The principal focus of all standards developed for the JCAHO is supposed to be on the patient. While the specifics of a standard for a particular performance area may emphasize the clinical or operational aspects of that performance area, the ultimate intent of the performance standard, according to the JCAHO, is the outcome for the patient (Joint Commission on Accreditation of Health Organizations, 1996b). As a part of its health care accreditation program, the JCAHO began almost decade ago to require health care institutions to report sentinel events as a part of the JCAHO accreditation watch program. Sentinel events are patient-care errors or accidents that lead to patient death or major injury (Moore, 1998). In theory, the focus on sentinel events may be considered to be a strong point in the hospital accreditation process. In actual application, however, the value to the consumer of the sentinel event focus is weakened considerably. In 1998, the JCAHO issued a revision to its sentinel event policy that encouraged health care organizations to voluntarily report sentinel events to the JCAHO, while the JCAHO in turn would stop making sentinel events information available to the public. This policy of the JCAHO was just one more example of the health care industry, it lawyers, and it lackeys in government trying to make a silk purse out of a sow ear [e.g., denying public access to specific information about health care mistakes so that the perpetrators of such mistakes could avoid being hauled into court by the people they harm]. Any health care organization that cares about its patients would voluntarily and without any urging of the JCAHO or any other organization develop standard operating procedures and control mechanisms to preclude the occurrence of all medical errors that harm patients. In 1999, the JCAHO published Preventing Adverse Events in Behavioral Health Care: A Systems Approach to Sentinel Events. The manual provides suggestions to health care organizations to help them to integrate standards for the prevention of adverse events (sentinel events) and other organizational risk management strategies (HO Releases Manual on Adverse Events999). Now, health care organizations can report sentinel events on line to the JCAHO and save even more money (that they can use to pay their lawyers to continue to shield their errors from the public). One area for which standards are established by the JCAHO is ethics. Ethical standards for health organizations apply to clinical practice, research, and all other aspects of the management of health organizations (Joint Commission on Accreditation of Health Organizations, 1996c). Patient rights and organization ethics are dealt with together by the JCAHO. Since 1991 the JCAHO has required all hospitals to have in place procedures and resources to deal with ethical issues related to patient care. Again, in theory, this approach may be considered to be a strong point in the hospital accreditation process. The standards on patient rights were supplemented in 1995 with the requirement that hospitals address issues related to organizational ethics. Organizational ethics requires a hospital to conduct iness relationships with patients and the public in an ethical manneroint Commission on Accreditation of Healthcare Organizations, 1997, p. RI-1). The patient rights ethical standards not only require that hospitals
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