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The United States of America is universally considered to be the leader of the international healthcare enhancement campaign. Average life expectancy, general living standards, health care standards and healthcare infrastructure of the United States of America are comparatively high in contrast with Asian and those in some European countries. Currently, the effectiveness of the United States healthcare system has been recognized by various international and domestic agencies. Analogously with the development of international commerce, proper and well-planned management is of paramount importance for effective functioning of an institution. In the United States the role of government control is exercised by the Joint Commission, the entity which is charged with the responsibility to oversee the medical practice and to exercise accreditation procedures.
However streamlined this process may seem to be, the accreditation standards of the Joint Commission are still far from being totally impeachable. The objective of this paper is to provide a critical review of the follow-up survey accreditation issue. The practice indicates that this aspect of the contemporary medical standardization practice of the United States remains one of the most controversial and disputable, primarily due to the ambulance and to vagueness of the conceptual framework and differences in its practical implementation throughout the states. The paper examines the negative impact inflicted by the application of this rule and concludes on the possible solutions to this problem.
As far as the object of our examination is concerned, the focus has been made the following standard. It has been substantially modified in 2008, and these modifications led to the unprecedented plethora of controversy and application divergences (Shannon, 2009). The standard is outlined as follows.
Accreditation with Follow-up Survey Note:
The Accreditation with Follow-up Survey could occur within 30 days or up to six months after the decision is rendered. Accreditation with Follow-up Survey will be recommended when one or more of the following conditions are met:
AFS01 The [organization] demonstrates systemic patterns, trends, and repeat findings primarily with direct impact standards.
AFS02 The [organization] demonstrates systemic patterns, trends, and repeat findings primarily with indirect impact standards.
AFS03 The [organization] fails to successfully address all RFIs in an ESC or MOS.
AFS04 At least two on-site ESC demonstrate the need for continued monitoring to assess whether the organization sustains improvements.
AFS05 The [organization], which has failed to resolve one or more of its original RFIs, may be scheduled for a second Accreditation with Follow-up Survey.
Outwardly, everything seems to be smooth and completely consistent with the existing hospital accreditation practice, as well as with the scholarly opinion. However, having conducted a series of researches it has become evident that these standards should be fundamentally modified noted to meet the needs of the practice. Unless the government considers the critical remarks issued by the hospitals management, it is hypothetically possible that the situation can be substantially aggravated in the forthcoming future.
First and foremost, it is necessary to focus on the fact that the objective of the standard is to outline the procedures that should be taken by the Joint Commission in order to grant an accreditation to soliciting agency (Thompson et al, 2008). The controversy of this rule is that it was designed to outline the criterions which generate the follow-up survey. In other words, it has been completed in order to give the chance to an entity, which does not fully meet the accreditation requirements, but which can be effectively removed in the foreseeable future. On the other hand, this provision gives leeway for the Joint Commission to manipulate and exercise pressure over the entities, since the terminology and conceptual framework of the standard is not explicit enough (Mathias, 2011). Although the initial aim of the government was to give the opportunity for the agencies to rejuvenate their infrastructure and to make consistent with the obligatory state healthcare regulations, practically the standard is used as leverage by the Joint Commission (Adamski, 2006).
Follow-up Survey Concept Indefiniteness
As define by Krajewski (2007), the unanimous opinion of the scholars and the practitioners in this regard is that failure to define what operations and activities constitute a follow-up survey is the gravest menace for the efficacy of this policy. The guidelines of accreditation merely stipulate that the follow-up survey should be carried out, however, it is not defined what exact activities should be understood under this term (Japsen, 2008). Therefore, the authorized government officials of the Joint Commission can undertake practically everything they deem necessary for the observance and statutory irregularities identification. The practice varies across the states. For instance, in Texas the Joint Commission appoints the officers who oversee that the improvement and enhancement procedures are properly exercised. In the state of Alabama these appointees have the right to express advisory opinion, while in Florida this opinion is of obligatory nature for the managers of the healthcare institution.
Practically, this conceptual indefiniteness results in ubiquitous interventions of the Joint Commission authorities into the management and the daily activities of healthcare institution which does not match the prescribed standards. Sometimes, it leads to the practice when the appointees bribe extortion and other violations of the criminal law. However, the most despicable fact in this regard is that a viable defense mechanism for the healthcare institutions owners has not been elaborated insofar. While publicly funded hospital institutions can rely on healthcare ministry, privately managed ones are deprived of this legitimate opportunity.
Indefinite Terminology of the Standard
Secondly, the standard in question is full of ambiguous and ambivalent terms. In particular, it is not explicitly defined what should be understood under systemic patterns, trends, repeat findings and indirect impact standards. Therefore, these terms and concepts are interpreted by the clinical managers and the joint commission officers differently. The court institutions deliver the third opinion in this regard, which generally differs from the first two. Moreover, it is assumed that the standard is excessively rigorous, since a competent and experienced joint commission investigator can identify sufficient flows in pre- accreditation examination of the healthcare institution almost anywhere.
Considering the fact that these flaws are evident for the government officials, as well as for the clinical workers, it remains undisputed that they can lead to a number of grave negative consequences. Firstly, the functioning of the healthcare institution can be virtually paralyzed when the joint commission issues corresponding injunction in this regard. The patients are likely to be in need of immediate medical assistance or observation, while the institution can be legally deprived of the opportunity to comply with its duties. On the other hand, the joint commission's opinion is that failure to address the accreditation requirements correctly can result in unqualified practice commencement. In this case, the patients will be served, but the quality of service will be very disputable and the noli nocere principle can be virtually disrupted. Specifically, in the light of the conceptual indefiniteness, vagueness and ambivalence of the current accreditation standard in respect to follow-up survey, these repercussions are likely to emerge on the contemporary medical agenda.
Having analyzed the controversial nature of this provision, I strongly believe that it would be reviewed and restructured by the Joint Commission in the upcoming years. Failure to manage the situation adequately can result in the paralysis of the healthcare institutions functioning, as well as to unprecedented litigation campaigned by the union of healthcare practitioners against the Joint Commission.