The Cyclical Impact of Joint Commission Site Visits on Risk-Adjusted Mortality Rates in Hospitals

Abstract

Hospital accreditation inspections are at once highly institutionalized and predictably cyclical, creating the potential for waves of isomorphic response (i.e. convergence around commonly legitimized accreditation standards) among accredited hospitals. Yet little is known about how – and to what extent – these isomorphic waves impact hospital performance, particularly the outcomes of care experienced by patients. In this study, monthly risk-adjusted mortality rates are observed in New Jersey hospitals over a ten year period to assess significant changes during reaccreditation cycles. The analysis reveals that mortality rates tend to improve following accreditation inspections but that the improvement fades in subsequent weeks, lending support for the notion that the response to institutional accreditation pressures may be cyclical rather than perpetual. Moreover, the analysis reveals that this effect is strongest among hospitals that have acquired fewer advanced technologies (a proxy for resource slack) suggesting the possibility that tight resource slack may exacerbate the tendency among hospitals to engage in cyclically isomorphic behavior.