"Compliance" is an important noun in medicine. It means: "Willingness to follow a prescribed course of treatment." So if a doctor tells you to take one baby aspirin every day and you do so, you are "in compliance." But there is a subtle hint of choice in the concept as well, contained in the idea of willingness. What if you’re not willing? No big deal, you’re not in compliance, that’s all.
Now what happens when JCAHO inspectors decide a hospital is not in compliance with its rules? First the hospital is warned, and then the inspectors return to verify compliance, but there is no hint of choice in the matter. Either the hospital obeys orders or it loses its Medicare/Medicaid provider status, that is to say, its income. Now it’s true that any provider is free to reject the M/M status and run a cash-only business, but that becomes a dicey issue if the business is "publicly" owned by a corporation, city, county, state, or the federal government, and is operated by a board of directors. What I’m saying is that a hospital either acquires a JCAHO seal of approval, or it’s finished.
Is JCAHO a federal agency? Not exactly. I urge you to read the history on their web site. Maybe we should call it a parasitic and symbiotic private bureaucracy that wields State power in the interests of the State. Provider "membership" is voluntary in the sense that paying taxes is voluntary.
Before JCAHO got a total grip on hospitals, a hospital staff still had the incentive and discretion to make decisions in response to immediate problems by itself. I hark back to the sudden outbreak of lung infections in one unit (1972) that nearly got out of hand. The hospital staff stopped it in a short time by imposing strict infection control procedures and enforcing them. We had five hospitals in that community and each one experienced occasional infection outbreaks, but none of them got out of hand — for the same reason. Nobody reached for the JCAHO rulebook first to see if they were in compliance before acting, that is before spending thought and money on solving the problem.
Personally, I have always had a distinct allergic response to medical bureaucrats, so I only know how they operate by observing the results. I can only presume that JCAHO gets its orders from the NIH, the massive federal bureaucracy that sits on top of the medical power pyramid. Under them comes the CDC, which decrees what is a disease and whether it’s important. These people know perfectly well that there is an epidemic of hospital infections in the US. They know that these infections are escaping into the community, mutating, and posing a serious threat to public health. Yet they yap about Bird Flu, the Asian Threat. What’s with those people? Do they only care about political agendas? I don’t have a clue.
The business of medicine is suffering from its own disease: the centralization of decision-making tied to the centralization of money. We’ve seen this process occur time and again in the fields of education, welfare, security, justice, and so on. The faceless, nameless bureaucrat in some office somewhere makes the decisions and dispenses the money with no responsibility or accountability. They don’t pay heed to the rate of infection, expense, disability, or death that results from their decisions, The District of Criminals is firmly in charge and answers to nobody. We’ve seen it happen before in history. This political disease is terminal.
I would like to conclude this series of articles on infection control with an email that I received from a biological-research laboratory technician:
Our lab has mice in a “mouse room” in the vivarium of the research-building. In each mouse-room, there is a sterile air-flow hood, and racks of mice, which are all inside cages that only receive air through filtration systems. Upon entering the room, we have to put on shoe-covers, gown, face-mask, a cap to cover our hair, and gloves. We must then mop in when entering, and mop-out before leaving, with a germ-killing solution.
So, apparently, it is quite well believed that these types of operating procedures work for eliminating disease in mice, but amazingly, resistance is given to using the same procedures for people!