The relationship between you and your accreditation surveyor is a lot like that of a parent and a teenager. And you're the teenager.

You're absolutely convinced that the way you run your surgical facility is not only the right way, but the best way as well. And you're really not interested in hearing someone else's opinion about how you should be minding your business — especially someone in a position of authority who's carrying a clipboard and a book of standards.

Of course, none of us know best, and all of us don't know what we don't know. Are you sterilizing correctly? Are your anesthesia machines in good repair? Are your doctors properly credentialed? You may think you're doing a really good job, but you need an independent third party to come in and show you what you can't see with your own eyes.

Enter the surveyor, the great variable in the accreditation process. Is he there to trip you up or to build you up, to humble and to humiliate or to coach and to counsel?

"Some of it is how a surveyor interprets things — how they see it and how you see it," says Kristine P. Kilgore, RN, BSN, the administrative director of the Surgical Care Center of Michigan in Grand Rapids, Mich., and an AAAHC surveyor. "I would hope that most surveyors aren't looking for the negatives."

Our readers, however, report that some surveyors are playing a game of gotcha, citing facilities for the silliest of infractions (see "Would You Believe Our Accreditation Surveyor Dinged Us For ...?" on page 38) and filling their visits with dread.

"Some surveyors think that if they don't find something wrong, they're not doing their jobs," says a surgery center administrator who asked to remain anonymous. "I said to ours at one point, ???I thought these surveys were to be educational and fun.' He just looked at me and didn't say anything. It was neither. He was out to get us."

We hope tales of persnickety surveyors aren't deterring the 72% of surgery centers that aren't yet accredited from seeking accreditation. Because just as it's a good bet that they're doing a fine job already, it's also a sure thing they'd benefit from outside evaluation and oversight — if for no other reason than to make sure everything is in order.

Currently, out of 5,186 Medicare-certified ASCs, 1,463, or 28%, are accredited by 1 of 4 accrediting bodies: AAAHC (by far the most popular choice, with 1,018 facilities), the Joint Commission, AAAASF or AOA. Five years ago, only 589 of 3,960 (15%) Medicare-certified facilities were accredited. So despite the daffy dings you'll read about, the percentage of accredited facilities has almost doubled and the number has almost tripled.