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

2. 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

3. 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 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

4. 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.

5. 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

6. 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”

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Overview of International Essentials for Quality and Patient Safety

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. Implementing the Essentials

27. 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

28. For more information: The Joint Commission Resources Web Site
The Joint Commission International
Joint Commission International Center for Patient Safety