Friday, September 16, 2011

Joint Commission Absurdity

The privilege of absurdity, to which no living man is subject but man only.

Thomas Hobbes (1588-1679), Leviathan (1651)

September 16, 2011 – Any social movement or scientific undertaking, taken to its extreme, is capable of absurdity.

Take management science, defined as the use of statistical methods, such as linear programming and simulation, in order to analyze and solve organizational problems.

In health care, management science has come to mean the use, study, and application of data, measurements, protocols, guidelines, algorithms, and processes to achieve continuous quality improvement.

An article in yesterday’s New York Times , Joint Commission Report Excludes Top Hospitals, " opened with this paragraph,

“In the latest advance for health care accountability, the country’s leading hospital accreditation board, the Joint Commission, released a list on Tuesday of 405 medical centers that have been the most diligent in following protocols to treat conditions like heart attack and pneumonia. Almost without exception, most highly regarded hospitals in the United States, from Johns Hopkins in Baltimore to the Mayo Clinic in Rochester, Minn., did not make the list. “

None of the 17 medical centers listed by U.S. News & World Report on its “Best Hospitals Honor Roll” this year are on the Joint Commission’s list of 405 hospitals that received at least a 95 percent composite score for compliance with treatment standards.

The Joint Commission list, at, omitted the Cleveland Clinic; Massachusetts General Hospital in Boston; Duke University Medical Center in Durham, N.C.; Ronald Reagan U.C.L.A. Medical Center; and the University of California San Francisco Medical Center, among others. It did not include a single hospital in New York City, or the most prominent centers in Chicago and Houston.

This Joint Commission report borders on absurdity. To exclude 17 leading medical centers, which have earned their reputations over decades of efforts to achieve excellence because they are not sufficiently diligent in slavishly following protocols is the height of absurdity.

There is more to health care, indeed to any social enterprise, than management and linear channeling of statistical methods to improve outcomes according to the arbitrary dictates of its programmers. Reputation counts.

The Joint Commission's list of 405 top performers included a disproportionate share of small and rural hospitals, as well as 20 Veterans Affairs medical centers. I am sure these small, rural, and VA hospitals deserved mention and do exemplary work, but to exclude leading medical centers is absurd.

To conclude,

To call something absurd,

is not to give it the bird.

Its protocol the Joint Commission should reword,

If it wants its message to be believed and heard.

Tweet: The Joint Commission has issued a list of 405 top hospital performers, which does not include the nation’s leading medical centers.

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