AMA participation on the Joint Commission a win-win

My position at the AMA is a tremendous learning opportunity and it is a privilege to serve our patients and profession. But even in my wildest dreams, I never thought I would be a board member of the Joint Commission -- and I'm sure the Joint Commission never anticipated someone like me.

Since 2003, I have served as an AMA commissioner on the Joint Commission's board of commissioners. With six other AMA commissioners, I bring real-world experience with running a practice and working in a hospital to an organization that needs diversity -- and welcomes it.

You may or may not know much about the Joint Commission, depending on your role in medicine. But I guarantee that it affects you every day. It is the accrediting body for more than 15,000 health care organizations and programs in the United States. The Joint Commission's Gold Seal of Approval is sought by the organizations that voluntarily seek accreditation for Medicare Conditions of Participation deemed-status.

My experience has taught me about standards, fairness, public reporting and performance measures -- and how to apply them to quality and safety improvement, rather than for reward and punishment.

The Joint Commission accreditation standards are helping to improve quality and patient safety in health care institutions that affect such an extraordinary number of patients and physicians. The AMA's ability to have physician input in the development of accreditation standards is, of course, a win-win situation. Without America's healers, the Joint Commission's mission would be impossible: "To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations."

My personal learning opportunity even extends beyond the U.S. through Joint Commission International's board. In this day and age on a "flat" world, more Americans receive care across our borders and overseas. Increasing numbers travel specifically to obtain care from extraordinary institutions with well-trained physicians in developing countries. Those organizations covet Joint Commission International accreditation. They see it as a testament to their quality and safety.

My service on the Joint Commission's board of commissioners is where I have had the opportunity to learn and work with some brilliant, talented, and diverse members of the board of commissioners -- including my fellow AMA commissioners: the late, great, Ron Davis, MD, who championed medical staffs' right to self-governance; Jim Rohack, MD, AMA president-elect, who taught me how to negotiate successfully when negotiations are seemingly over; Rebecca Patchin, MD, chair-elect of the AMA Board of Trustees and Nicole Jamali, MD, stubbornly insisting on real-world medicine; Ed Langston, MD, immediate past chair of the AMA board, who chairs the Accreditation Committee; and Richard Frankenstein, MD, who superbly chaired the Standards and Surveys committee, ensuring fairness. Kudos also to Joe English, MD, Josie Williams, MD, and our newest commissioner, AMA trustee Mary Anne McCaffree, MD.

For the past several years, the AMA commissioners have successfully advocated for language in accreditation standards that strengthens the role and ability of medical staffs to protect quality and safety within accredited institutions.

Great credit goes to the AMA Organized Medical Staff Section and its governing council. With input from the OMSS, we have been negotiating for several years to finally get the medical staff standards right for patients and doctors. OMSS has been an integral part of this process and responsible for so much of the success.

This is not to say that simple but important revisions could overcome all of the challenges posed by the Joint Commission standards. We have had setbacks.

We were not successful in including the words "physicians and other" before "Licensed Independent Practitioners," or in deleting the use of the word "disruptive" from the standard on abusive or threatening behavior. We also lost a battle on the unfair "Rhode Island Roll-up," which publicly reports a total score that equates giving a beta-blocker with "checking off" anti-smoking counseling -- clearly a ludicrous scale.

Every challenge, however, has been a learning experience.

And there is always a real-world balancing act between maintaining fiduciary responsibility for the Joint Commission and being a patient and physician advocate. While both are important, we never forget we are the voices of America's physicians and their patients.

Another improvement should appeal to every health information technology buff -- that is, to have an electronic version of Joint Commission standards, and to see development of the assistance and assessment tool, Accreditation Manager Plus. The creation of new survey methodology and a simpler standard format are also important gains.

The Joint Commission's new president, Mark Chassin, MD, MPH, is moving the organization further with new ideas. He repeatedly reminds us that any measure used for public reporting (or pay-for-performance) should have three characteristics: It must be evidence-based, it must be shown absolutely that the activity being measured truly improves outcomes, and it must be truly measurable (unlike anti-smoking counseling). Dr. Chassin is a true friend of America's physicians, and we are fortunate to be able to work closely with him.

The AMA was created in 1847 to improve the standards of American medicine. That job continues, and it's crucial we be part of organizations that share this goal.

That which we can help enlighten can help enlighten us.