV, too, will have its challenges. It won't be an easy road convincing hospitals to move away from what they've always known—The Joint Commission—and work through a new and different accreditation process. But there's hope for them already. Before CMS' announcement last week, 27 hospitals had already received accreditation from DNV in addition to that of the Joint Commission.

Will DNV ever strike fear in the hearts of hospital executives as JCAHO once did? That remains to be seen. But with an increased focus on quality and patient safety from both CMS and accreditation agencies, you can bet that your hospital's accreditation process will get tougher each year.

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at
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