Joint Commission on Accreditation of Healthcare Organizations
Encyclopedia
The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is a United States-based not-for-profit organization that accredits over 19,000 health care organizations and programs in the United States. A majority of state governments have come to recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid
reimbursement. Surveys (inspections) typically follow a triennial cycle, with findings made available to the public in an accreditation quality report on the Quality Check Web site.
The declared mission of the organization is "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value".
Although The Joint Commission was renamed Joint Commission on Accreditation of Hospitals in 1951, it was not granted deeming power for hospitals until 1965, when it was deemed that a hospital that met Joint Commission accreditation met the Medicare
Conditions of Participation. Recently, Section 125 of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) removed The Joint Commission’s statutorily-guaranteed accreditation authority for hospitals, to be effective July 15, 2010. At that time, The Joint Commission’s hospital accreditation program will be subject to Centers for Medicare & Medicaid (CMS) requirements for accrediting organizations seeking deeming authority. To avoid a lapse in deeming authority, The Joint Commission must submit an application for hospital deeming authority consistent with these requirements and within a time frame that will enable CMS to review and evaluate their submission. CMS will make the decision to grant deeming authority and determine the term.
In 2008, the Joint Commission collected $165 million in revenue, mainly from the fees it charges U.S. health care organizations for evaluating their compliance with federal regulations. Its expenses during this period were $162 million. Its total return on investments in 2008 was -$27 million (loss), and the total value of its investments was $83 million. In 2007, its collected revenue was $149 million. Its expenses were $148 million. Its total return on investments was $5 million, and the total value of its investments was $107 million. The Joint Commission's primary investments in 2007 and 2008 were in stocks (about 50% of investments) and trusts (about 40% of investments).
Hospital Standardization Program. In 1951, a new entity, the Joint Commission on Accreditation of Hospitals was created by merging the Hospital Standardization Program with similar programs run by the American College of Physicians
, the American Hospital Association
, the American Medical Association
, and the Canadian Medical Association
. In 1987, the company was renamed the Joint Commission on Accreditation of Healthcare Organizations (JCAHO, pronounced "Jay-co"). In 2007, the Joint Commission on Accreditation of Healthcare Organizations underwent a major rebranding and simplified its name to The Joint Commission. The rebranding included the name, logo, and tag line change to "Helping Health Care Organizations Help Patients."
The name change was part of an overall effort to make the name easier to remember and to position the commission to continue to be responsive to the needs of organizations seeking fee-based accreditation. The Joint Commission advocates the use of patient safety measures, the spread of information, the measurement of performance, and the introduction of public policy recommendations.
Joint Commission International (JCI) was established in 1997 as a division of Joint Commission Resources, Inc. (JCR), a private, not-for-profit affiliate of The Joint Commission. Through international accreditation, consultation, publications and education programs, JCI extends The Joint Commission's mission worldwide by helping to improve the quality of patient care by assisting international health care organizations, public health agencies, health ministries and others evaluate, improve and demonstrate the quality of patient care and enhance patient safety in more than 60 countries. International hospitals may seek accreditation to demonstrate quality, and JCI accreditation may be considered a seal of approval by medical travelers from the U.S.
TJC is based in Oakbrook Terrace, Illinois.
The unannounced full survey is a key component of The Joint Commission accreditation process. "Unannounced" means the organization does not receive an advance notice of its survey date. The Joint Commission began conducting unannounced surveys on January 1, 2006. Surveys will occur 18 to 39 months after the organization's previous unannounced survey.
There has been criticism in the past from within the U.S. of the way the Joint Commission operates. The Commission's practice had been to notify hospitals in advance of the timing of inspections. A 2007 article in the Washington Post noted that about 99% of inspected hospitals are accredited, and serious problems in the delivery of care are sometimes overlooked or missed. Similar concerns have been expressed by the Boston Globe, stating that "The Joint Commission, whose governing board has long been dominated by representatives of the industries it inspects, has been the target of criticism about the validity of its evaluations". The Joint Commission over time has responded to these criticisms. However, when it comes to the international dimension, surveys undertaken by JCI still take place at a time known in advance by the hospitals being surveyed, and often after considerable preparation by those hospitals.
Preparing for a Joint Commission survey can be a challenging process for any healthcare provider. At a minimum, a hospital must be completely familiar with the current standards, examine current processes, policies and procedures relative to the standards and prepare to improve any areas that are not currently in compliance. The hospital must be in compliance with the standards for at least four months prior to the initial survey. The hospital should also be in compliance with applicable standards during the entire period of accreditation, which means that surveyors will look for a full three years of implementation for several standards-related issues.
As for the surveyors, the Joint Commission and JCI employ salaried individuals, people who generally work or have worked within health care services but who may devote half or less of their time for the accrediting organization. The surveyors travel to health care organizations to evaluate their operational practices and facilities (i.e., structure/input and process metrics) against established Joint Commission standards and elements of performance.
Substantial time and resources are devoted by health care organizations ranging from medical equipment suppliers and staffing firms to tertiary care academic medical centers to prepare for and undergo Joint Commission surveys. There is growing concern, however, over the lack of verifiable progress towards meeting the organization's stated goals. Although the Joint Commission increasingly cites and demands "evidence-based medicine" in its regulatory requirements, there is a relative paucity of evidence demonstrating any significant quality improvement due to its efforts, while there is a growing body of literature showing no improvement or actual deterioration in quality despite the increasingly stringent and expensive requirements.
There are also other healthcare accreditation organizations in the U.S. unrelated to the Joint Commission. These include the American Osteopathic Association
, or AOA, Healthcare Facilities Accreditation Program
(HFAP), Commission on Accreditation of Rehabilitation Facilities (CARF), Community Health Accreditation Program
(CHAP), the Accreditation Commission for Health Care
, Inc. (ACHC), Utilization Review Accreditation Commission (URAC), the "Exemplary Provider Program" of The Compliance Team
and the Healthcare Quality Association on Accreditation
(HQAA), who are recognised in the state of Ohio. HFAP is older than the Joint Commission, having been in operation since 1945.
On September 26, 2008 the U.S. Centers for Medicare & Medicaid (CMS) granted deeming authority for hospitals to DNV Healthcare Inc (DNVHC, Inc.) DNVHC is an operating company of Det Norske Veritas (DNV), an international company that has been operating in the U.S. since 1898.
The company updates its accreditation standards and expands patient safety goals on a yearly basis, and posts them on its Web site for all interested persons to review, making this information and process transparent
to all stakeholders ranging from institutions, to practitioners, to patients and their advocates
.
The purpose of The Joint Commission’s National Patient Safety Goals is to promote specific improvements in patient safety. The Goals highlight problematic areas in health care and describe evidence and expert-based solutions to these problems. Recognizing that sound system design is intrinsic to the delivery of safe, high quality health care, the Goals focus on system-wide solutions, wherever possible.
The NPSGs have become a critical method by which The Joint Commission promotes and enforces major changes in patient safety in thousands of participating health care organizations in the United States and around the world. The 2009 NPSGs include new regulations targeting the spread of infection due to multidrug-resistant organisms, catheter-related bloodstream infections (CRBSI), and surgical site infections (SSI). The new regulations for CRBSI and SSI prevention apply not only to hospitals, but also to ambulatory care and ambulatory surgery centers. Engaging patients in patient safety efforts is also a major new component of the NPSGs. The Universal Protocol to reduce surgical errors and existing regulations on medication reconciliation have also been modified for 2009, based on feedback received by The Joint Commission.
, international healthcare accreditation
of hospitals located in countries around the world has increasingly grown in importance.
Joint Commission International, or JCI, is one of the groups providing international healthcare accreditation services to hospitals around the world and brings income into the U.S.-based parent organization. This not-for-profit private company currently accredits hospitals in Asia, Europe, the Middle East and South America, and is seeking to expand its business further).
JCI also offers a variety of educational programs, especially "Practicums" – more information, including attendance costs, is available through their Web site.
There are other accreditation organisations based in countries other than the USA which fulfill a similar internationally-orientated role to JCI. These include:
There may be additional costs related to consultancy work etc. directed towards assisting a hospital to be successful in the accreditation process.
Other international accreditors incur different levels of costs, some costing less than JCI.
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
reimbursement. Surveys (inspections) typically follow a triennial cycle, with findings made available to the public in an accreditation quality report on the Quality Check Web site.
The declared mission of the organization is "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value".
Although The Joint Commission was renamed Joint Commission on Accreditation of Hospitals in 1951, it was not granted deeming power for hospitals until 1965, when it was deemed that a hospital that met Joint Commission accreditation met the Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
Conditions of Participation. Recently, Section 125 of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) removed The Joint Commission’s statutorily-guaranteed accreditation authority for hospitals, to be effective July 15, 2010. At that time, The Joint Commission’s hospital accreditation program will be subject to Centers for Medicare & Medicaid (CMS) requirements for accrediting organizations seeking deeming authority. To avoid a lapse in deeming authority, The Joint Commission must submit an application for hospital deeming authority consistent with these requirements and within a time frame that will enable CMS to review and evaluate their submission. CMS will make the decision to grant deeming authority and determine the term.
In 2008, the Joint Commission collected $165 million in revenue, mainly from the fees it charges U.S. health care organizations for evaluating their compliance with federal regulations. Its expenses during this period were $162 million. Its total return on investments in 2008 was -$27 million (loss), and the total value of its investments was $83 million. In 2007, its collected revenue was $149 million. Its expenses were $148 million. Its total return on investments was $5 million, and the total value of its investments was $107 million. The Joint Commission's primary investments in 2007 and 2008 were in stocks (about 50% of investments) and trusts (about 40% of investments).
History
The Joint Commission's predecessor organization was an outgrowth of the efforts of Ernest Codman to promote hospital reform based on outcomes management in patient care. Codman’s efforts led to the founding of the American College of SurgeonsAmerican College of Surgeons
The American College of Surgeons is an educational association of surgeons created in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.-Membership:...
Hospital Standardization Program. In 1951, a new entity, the Joint Commission on Accreditation of Hospitals was created by merging the Hospital Standardization Program with similar programs run by the American College of Physicians
American College of Physicians
The American College of Physicians is a national organization of doctors of internal medicine —physicians who specialize in the prevention, detection, and treatment of illnesses in adults. With 130,000 members, ACP is the largest medical-specialty organization and second-largest physician group in...
, the American Hospital Association
American Hospital Association
The American Hospital Association is an organization that promotes the quality provision of health care by hospitals and health care networks through such efforts as promoting effective public policy and providing information related to health care and health administration to health care...
, the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
, and the Canadian Medical Association
Canadian Medical Association
The Canadian Medical Association , with more than 70,000 members, is the largest association of doctors in Canada and works to represent their interests nationally. It formed in 1867, three months after Confederation...
. In 1987, the company was renamed the Joint Commission on Accreditation of Healthcare Organizations (JCAHO, pronounced "Jay-co"). In 2007, the Joint Commission on Accreditation of Healthcare Organizations underwent a major rebranding and simplified its name to The Joint Commission. The rebranding included the name, logo, and tag line change to "Helping Health Care Organizations Help Patients."
The name change was part of an overall effort to make the name easier to remember and to position the commission to continue to be responsive to the needs of organizations seeking fee-based accreditation. The Joint Commission advocates the use of patient safety measures, the spread of information, the measurement of performance, and the introduction of public policy recommendations.
Joint Commission International (JCI) was established in 1997 as a division of Joint Commission Resources, Inc. (JCR), a private, not-for-profit affiliate of The Joint Commission. Through international accreditation, consultation, publications and education programs, JCI extends The Joint Commission's mission worldwide by helping to improve the quality of patient care by assisting international health care organizations, public health agencies, health ministries and others evaluate, improve and demonstrate the quality of patient care and enhance patient safety in more than 60 countries. International hospitals may seek accreditation to demonstrate quality, and JCI accreditation may be considered a seal of approval by medical travelers from the U.S.
TJC is based in Oakbrook Terrace, Illinois.
Operation
All health care organizations, other than laboratories, are subject to a three-year accreditation cycle. With respect to hospital surveys, the organization does not make its findings public. However, it does provide the organization's accreditation decision, the date that accreditation was awarded, and any standards that were cited for improvement. Organizations deemed to be in compliance with all or most of the applicable standards are awarded the decision of Accreditation.The unannounced full survey is a key component of The Joint Commission accreditation process. "Unannounced" means the organization does not receive an advance notice of its survey date. The Joint Commission began conducting unannounced surveys on January 1, 2006. Surveys will occur 18 to 39 months after the organization's previous unannounced survey.
There has been criticism in the past from within the U.S. of the way the Joint Commission operates. The Commission's practice had been to notify hospitals in advance of the timing of inspections. A 2007 article in the Washington Post noted that about 99% of inspected hospitals are accredited, and serious problems in the delivery of care are sometimes overlooked or missed. Similar concerns have been expressed by the Boston Globe, stating that "The Joint Commission, whose governing board has long been dominated by representatives of the industries it inspects, has been the target of criticism about the validity of its evaluations". The Joint Commission over time has responded to these criticisms. However, when it comes to the international dimension, surveys undertaken by JCI still take place at a time known in advance by the hospitals being surveyed, and often after considerable preparation by those hospitals.
Preparing for a Joint Commission survey can be a challenging process for any healthcare provider. At a minimum, a hospital must be completely familiar with the current standards, examine current processes, policies and procedures relative to the standards and prepare to improve any areas that are not currently in compliance. The hospital must be in compliance with the standards for at least four months prior to the initial survey. The hospital should also be in compliance with applicable standards during the entire period of accreditation, which means that surveyors will look for a full three years of implementation for several standards-related issues.
As for the surveyors, the Joint Commission and JCI employ salaried individuals, people who generally work or have worked within health care services but who may devote half or less of their time for the accrediting organization. The surveyors travel to health care organizations to evaluate their operational practices and facilities (i.e., structure/input and process metrics) against established Joint Commission standards and elements of performance.
Substantial time and resources are devoted by health care organizations ranging from medical equipment suppliers and staffing firms to tertiary care academic medical centers to prepare for and undergo Joint Commission surveys. There is growing concern, however, over the lack of verifiable progress towards meeting the organization's stated goals. Although the Joint Commission increasingly cites and demands "evidence-based medicine" in its regulatory requirements, there is a relative paucity of evidence demonstrating any significant quality improvement due to its efforts, while there is a growing body of literature showing no improvement or actual deterioration in quality despite the increasingly stringent and expensive requirements.
Alternatives in the US
The Joint Commission is not a complete monopoly and while many states in the U.S. make use of their services, not all do. Some states have set up their own alternative assessment procedures, and the Joint Commission is not recognized for state licensure in the states of Oklahoma (except for hospital-based outpatient mental health services), Pennsylvania, and Wisconsin. In California, The Joint Commission is part of a joint survey process with state authorities.There are also other healthcare accreditation organizations in the U.S. unrelated to the Joint Commission. These include the American Osteopathic Association
American Osteopathic Association
The American Osteopathic Association is the representative member organization for the over 78,000 osteopathic medical physicians in the United States...
, or AOA, Healthcare Facilities Accreditation Program
Healthcare Facilities Accreditation Program
The Healthcare Facilities Accreditation Program , is a not-for-profit organization dedicated to helping healthcare organizations maintain the highest standards in patient care and comply with ever-changing government regulations and a constantly evolving healthcare environment.Headquartered in...
(HFAP), Commission on Accreditation of Rehabilitation Facilities (CARF), Community Health Accreditation Program
Community Health Accreditation Program
The Community Health Accreditation Program is an independent, US not-for-profit accrediting body and is an alternative to the Joint Commission...
(CHAP), the Accreditation Commission for Health Care
Accreditation Commission for Health Care
The Accreditation Commission for Health Care is a US non-profit health care accrediting organization. It represents an alternative to the Joint Commission....
, Inc. (ACHC), Utilization Review Accreditation Commission (URAC), the "Exemplary Provider Program" of The Compliance Team
The Compliance Team
The Compliance Team Inc., is a US for-profit organization which runs the "Exemplary Provider" accreditation programs, a US-based alternative to the Joint Commission...
and the Healthcare Quality Association on Accreditation
Healthcare Quality Association on Accreditation
The Healthcare Quality Association on Accreditation is a US not-for-profit health care accrediting body and is an alternative to the Accreditation Commission for Health Care and Joint Commission...
(HQAA), who are recognised in the state of Ohio. HFAP is older than the Joint Commission, having been in operation since 1945.
On September 26, 2008 the U.S. Centers for Medicare & Medicaid (CMS) granted deeming authority for hospitals to DNV Healthcare Inc (DNVHC, Inc.) DNVHC is an operating company of Det Norske Veritas (DNV), an international company that has been operating in the U.S. since 1898.
Goals and initiatives
The stated mission of The Joint Commission is: "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value"The company updates its accreditation standards and expands patient safety goals on a yearly basis, and posts them on its Web site for all interested persons to review, making this information and process transparent
Transparency (humanities)
Transparency, as used in science, engineering, business, the humanities and in a social context more generally, implies openness, communication, and accountability. Transparency is operating in such a way that it is easy for others to see what actions are performed...
to all stakeholders ranging from institutions, to practitioners, to patients and their advocates
Advocacy
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource allocation decisions within political, economic, and social systems and institutions; it may be motivated from moral, ethical or faith principles or simply to protect an...
.
The purpose of The Joint Commission’s National Patient Safety Goals is to promote specific improvements in patient safety. The Goals highlight problematic areas in health care and describe evidence and expert-based solutions to these problems. Recognizing that sound system design is intrinsic to the delivery of safe, high quality health care, the Goals focus on system-wide solutions, wherever possible.
The NPSGs have become a critical method by which The Joint Commission promotes and enforces major changes in patient safety in thousands of participating health care organizations in the United States and around the world. The 2009 NPSGs include new regulations targeting the spread of infection due to multidrug-resistant organisms, catheter-related bloodstream infections (CRBSI), and surgical site infections (SSI). The new regulations for CRBSI and SSI prevention apply not only to hospitals, but also to ambulatory care and ambulatory surgery centers. Engaging patients in patient safety efforts is also a major new component of the NPSGs. The Universal Protocol to reduce surgical errors and existing regulations on medication reconciliation have also been modified for 2009, based on feedback received by The Joint Commission.
International healthcare accreditation
With the advent of medical tourismMedical tourism
Medical tourism is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care...
, international healthcare accreditation
International healthcare accreditation
Due to the near-universal desire for quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process...
of hospitals located in countries around the world has increasingly grown in importance.
Joint Commission International, or JCI, is one of the groups providing international healthcare accreditation services to hospitals around the world and brings income into the U.S.-based parent organization. This not-for-profit private company currently accredits hospitals in Asia, Europe, the Middle East and South America, and is seeking to expand its business further).
JCI also offers a variety of educational programs, especially "Practicums" – more information, including attendance costs, is available through their Web site.
There are other accreditation organisations based in countries other than the USA which fulfill a similar internationally-orientated role to JCI. These include:
- Accreditation Canada
- The Australian Council on Healthcare Standards or ACHS
- QHA Trent AccreditationQHA Trent AccreditationQHA Trent Accreditation is a United Kingdom-based independent holistic accreditation scheme for hospitals and clinics that functions worldwide. It represents an option for healthcare providers to international accreditation schemes such as Joint Commission International from the USA...
(based in the United Kingdom)
- In INDIA National Accreditation Board for Hospitals and Healthcare Providers or NABHNABHNABH is an acronym for National Accreditation Board for Hospitals & Healthcare Providers is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organizations...
Cost of accreditation
JCI publishes an average fee of $46,000.00 USD for a full hospital survey. Reimbursement for surveyors' travel, living expenses and accommodations is required in addition to the fee.There may be additional costs related to consultancy work etc. directed towards assisting a hospital to be successful in the accreditation process.
Other international accreditors incur different levels of costs, some costing less than JCI.
See also
- List of healthcare accreditation organisations in the USA
- Hospital
- Patient safetyPatient safetyPatient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
- Patient safety organizationPatient safety organizationA patient safety organization is a group, institution or association that improves medical care by reducing medical errors. In the 1990s, reports in several countries revealed a staggering number of patient injuries and deaths each year due to avoidable adverse health care events...
- URACUracURAC, formerly known as the Utilization Review Accreditation Commission, is a nonprofit organization promoting healthcare quality by accrediting healthcare organizations.- Mission :...
- Hospital accreditationHospital accreditationHospital accreditation has been defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”...
- List of International Healthcare Accreditation Organizations
- Evidence-based medicineEvidence-based medicineEvidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
- Medical ethicsMedical ethicsMedical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...