Ready or not, here the Joint Commision comes

Every three years, medical institutions are evaluated by a national nonprofit group that scrutinizes safety and quality, from medication record-keeping to hand-washing, before awarding accreditation.

Joint Commission inspections of hospitals and nursing homes are serious occasions, intense week-long visits to decide whether the institutions meet its roughly 250 standards. The timing of the inspections is supposed to be secret, after a chorus of criticism halted the announced visits that were the norm until 2006.

Minutes from a February meeting of the psychiatry department at Cambridge Health Alliance offer some insights into how hospitals prepare for those surprise visits, and just how much of a surprise they actually are.

Psychiatry chief Dr. Jay Burke "reminded staff this is the second week of the period when we are actually vulnerable for a survey visit," according to the document obtained by the Globe.

The Joint Commission allows hospitals to black out 10 days a year. For Cambridge Health Alliance, that can mean school vacation weeks in February and April, when staff is out, or days when new interns arrive, crowding hospital units, said Priscilla Dasse, CHA's senior vice president for performance improvement.

In the psychiatry department meeting, the staff was praised for results from its own mock surveys and urged to "stay vigilant and ready on a moment's notice to welcome the surveyors."

Dasse said every department meeting includes time spent on preparing for a Joint Commission visit. Because CHA was last inspected in June 2005, it's on notice for all of 2008. It's still waiting for its inspection, which comes with about 15 minutes warning, she said, usually when the team of eight inspectors is already in a cab headed to the hospital.

"It is unannounced. We have to be ready for them to walk in today," Dasse said. "This is all about safety and quality and the environment of patient care. We have to be sure on a daily basis we are in compliance."

That vigilance includes a pager system to notify staff of "emergencies or important events such as the start of a survey," the psychiatry minutes said.

That kind of last-minute notice won't change the picture the inspectors get, Dasse said.

"There's nothing you can do to prepare staff" while the inspection is going on, she said. "We want them to be ready for this all the time, to be clear about how the process works to deliver the care we need to deliver."