Joint commission on accreditation of healthcare organisations (JCAHO)

Joint commision on accreditation of healthcare organisation(JCAHO) is the oldest and pioneer organisation who started the hospital accreditation program in USA. They developed the quality standard for compilation by hospitals and the system of accreditation was based essentially on assessment of compliance of these standards through self assessment as well as on-site survey by an external team of surveyors appointed by JCAHO.

JCAHO accreditation is a continuous data driven approach that focuses on the operational system critical to the safety of patients and quality of patient care. Over the years the system of evolution has been changing and evolving to enhance its effectiveness. In 2004 certain major changes were introduced in the process of on-site survey. These changes called upon the managements and quality professional of the organisation to maintain there organisation in a continuous survey readiness mode. Key component of the new methodology of accreditation survey are:

 

1. Periodic performance review(PPR)

A mandatory annual internal review by the organisation to evaluate its level of compliance with the applicable standards, identifies the area of non compliance, develop a plan of action to rectify the non-compliance and implement it with the approval of the JCAHO. It’s a self assessment done midway through the triennial.

 

2. Tracer methodology

Tracer methodology is on-site evaluation and involves tracing the patient’s stay from, “point of entry to post discharge and all the points in between”. In tracer methodology, the surveyors select a patient and use that individual’s medical record on a road map to move through the organization to access and evaluate the faculties compliance with selected standards and system of providing care and services. Patient’s are traced from their point of entry through post discharge. Surveyors access the patient’s care and safety by talking to the staff in the area that provide service to an individual. They follow the patients treatment path and faculties compliance with JCAHO standard. The system is reviewed for delivery of safe and quality health care. The patients selected as tracers  are generally those who have received complex and multiple services and are either recently discharged or active patients. They are selected on the basis of data collected prior to the on-site survey.

Tracing the patients through the continuum of care requires healthcare organisations to work as a team focusing on all the areas instead of preparing selected particular areas of survey. The approach seems to be better as it looks at the care from a patient’s perspective.

 

3. Priority focus process(PFP)

PFP is another major change in the on-site survey process which focuses on the patients safety and quality of care issues most relevant to the organisation. The issues are determined by surveyors on the basis of data from multiple sources including, the statistical data from past surveys of the facility and/or data provided by the joint commission or other public sources.

 

4. Unannounced survey

Unannounced surveys were started with a view to enhance the credibility of the accreditation process through real time observation of the process of patient care delivery under real circumstances.

The accreditation decision process focused on ongoing standards compliance and is based on the evidence of standard compliance as observed by surveyors during the on-site surveys. The accreditations may be awarded in differents categories such as accreditation,  provisional accreditation, conditional accreditation, preliminary accreditation.

 

JCI Accreditation Program

JCI accreditation of hospitals was started by JCAHO in the year 2002 with the purpose of accreditation of hospitals across the globe. The program involves accreditation of hospitals in any country of the world on the basis of uniform quality standard called the JCI standards, designed for international application. At present JCI has accreditation programs against the following laid down standards.

1. Ambulatory care standard
2. Care continuum standards
3. Clinical laboratory standards
4. Disease or condition specific care standards
5. Hospital standards

 

JCI standards(2nd edition) are very comprehensive standards covering all aspects of quality and safety of patient care in hospitals. It has 11 chapters, each chapter dealing with specific aspects of patient care, and prescribing standards pertaining to that aspect. In total there are 95 standards that all organisations must meet to be accredited.

Table 5.1 structure of JCI standards (2nd edition)

 

Chapter   Title                                                    Standards   Core          clauses       clauses

                                                                                             Standards                      in bold

                                                                                                                                  Typeface

---

1. Access to care and continuity     (AAC)        5             4                 17                9

Of care

1. Patient and family rights             (PFR)        10            9                 20               16
2. Assessment of patients              (AOP)        7              7                 32               18
3. Care of patients                          (COP)       19            11                35               28
4. Patient and family education       (PFE)        4              3                 5                 3
5. Quality improvement and            (QPS)       5              4                 39               15

Patient safety

1. Prevention and control                (PCI)        12             7                  9                 0

Of infection

1. Governance, leadership and      (GLD)        5              5                  21               7

direction

1. Facility management and           (FMS)      10              9                 17                5

safety

1. Staff qualification and                 (SQE)      15              9                 12                5

education

1. Management of information        (MOI)        3              3                  21               4

 

 

---

11                                                                     95             71                228             110

 

---

Note: the standard is not typeface but having any clause/subclause in bold typeface have been traced as core standards.

The standards are more or less similar to the NABH standards except the matter of withdrawal/withholding of resuscitative services/life support treatment, where patients wish are to be respected. The aspect has not been included in the NABH standards, perhaps because of any leagal provision supporting DNA in India.

 

JCI Accreditation Process

The process of accreditation has step as given in figure 5.1.

 

Steps in the process	Time prior to the survey
Obtain the JCI standards manual and begin preparation for JCI accreditation	12-24 months
Submit application for survey to JCI, and schedule the survey date with JCI	6-9 months
Receive the complete JCI survey contact and travel instructions	4-6 months
JCI survey team leader contacts your organization to determine the survey agenda	2 months before survey
JCI accreditation survey take place	Survey date
Receive accreditation decision and official survey findings reports with two month after survey from the JCI If Accreditation is not awarded
Submit revised application and schedule triennial JCI accreditation survey	6-9 months prior to triennial due date
JCI informs about the deficiencies to be made up and requirement of resurvey	After making up the deflciencles, on dates schedules

 

Fig. 5.1 steps in the JCI accreditation process

 

The process is essentially the same as for NABH Accreditation, except that the survey is carried out by an international team of consultants, from countries other than the applicant country.

Compared to ISO certification and NABH certification, JCI accreditation process takes longer duration-anything from one to two years, may be even more, depending upon the hospital and the time, energy and other resources they can commit to the process of accreditation. The process is tougher then NABH accreditation because of:

1. The much higher equipment requirements for JCI accreditation. In order to be eligible for receiving international patients, the hospitals have to be technologically highly advanced. They have to have the high tech equipment like:

A PET scanner, a3 tesla MRI scanner, a flat-panel decorator cardiac cath. Lab system, a combined gamma camera/CT system and a 64 slice CT scanner.

2. Much higher standards of hospitality services-something like a 4-5 star hotel.

3. Rather rigid evaluation of the compliance level by the international team of surveyors.

In view of the above, JCI accreditation appears to be a very costly process. The survey process alone cost crores of rupees, leave aside the cost of sophisticated technology required to meet the international standards of JCI. From the point of view of health tourism JCI accreditation but its cost effectiveness and benefits are yet to be seen. Perhaps, it would be prudent for an indian hospital to first achieve the NABH standards and then further improve to meet the JCI standards.