PrintMay 14, 2009
Republicans Should Just Take the Hit
There may be political lessons for the GOP to be drawn from the world of superfluous bureaucracies. Every three years American hospitals turn themselves inside out preparing for the visit of inspectors from the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO (pronounced jay-koh). A passing grade from JCAHO is indispensable. The JCAHO website explains:
Congress passes the Social Security Amendments of 1965 with a provision that hospitals accredited by JCAH are "deemed" to be in compliance with most of the Medicare Conditions of Participation for Hospitals and, thus, able to participate in the Medicare and Medicaid programs.
In other words, hospitals either pass inspection (and get accredited) ... or Medicare reimbursement is withheld. I've worked in hospitals where, a year before the inspectors' scheduled visits, department heads would huddle together and pore over manuals crammed full of the minutiae of JCAHO's requirements. As inspection day approached, the staff had numerous mandatory in-service meetings where we heard scary stories about inspectors stopping nurses in the hall and interrogating them on almost anything pertaining to the hospital.
One day I was trying valiantly to memorize the hospital's mission statement (how that improves patient care I'll never know) while a co-worker from another department laughed at me. I asked him how he was preparing for the imminent JCAHO Inquisition.
"We're not preparing at all," he told me.
"But you'll fail!" I exclaimed.
"That's the idea," he explained. "We've learned the best way to handle these people is to just take the hit right away. That way, they move on and leave us alone to do our jobs. After a few weeks they'll send instructions as to how to fix whatever minor problem they found. We fix it, they pass us, everyone's happy. "
I was baffled. "But the hospital wants us to be in compliance with all these requirements so they can pass inspection this first go-around."
"Oh, you silly, silly nurse," he sighed. "Don't you know how the world works? I don't care how well you know the fire evacuation routes or whether your trash cans meet this year's requirement, you aren't going to pass. That's not how it works. The inspectors will keep looking until they find a reason to fail you. So our plan is take the hit and fail right away."
The tortured, bureaucratic JCAHO logic was so outrageous that I asked him to elaborate.
"It's simple," he replied. "These inspectors love their gigs. If JCAHO inspectors start actually passing hospitals on the first visit, they're out of work. So they write up huge binders full of ridiculous standards that no one, least of all overworked health care workers, could be expected to remember. Then they hang around until they catch you using the wrong kind of adhesive tape. You fail. They justify their inspections and keep their jobs.
One day I was trying valiantly to memorize the hospital's mission statement (how that improves patient care I'll never know) while a co-worker from another department laughed at me. I asked him how he was preparing for the imminent JCAHO Inquisition.
"We're not preparing at all," he told me.
"But you'll fail!" I exclaimed.
"That's the idea," he explained. "We've learned the best way to handle these people is to just take the hit right away. That way, they move on and leave us alone to do our jobs. After a few weeks they'll send instructions as to how to fix whatever minor problem they found. We fix it, they pass us, everyone's happy. "
I was baffled. "But the hospital wants us to be in compliance with all these requirements so they can pass inspection this first go-around."
"Oh, you silly, silly nurse," he sighed. "Don't you know how the world works? I don't care how well you know the fire evacuation routes or whether your trash cans meet this year's requirement, you aren't going to pass. That's not how it works. The inspectors will keep looking until they find a reason to fail you. So our plan is take the hit and fail right away."
The tortured, bureaucratic JCAHO logic was so outrageous that I asked him to elaborate.
"It's simple," he replied. "These inspectors love their gigs. If JCAHO inspectors start actually passing hospitals on the first visit, they're out of work. So they write up huge binders full of ridiculous standards that no one, least of all overworked health care workers, could be expected to remember. Then they hang around until they catch you using the wrong kind of adhesive tape. You fail. They justify their inspections and keep their jobs.
"So we've decided to take the hit right off, he continued. "We'll get dinged for something simple and obvious. I think this year we'll let them catch us not wearing our nametags. Then they'll go away and bother you guys instead."
I had to admit, it made a lot of sense. Imagine the freedom of admitting that failure is inevitable! Why not just take the hit?
Today in Washington DC we have another Joint Commission. It's the Joint Commission on Accreditation of Political Speech. (JCAPS). JCAPS is run by the Democrats and liberal elite. Their on-site inspectors are the Washington press corps. Like JCAHO, JCAPS have metaphorical binders crammed full of minute regulations of what political speech is acceptable. A few examples:
1. Nothing said by a Republican may overtly or even discreetly be seen as criticism of President Obama. If a Republican wishes to criticize President Obama's socialized medicine plan, private industry takeovers, gargantuan deficits, or cap and trade shakedown, it must be worded in such a way that President Obama is held completely innocent. Blaming the staff or Congress is an acceptable method of achieving compliance with this regulation. If the inspectors deem that your speech has strayed into a straightforward criticism of President Obama, you will fail. Punishment: You will be labeled a racist.
2. There will be no defense of George Bush and the past eight years. Failure to affix blame for the economy, national security, or any other problem arising in the next four years on the previous administration will result in failure. Punishment: You will be labeled a bigot, a warmonger, etc.
3. Stating that marriage should be between one man and one woman is strictly forbidden. (For a prime example of blatant non-compliance with this regulation, see Carrie Prejean.) Failure to accept the inevitability of gay marriage throughout the United States will result in failure. Punishment: You will be labeled a homophobe.
I had to admit, it made a lot of sense. Imagine the freedom of admitting that failure is inevitable! Why not just take the hit?
Today in Washington DC we have another Joint Commission. It's the Joint Commission on Accreditation of Political Speech. (JCAPS). JCAPS is run by the Democrats and liberal elite. Their on-site inspectors are the Washington press corps. Like JCAHO, JCAPS have metaphorical binders crammed full of minute regulations of what political speech is acceptable. A few examples:
1. Nothing said by a Republican may overtly or even discreetly be seen as criticism of President Obama. If a Republican wishes to criticize President Obama's socialized medicine plan, private industry takeovers, gargantuan deficits, or cap and trade shakedown, it must be worded in such a way that President Obama is held completely innocent. Blaming the staff or Congress is an acceptable method of achieving compliance with this regulation. If the inspectors deem that your speech has strayed into a straightforward criticism of President Obama, you will fail. Punishment: You will be labeled a racist.
2. There will be no defense of George Bush and the past eight years. Failure to affix blame for the economy, national security, or any other problem arising in the next four years on the previous administration will result in failure. Punishment: You will be labeled a bigot, a warmonger, etc.
3. Stating that marriage should be between one man and one woman is strictly forbidden. (For a prime example of blatant non-compliance with this regulation, see Carrie Prejean.) Failure to accept the inevitability of gay marriage throughout the United States will result in failure. Punishment: You will be labeled a homophobe.
And so on.
Throughout America, Republican politicians are facing the JCAPS inspectors. Politicians on the right try to oppose the Obama administration's leftist policies, and yet follow all of the politically correct regulations so that the Republicans can pass the media's inspection.
Throughout America, Republican politicians are facing the JCAPS inspectors. Politicians on the right try to oppose the Obama administration's leftist policies, and yet follow all of the politically correct regulations so that the Republicans can pass the media's inspection.
Oh you silly, silly Congressman! Don't you know how this works? You are a Republican! You are never going to pass!
Here is some advice for Republican politicians: Just take the hit. If you need to see how it's done, study Dick Cheney in this interview. He may be failing as far as JCAPS is concerned, but he is free. Free to speak the truth, to stand up and yell the emperor has no clothes. What a relief it must be.
Here is some advice for Republican politicians: Just take the hit. If you need to see how it's done, study Dick Cheney in this interview. He may be failing as far as JCAPS is concerned, but he is free. Free to speak the truth, to stand up and yell the emperor has no clothes. What a relief it must be.
I remember facing down many an eight-year-old in the ER, explaining that no matter how much he bargained or fought, the IV was going in his arm. He might as well just take the hit. And when the IV was in, the little guy would look up and say, "That wasn't so bad." (I am very good with an IV).
Republicans, I am not telling you that taking the hit from the JCAPS inspectors isn't going to hurt. But once you've taken the hit, and just gone ahead and failed the inspection, you're free! You can go forward and do your job. Stop letting fear of failure keep you from protecting America from President Obama's socialist vision. As far as average Americans are concerned, you'll start passing with flying colors!
Carol Peracchio is a registered nurse.
