The Joint Commission PRACTICE STANDARDS AUTHORS: BRIAN BROWN, MICHAEL KLEIN, LAURA SCURLOCK

What is The Joint Commission? “An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 20,500 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards” (“About the Joint Commission”, The Joint Commission is formerly known as JCAHO, or Joint Commission on Accreditation of Healthcare Organizations.

Who created the Joint Commission ? The American College of Physicians (ACP), the American Hospital Association (AHA), the American Medical Association (AMA), and the Canadian Medical Association (CMA) worked with the American College of Surgeons (ACS) to form the Joint Commission on Accreditation of Hospitals (JCAH), the first name of The Joint Commission (“Our History”, 2014).

Why was the Joint Commission created? “Mission: 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” (“About The Joint Commission”, 2014). “Vision: All people always experience the safest, highest quality, best-value health care across all settings” (“About The Joint Commission”, 2014). The Joint Commission was established to track the effectiveness of treatment and the quality of care

History of The Joint Commission The roots of The Joint Commission go back to 1910 when Ernest Codman proposed keeping track of the result of each hospitalized patient In 1913 the American College of Surgeons (ACS) was established In 1917 the Minimum Standard for Hospitals was developed by the ACS In 1918 the first on-site hospital evaluations were done In 1926 the first standards manual was printed In 1951 the Joint Commission on Accreditation of Hospitals (JCAH) was formed in Chicago, IL. The purpose was to provide voluntary accreditation to health care facilities (“Our History”, 2014).

History continued In 1966 long term care facilities became eligible for evaluation In 1970 standards were redesigned to reflect optimal levels of care rather than minimum requirements In 1987 the organization’s name was changed to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), showing a greater range of activities and scope of responsibilities In 2007 the organization was rebranded and the name was shortened to The Joint Commission In 2012 The Joint Commission continued its goal of ensuring optimal health care: reports and recommendations on safety, hospital- associated infections, and opioid safety measures. (“Our History”, 2014).

Accreditation processes Organizations must meet the following criteria in order to begin the Joint Commission accreditation process: The organization must be in the United States or territories, or be operated by the United States government The organization must participate in the assessment and improvement of quality care Identification of what services are provided is necessary Services that are addressed in the Joint Commission standards must be provided The organization meets the parameters for a minimum number of patients served (The Joint Commission, 2014)

Impact of The Joint Commission and accreditation Accreditation by The Joint Commission has been shown to increase standards of care (Alkhenizan & Shaw 2011). Clinical outcomes are improved by accreditation programs (Alkhenizan & Shaw 2011).

Benefits of being Joint Commission accredited: Risk management evaluation Educational opportunities for staff Patient safety and quality of care are promoted Customized reviews are provided via Joint Commission surveys Risk management and risk reduction can be improved Potential employees may be more likely to pursue employment at a Joint Commission accredited organization Some states allow Joint Commission accreditation to pass as their Medicare qualifications without going through additional surveys (The Joint Commission, 2014)

Certification Facilities that are Joint Commission accredited can also become Joint Commission certified. Certification can be earned in many different areas that cover chronic diseases and conditions such as stroke, heart failure and chronic obstructive pulmonary disease (COPD) There are many benefits to being Joint Commission certified: The quality of patient care is improved as variations in clinical practice are decreased Standards help to provide a plan for disease management Strengthens community confidence in the organizations care If a patient was suffering from a stroke, they may prefer to be treated at a certified stroke center versus a non- certified organization (The Joint Commission, 2014)

What does the Joint Commission do for health care today? “Accredits and certifies more than 20,500 health care organizations and programs in the US.“ ( mmission_main.aspx, 2014)

Relationship to government agencies? "JCAHO has no official connection to United States government regulatory agencies, and has no legal enforcement power.“ (msdonline, 2014).

Core Measures Part of Joint Commission accreditation is tracking of core measures. “The Joint Commission's core measures serve as a national, standardized performance measurement system providing assessments of care delivered in given focus areas” (Masica, Richter, Convery, & Haydar, 2009, p. 103). Core measure sets include: Stroke Venous thromboembolism Substance use Pneumonia Heart Failure Acute Myocardial Infarction (The Joint Commission, 2014)

Joint Commissions 2015 Nursing Care National Patient Safety Goals: ID patient correctly Prevent Falls Prevent Infection Use Meds Safely Prevent Bed Sores ( 2014)

Other valuable resources related to the Joint Commission's National Patient Safety Goals include: Look-alike/sound-alike drug list “Do Not Use” abbreviations list A copy of the entire 2014 National Patient Safety Goals presentation ( 2014)

Limitations of The Joint Commission The organization is unable to effectively mediate ethical disputes that are not strictly black and white Some critics claim The Joint Commission is too lenient Critics have said that reports from The Joint Commission have been misleading to consumers and do not address all the factors that should be considered for patient care. (Bundy, 2011).

In conclusion, the Joint Commission strives to improve health care and hold it’s accredited facilities responsible in providing safe, quality care. While accreditation is not a requirement, it does offer many benefits to the facility, the patients and the employees. Health care is constantly changing and we as health care workers should strive to provide safe, quality care while evolving in order to provide the best care.

The Joint Commission’s impact on my practice: Michael Klein My current place of employment is accredited by various organizations, however, the Joint Commission is not one. This may change in the future as the sister hospital of Elkhart General, Memorial Hospital of South Bend, was recently accredited by the Joint Commission. Even though the Joint Commission does not directly affect my daily practice, I understand and appreciate its importance. My current work environment promotes the values of the Joint Commission, but uses other accrediting bodies to evaluate quality.

Joint Commission and it’s influence on my individual practice: Brian Brown In my current nursing practice of assisted living senior care, Joint Commission practice standards do not directly influence my nursing practice on a day-to-day basis. Joint Commission discontinued the assisted living portion of its accreditation program in (hcpro, 2014) I do however, see the importance of Joint Commission and its very strong influence on other areas of health care. With this said I do see the benefit in reviewing the Joint Commission’s standards as I could find myself in that setting some day and many of the materials can still be beneficial to me know such as the patient safely goals.

Influence of Joint Commission on my Nursing practice: Laura Scurlock I work in the Long Term Care field and the home where I am employed is not Joint Commission accredited. Nursing homes in Michigan are regulated by the State and Federal governments Joint Commission does have numerous benefits that are listed in the slides above. While Joint Commission accreditation is not relevant in my current line of work, we do work to achieve many of the National Patient Safety Goals that are included in Joint Commission standards. Overall, Joint Commission works to ensure patient safety and quality improvement which are areas that my employer does focus on heavily I am part of the Quality Assurance and Performance Improvement group at work. Our purpose is to choose projects that need to be reviewed to help ensure the best quality of life for our residents.

References Alkhenizan, A., & Shaw, C. (2011). Impact of accreditation on the quality of healthcare services: A systematic review of the literature. Annals of Saudi medicine, 31(4), 407–416. doi: / Bundy, D. (2011). The Joint commission and Patient safety. Retrieved from Johns Hopkins University, Bloomberg School of Public Health website: Sec17OCW_Bundy.pdf HCPro Inc. (2005). JCAHO discontinues assisted living accreditation program. Retrieved from: Joint Commission. (2014). Retrieved from Masica, A.L., Richter, K.M., Convery, P., & Haydar, Z. (2009). Linking Joint Commission inpatient core measures and National patient safety goals with evidence. Baylor University Medical Center Proceedings, 22(2), 103. Medical Specialties Distributors, LLC (2014). What is JCAHO? Retrieved from: The Joint Commission. (2014). Benefits of Joint Commission accreditation. Retrieved from The Joint Commission. (2014). Core measure sets. Retrieved from