The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is a private sector United States-based not-for-profit organization. The Joint Commission operates voluntary accreditation programs for hospitals and other health care organizations. The Joint Commission accredits over 17,000 health care organizations and programs in the United States.^[1] A majority of state governments recognize Joint Commission accreditation as a condition of licensure and receiving 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 this private 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".^[2]

The Joint Commission, from its inception in 1951 as the Joint Commission on Accreditation of Hospitals, was granted deeming power for hospitals "Under 42 U.S.C. §§ 1395bb(a),(b), a hospital that meets Joint Commission accreditation is deemed to meet the Medicare Conditions of Participation" (which is a requirement for Medicare). 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.^[3] 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 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).^[4]

History of the Joint Commission and JCI

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 Surgeons and its Hospital Standardization Program. In 1951, a new entity, the Joint Commission on Accreditation of Hospitals was created by merging of the Hospital Standardization Program with similar ones run by the American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association. In 1981, the company was renamed the Joint Commission on Accreditation of Healthcare Organizations (JCAHO, pronounced "Jay-co").^[5] 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 overall efforts to make the name easier to remember and to be sure the commission continues to be more responsive to the needs of organizations seeking accreditation. The Joint Commission advocates the use of patient safety measures, the spread of valuable information, measurement of performance, and the introduction of public policy recommendations.^[6]

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.^[7] International hospitals seek accreditation to demonstrate quality, and JCI accreditation is considered a seal of approval by medical travelers from the U.S. ^[8]

How the Joint Commission works

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.^[9] 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.^[10]

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.^[11] 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.^[12] 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".^[9] 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 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.^[13]

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.

Alternatives to the Joint Commission within the USA

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, while in California, The Joint Commission is part of a joint survey process with state authorities.^[14]

Also, there are in fact other American-based healthcare accreditation organizations working within the U.S., all of which are completely separate to the Joint Commission.^[15] These include the American Osteopathic Association,^[16] or AOA, Healthcare Facilities Accreditation Program (HFAP),^[17] Commission on Accreditation of Rehabilitation Facilities (CARF),^[18] Community Health Accreditation Program (CHAP),^[19] the Accreditation Commission for Health Care, Inc. (ACHC),^[20] Utilization Review Accreditation Commission (URAC),^[21] the "Exemplary Provider Program" of The Compliance Team^[22] and the Healthcare Quality Association on Accreditation (HQAA), who are recognised in the state of Ohio.^[23] HFAP is older than the Joint Commission, having been in operation since 1945.^[16]

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 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.^[24] 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.^[25]

International healthcare accreditation

With the advent of medical tourism, 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).^[26]

JCI also offers a variety of educational programs, especially "Practicums" - more information, including attendance costs, is available through their Web site.^[27]

There are other accreditation organisations based in countries other than the USA which fulfill a similar internationally-orientated role to JCI. These include:

• The Canadian Council on Health Services Accreditation or CCHSA^[28]
• The Trent Accreditation Scheme (Trent Accreditation Scheme or TAS - United Kingdom)^[29]
• The Australian Council on Healthcare Standards or ACHS^[30]

Costs of JCI accreditation

JCI publishes an average cost representing the fee for undergoing a survey.^[31] In addition, there are costs related to surveyors' living expenses and accommodation, and surveyors' air fares.

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 safety
• Patient safety organization
• URAC
• Hospital accreditation
• List of International Healthcare Accreditation Organizations
• Evidence-based medicine
• Medical ethics

Notes

External links

• The Joint Commission
• Joint Commission International