Joint Commission

The Joint Commission is a private sector United States-based non-profit organization. It is the best known of a number of active healthcare accreditation groups in the USA (see alternatives).

The declared mission of this private organization is "To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.".

It is often believed (erroneously) that The Joint Commission is an American or even a World public authority, which is not the case. This perception occurs because of the company's deeming power - "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 reimbursement).

The Joint Commission is therefore virtually a monopoly, enjoying unique statutory protection in the USA and collecting $113 million in annual revenue, mainly from the fees it charges US hospitals for evaluating their compliance with federal regulations.

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. From 1981 onwards the company was re-branded as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO, pronounced "jay-co"). It is now more usually known as The Joint Commission.

Much more recently, an international offshoot called Joint Commission International, or JCI, has been founded (1997). This group surveys hospitals outside of the USA, using a different set of standards to those used to survey US hospitals (see below), and generates income for the parent company in the USA.

How the Joint Commission works
With respect to hospital surveys, the organization does not make its findings public. However, it does provide the organization's accreditation decision, the date that accreditation was awarded, and any standards that were cited for improvement. This information is on the organization's Quality Report, which is on the Quality CheckTM website at. Organizations deemed to be in compliance with all or most of the applicable standards are "accredited". In the USA, hospitals and other types of health care organizations are highly motivated to do well during Joint Commission surveys, as accredited organizations are deemed by the Centers for Medicare and Medicaid Services to meet the Medicare and Medicaid certification requirements -- necessary for gaining reimbursement from Medicare and managed care organizations.

There has been criticism in the past from within the USA of the way the Joint Commission operates. The Commission's practice had generally been to notify hospitals in advance of the timing of inspections. An 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. 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". . The Joint Commission has over time responded to these criticisms, and in the USA, all hospital surveys since January 1 2006 have been unannounced, as the scheduled evaluations of the past used to allow institutions to prepare for them and there was no guarantee that adequate standards were being maintained between surveys. 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.

As for the surveyors, the Joint Commission and JCI utilise full-time salaried individuals, people who generally used to work within healthcare services but who now work 100% of their time for the accrediting organisation. They are sent out to health care organizations to evaluate their operational practices and facilities (i.e., structure/input and process metrics).

It is not part of the remit of JCI surveyors to assess the quality of performance of individual doctors or the ethical framework within which they operate, and the organization does not get involved in medical ethical issues - the Joint Commission stopped trying to provide guidance on medical ethics to US hospitals many years ago.

The standards applied to hospital accreditation by the Joint Commission working within the USA and JCI working overseas are different. Outside of the USA, JCI applies a single set of standards that are applied uniformly, without adaptation or variation, across hospitals wherever they are located in the world.

Alternatives to the Joint Commission within the USA
That the Joint Commission is not a complete monopoly is because although many of the states of the USA make use of their services, not all do. Some states have set up their own alternative assessment procedures, and the Joint Commission is not being recognized for state licensure of those hospitals located 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.

The apparent lack of an option of accreditation partner for US-based hospitals is seen by some authorities as a weakness within a free market economy, and a new USA-based accreditation scheme, set up by TÜV Healthcare Specialists and utilising a system firmly based upon ISO 9001 and NIAHO Standards was introduced in 2005. TÜV Healthcare Specialists applied for permission to deem authority for hospitals that wished to participate in the Medicare and Medicaid programs to do so, but the application was denied in 2006.

Also, there are other US-based healthcare accreditation organisations working within the USA which are completely separate to the Joint Commission, including the Commission on Accreditation of Rehabilitation Facilities (CARF) ,Community Health Accreditation Program (CHAP), the Accreditation Commission for Health Care, Inc. (ACHC), , the "Exemplary Provider Program" of The Compliance Team and the Healthcare Quality Association on Accreditation (HQAA), who are recognised in the state of Ohio. 

The Joint Commission's goals and initiatives
The stated mission of The Joint Commission is: "To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations."

The company updates its accreditation standards and expands patient safety goals on a yearly basis, and posts them on its website 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. }}. In reality much of the Joint Commission's power stems from the fact that in most states of the USA, the organization functions as a virtual monopoly when it comes to deciding whether or not individual hospitals are able to participate in the Medicare and Medicaid programs, and this great power is, accordingly, a major factor in ensuring that hospitals are, in effect, obligated to make use of its services if they wish to earn money from Medicaid and Medicare. The Joint Commission recognizes the strength of this position, and the opportunities it presents to the organization; quoting from the Joint Commission's web pages, "The Joint Commission actively monitors and inspects state legislative and regulatory activities for the purpose of identifying additional opportunities for state reliance on Joint Commission accreditation".

International healthcare accreditation
With the advent of medical tourism, international healthcare accreditation of hospitals located in many 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 US-based parent organisation. This not-for-profit company currently accredits hospitals in Asia, Europe, the Middle East and South America, and is seeking to expand its business further.

JCI also offers a variety of educational programs, especially "Practicums" - more information, including attendance costs, is available through their website.
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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
 * The Trent Accreditation Scheme (Trent Accreditation Scheme or TAS - United Kingdom)
 * The Australian Council on Healthcare Standards or ACHS

Also, * The Society for International Healthcare Accreditation, or SOFIHA, is a free-to-join group providing a forum for discussion and for the sharing of ideas and good practice by providers of international healthcare accreditation and users of the same

Costs of JCI accreditation
JCI publish the cost incurred in undergoing surveys. In addition, there are on top of this costs related to surveyor's 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.