Is anonymous reporting to JCAHO feasible?
Is anonymous reporting to JCAHO feasible?
'JCAHO is accountable to the public'
"In talking with hospital caregivers throughout the nation, I've found that anonymous reporting would calm many of their fears about the confidentiality of the data being shared with the Joint Commission," says Patrice Spath, ART, consulting editor for Hospital Peer Review and a health care quality consultant in Forest Grove, OR. (See the September issue of Hospital Peer Review for several articles about sentinel events and reporting.) "If the Joint Commission's priority goal is to create an aggregate database of events so they can analyze them to find out their cause, so we can all learn from the errors of others, why can't facilities be given the opportunity to report details of their events anonymously in the same manner as the Medical Errors Reporting Program?" (See related article on how MERP handles anonymous reports, p. 183.)
"In fact, we are considering anonymous reporting, and I'm currently researching the issue," says Chuck Mowll, executive vice president of government relations and external affairs at the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations.
"Our sentinel event policy has two primary objectives," he says. The first is to form a data base that will allow the agency, through alerts, to share lessons learned and help organizations avoid events in the future. "You could argue that reporting to that database conceivably could be anonymous, though it couldn't be fine-tuned accurately and reliably."
But he says anonymous reporting wouldn't meet the second objective of the policy - follow-up of events. "Our whole business is quality and quality oversight. When an adverse event happens, that's part of quality improvement, and we need to be a part of those efforts."
When a sentinel event happens, Mowll says, consumer groups and governmental agencies turn to the Joint Commission and ask, "What are you doing to follow up on that event?" The public looks to the agency to accredit organizations, monitor activities, and make sure it is doing something to respond to events and reduce the risk of recurrence.
"We need to be publicly accountable," Mowll says, "and to do that we must have a timely and effective response from hospitals when sentinel events happen. Our job is to make sure they put plans in place to prevent future occurrences. That has driven us to do our utmost to get reports and root-cause analyses.
"It would be pretty hard to say that we're looking to ensure that health care organizations are doing the right things right and that they have the right processes in place so they can have good outcomes, and then when there's a bad outcome, not be involved in that. We cannot work at this point with anonymous information. We have no mechanism set up to do so."
The Joint Commission wants to be able to delve deeper than MERP to get to root causes, says Mowll. No root-cause analyses could be done on anonymous reports, however. The information relayed anonymously might be fictitious or even from a disgruntled employee, and that would result in an inaccurate database. Because the agency's function is to help facilities correct problems so events don't recur, they need to know the origin of the information.
But can't hospitals account for their own sentinel events? Mowll says, "Risk managers do say to us, 'Let us do our job. You, JCAHO, should rely on the risk reduction processes we have in place.' In our experience, about half of hospitals we work with have not had the comprehensive risk reduction processes in place that they should have. Half have, but half haven't. That latter half have found our assistance helpful."
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