by Joint Commission International (JCI) Color Palette “Essentials” Joint Commission International’s Essentials of Health Care Quality and Patient Safety by Joint Commission International (JCI)

The State of Global Health Care Each year 1 million people die from complications following major surgery Nearly 1 in 10 patients is harmed as a result of a medical error Estimated that 50% of complications and deaths could be avoided if certain basic standards of care were followed

Adverse Events in Healthcare The problem of adverse events in health care is serious 10% of hospital patients suffer an adverse event each year (UK, New Zealand, Canada and Europe) 16.6% of hospital patients suffer an adverse event (Australian study) 98,000 hospital deaths every year through error (USA) 1.4 million hospital patients worldwide acquire HAI (at any given time) UK: 100,000 cases of HAI lead to 5,000 deaths a year USA: 1 out of every 135 hospital patients acquires HAI There is an ever increasing incidence of adverse events in healthcare. Various studies have investigated the extent of adverse events around the world and the depth of the problem is deep and understanding of them is murky at best. The IOM’s study – To Err is Human captured the attention of the American media. “Up to 98,000 unanticipated and unnecessary deaths per year – the 7th leading cause of deaths in America.” Many challenged the figure. The report also caused a stir internationally with some suggesting that this was a further indictment of the US healthcare system. But errors in health care know no borders. As other countries – United Kingdom, Australia, New Zealand, Denmark – found the frequency of preventable adverse events among hospitalized patients ranged from 10% to 16.6%. There is an ever increasing incidence of adverse events in health care. Various studies have investigated the extent of adverse events: For example The UK department of health in its 2000 report an organization with a memory estimated that 1 in every 10 hospital patients experiences and adverse event 2) Similar rates were also found in studies in other countries such as New Zealand and Canada and also in Europe's Working party on Quality Care in Hospitals report 3) The problem of health care-associated infection also poses a serious threat to patient safety: at any given time 1.4 million people have acquired a HAI in the world. In the UK there are 100,000 case of HAI e year and 5000 deaths. In the US 1 out of every 136 patient acquires a HAI. Failures in patient safety result in an enormous number of human deaths and also in suffering but they also have a huge economic impact. In the UK additional hospitalisation, litigation claims and hospitals –associated infection cost about US$6 billion a year. In the US disability costs, additional medical expenses and lost income can be as high as US$29 billion a year. The costs of HAI are also very high. Studies in the UK have shown that HAI cost UK about 1 billion a years and in the US between 4.5-5.7 billion each year. The situation in developing countries is far more serious, although there is less data, with millions of child and adult patients suffering from ill health, disability and death caused by unsafe vaccinations, infections, unsafe blood, inadequate infection control and lack of hygiene practices in health care, and many other factors. Some data include: i) developing countries account for 77% of all reported case of counterfeit drugs ii) About 50% of medical equipment is non-usable of faulty

Economic Impact of Patient Safety Problems The economic impact is important: UK: costs as high as US $6 billion a year USA: about US $29 billion a year The problem of adverse events in health care is even more serious in developing countries. Less data is available Obviously, errors have tremendous financial impact.

JCI Mission and quality of care in the international community Improve the safety and quality of care in the international community through the provision of education, publications, consultation, evaluation, and accreditation services

How We Meet Our Mission Accreditation of health care organizations worldwide Assisting Ministries of Health and governmental agencies to strengthen the role of quality oversight at the country level “Essentials”

Organizational Base Joint Commission International (JCI) is the international arm of The Joint Commission (USA). Both organizations are independent, non-profit, non-governmental agencies Since 1994, JCI staff have worked in 80 countries to provide education, consultation, and/or accreditation services

Essentials Quality and safety improvement framework designed to help organizations focus on the risk areas that have the greatest impact on patient safety JCI can better serve organizations at every stage in their journey to higher quality care

Essentials Essentials can help to: Determine levels of risk to patient safety in a health care organization Develop strategies to mitigate risks Better allocate resources to improve quality and safety

Essentials System Design Essentials was designed for use by: Governmental organizations (Ministries of Health, regional or municipal health authorities) Multinational organizations, such as international insurance providers Hospital systems Intergovernmental organizations

How Essentials Is Applied Essentials will help an organization to: Identify the risks that have the greatest impact on safety Design an approach for addressing these risks Implement changes Periodically reassess the impact of these changes

Why JCI Developed Essentials Provide objective information that will guide strategic and financing decisions Provide the tools to gather and analyze the level of risk Enable health care purchasers and insurance companies to direct patients to lower risk healthcare settings

Why JCI Developed Essentials Many healthcare organizations frequently lack the fundamentals to begin the quality journey Essentials helps provide direction and a framework for implementing other JCI quality improvement and patient safety tools

JCI Methodology / Framework Builds upon scientific research, best practices and Joint Commission experience in developing evidence based standards for evaluating level of risk in its organizations JCI uses a similar approach in development of other solutions based programs and services

How Essentials & Accreditation Differ Essentials is different from JCI accreditation, which recognizes hospitals meeting the highest standards for care Essentials is a resource for developing organizations working on more fundamental elements of quality and safety No formal recognition – such as accreditation or certification -- given to hospitals using the Essentials framework

Overview of International Essentials for Quality and Patient Safety

Essentials Address Five Risk Areas Developed from extensive international healthcare literature and experience Ten Criteria for each Risk Area provide clear and achievable risk reduction strategies Progressive “Levels of Effort” are identified for each Criterion

Overview of Five Risk Areas Five widely recognized domains of risk Leadership Process and Accountability Competent and Capable Workforce Safe Environment for Staff and Patients Clinical Care of Patients Improvement of Quality and Safety

Risk Area #1: Leadership Process and Accountability Responsibilities and accountabilities identified Leadership for quality and safety Collaboration and cooperation at all levels Quality requirements in contracts Quality, patient safety, and risk management are integrated

Risk Area #2: Competent and Capable Workforce Personnel files and job descriptions Review of credentials of physicians Review of credentials of nurses Review of credentials of other health professionals Staff are oriented to their jobs

Risk Area #3: Safe Environment of Staff and Patients Regular inspection of buildings Control of hazardous materials Fire safety program Biomedical equipment safety Stable water and electricity sources

Risk Area #4: Clinical Care of Patients Correct patient identification Prior to medication or blood administration, procedures, surgery Informed consent Before surgery, anesthesia, use of blood products, and other high risk procedures Medical and nursing assessments for all patients Standardized and timely

Clinical Care of Patients continued Laboratory services are available and reliable Diagnostic imaging services available, safe, and reliable Planned and provided care is written Guidance on uniform documentation and care planning Monitoring data are used to improve care

Clinical Care of Patients continued Anesthesia and sedation are used appropriately Policies and procedures Data on complications and incidents used to improve Surgical services appropriate to patient needs Medication use is safely managed Complex set of processes; selection, storage, prescribing, dispensing, administration, and monitoring Patient are educated to participate in their care

Risk Area #5: Improvement of Quality and Safety There is an adverse event reporting system Adverse events are analyzed High risk processes and high risk patients are monitored Examples: emergency care, resuscitation Patient examples: immune-suppressed or , comatose patients

Implementing the Essentials

How Can JCI Help? JCI will assist organizations through education programs, and if needed, expert assistance and advice JCI will help organizations collect their data and compare it with other similar organizations JCI will use an on-line collection and database tool

For more information: The Joint Commission Resources Web Site www.jcrinc.com The Joint Commission International www.jointcommissioninternational.org Joint Commission International Center for Patient Safety www.jcipatientsafety.org cramponi@jcrinc.com