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It Came From Norway To Take On A Medical Goliath

Sometimes it's the hospital that gets the exam.
Sometimes it's the hospital that gets the exam.

Even if I hadn't known the hospital inspectors were coming, I would have figured it out quickly enough from my email.

The admonitions were flying:

"Know your safety protocols backwards and forwards!"

"Sign things legibly, or at the very least print your name below the signature."

"Wash your hands before and after patient contact. (The surveyors will be watching .... )"

It's boilerplate stuff that doctors like me should do all the time but often overlook.

Now we were about to be graded. Hospitals that the quality inspectors deem deficient can lose their accreditation and be barred from Medicare reimbursement.

A nonprofit called the Joint Commission, though not on the tip of patients' tongues, is the outfit we're accustomed to seeing every three years for these quality checkups.

So I was surprised to learn that the surveyors, as they like to be called, were coming instead from a Norwegian company called DNV, that's short for Det Norske Veritas, or, in English, "The Norwegian Truth."

The company has been approved by the federal Centers for Medicare and Medicaid to certify hospitals since 2008.

Suffice it to say that most doctors, like me, have never heard of them.

My first thought was, "What? There's an alternative?"

I'd always believed that the Joint Commission had a monopoly in the hospital accreditation and certification business. At the very least, it always seemed to be some sort of quasi-governmental organization.

As it turns out, that isn't true. Welcome, upstarts. With little competition until now, the Joint Commission has tended to be viewed adversarially by hospital insiders.

My second thought was, how could an Oslo company that started out assessing the risks of ocean-going vessels in 1864 know anything about accrediting U.S. hospitals?

Interestingly, though rooted in Norway, DNV has had various risk management businesses in the U.S. since 1898. And Patrick Horine, CEO of DNV Healthcare, is a persistent man. He spent five years working to obtain CMS approval to become a hospital accreditor--continuing even after he was rejected the first time. "It was like climbing Mount Everest twice," Horine told Shots.

The new kid does things differently. Horine, who started out as a consultant helping hospitals prepare for traditional audits, figured there had to be a better way: "As soon as surveyors left the building and hit the parking lot, it was always back to business as usual," he said. "There was nothing to sustain quality improvements after surveys."

So DNV surveys its client hospitals annually, rather than every three years, which has been the Joint Commission's norm. But, the Joint Commision's Ann Scott Blouin, says it now offers annual visits on a voluntary basis — with about 10 percent of hospitals opting for that approach.

DNV brings a new standard for hospitals: ISO 9001 accreditation.

ISO 9001 is an internationally recognized quality system in manufacturing and service industries. Before DNV applied it to the field, ISO 9001 had never before been used in U.S. hospitals.

Now, the Joint Commission is testing its own ISO 9001 accreditation program at four sites across the U.S., according to Blouin.

DNV has a long way to go. Right now, it accredits about 350 U.S. hospitals compared with nearly 5,000 by the Joint Commission.

But DNV has doubled its list of customers in just two years, putting the Goliath of accreditation on notice.

Dr. Schumann is a general internist and educator at the University of Oklahoma School of Community Medicine in Tulsa, Okla. Follow him: @glasshospital

Copyright 2021 NPR. To see more, visit

John Henning Schumann, M.D., is an internal medicine physician and writer ( He has contributedto Slate,The Atlantic,Marketplace, and National Public Radio’s health blog,Shots.
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