Agency blasts collegial approach

Hospital regulation system leaves enforcement gaps


WASHINGTON Ė Hospital regulators rely-too much on trust and cooperation and not enough on tough enforcement, undermining the nationís system for assuring patient safety a government oversight agency concludes.

An increasingly collegial approach helps some hospitals improve, but such systems are "unlikely to detect substandard patterns of care individual practitioners with questionable skills," according to a report released Tuesday by the Department of Health and Human Servicesí inspector general.

"They could not detect a flaw that the hospitals did not want them to detect," said George Grob, a deputy inspector general who oversaw the four-volume report.

The report found several systemic problems: Reviewers lack time to poke around a hospital to find unexpected problems. They are not briefed on a hospitalís background and any troubles it had. A hospital can choose which medical records are examined. And hospital staff know when commission reviews are coming, making it less likely that problems will be spotted.

A collegial approach emphasizes cooperation, flexibility, trust, confidentiality and improving systems. A regulatory approach involves more rigid enforcement of minimum standards, skepticism, public accountability and prevention of harm.

The Joint Commission for Hospital Accreditation, which regulates about 80 percent of the nationís 6,200 hospitals, defended its collegial approach, In the last couple of years, it has trumpeted efforts to encourage hospitals to notify them when something goes wrong. In exchange, the commission promises not to punish hospitals for the admissions.

"the educational thrust embodied in a collegial orientation is the most critical election in achieving lasting improvement," commission president Dr. Dennis OíLeary wrote in a letter responding to the report.