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JCI Accreditation: an Interview with Karen Timmons |
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The Joint Commission is a Chicago-based organization which accredits 15,000 hospitals in the United States. The Joint Commission International (JCI) is its subsidiary which accredits hospitals outside the U.S. As the medical travel trend grows, JCI accreditation is becoming an important benchmark for quality standards. Following a recent industry conference, Medical Tourism Insight editor Andrew Everett interviewed Karen Timmons, CEO of JCI, in order to find out more about how JCI works, and what accreditation means to patients. Patients are concerned about ensuring quality and safety when traveling abroad for medical care. JCI accreditation sounds like a logical way of screening unknown hospitals. Can you explain how JCI accreditation ensures the consumer of quality and safety?
Your question referred to a consumer’s “screening” process, and to that point, consumers “screen” in the effort to avoid risking their good health in a substandard health care facility. JCI accreditation is essentially a risk-reduction activity. Compliance with JCI accreditation standards is intended to reduce the risk of adverse outcomes and improve safety. JCI standards emphasize the need to consider risks and to take action to reduce risks before an unwanted event affects patients or staff. This focus on reducing risks to patients and staff can be seen in both JCI’s patient-related standards and organization-related standards. JCI is a subsidiary of the Joint Commission, which has accredited 15,000 U.S. hospitals. How do the international accreditation standards differ from the U.S. standards? Development of our international accreditation standards is actively overseen by a global task force, whose members were drawn from each of the world’s populated continents. Although many of the JCI standards are similar to those of the United States–based Joint Commission, U.S. standards reflect many local, state and national laws which do not apply internationally. JCI standards are broader-based in order to respect country and cultural differences. With each revision, though—especially in the upcoming third edition of our hospital standards, which will be published in July 2007 and enforced January 2008—international standards are becoming more challenging, rapidly closing the gap between JCI and U.S. standards. There are currently about 110 hospitals with JCI accreditation. Why are there relatively few hospitals accredited by JCI? Is it because very few hospitals in the world meet your standards? Or is it because the accreditation process is expensive? JCI’s hospital accreditation numbers are lesser than those of The Joint Commission and there are two major reasons for the disparity: First, JCI is in its infancy when compared The Joint Commission’s 56-year tenure as an accrediting body. JCI launched its accreditation program in 1999 and has steadily built on its cadre of participating organizations each year. We’re not where we want to be yet, but we’re comfortable that we’re moving rapidly in the right direction. Second, JCI accreditation is voluntary, not mandatory. Organizations choose JCI accreditation not because they have to—it’s because they want to. Our accredited organizations want an external quality evaluation model. They want to bring the common understanding of key quality and patient safety concepts such as good medication management, infection control, facility management, community disaster planning, and other risk reduction strategies to their organization. And, finally, they know that providing the highest quality and safety of health services for their patients makes not only good management sense, but good business sense. What must a hospital typically do in order to get ready for an initial JCI inspection? How long does it generally take to prepare for this?
Having said that, it is also important to note that once an organization has gone through a survey and has been accredited by JCI, we encourage—and expect—the organization to strive for continuous standards compliance; that is, to always be ready for a survey. Organizations that are continually performing in the patient’s best interests don’t have to prepare for a survey; they’re ready all day, every day. Renewal of accreditation is every three years. Are there any spot checks in the interim? There are no “spot checks” in the truest sense of those words, but there are reasons for JCI to return to an organization sooner than the triennial survey. First, we have begun performing “validation surveys” in all organizations within 60 to 180 days of all initial or triennial re-surveys. These validation surveys are free to an organization and do not impact the organization’s accreditation decision, but they do provide JCI with immediate feedback on the validity of the survey’s results. Also, if during an organization’s survey we find standards not met, we will respond by scheduling what we call a “focused survey” for that organization. A focused survey is exactly as it sounds—a concentrated examination of only the areas in which an organization does not meet standards. If, in the view of the JCI Accreditation Committee, the organization’s performance during the focused survey meets standards, the organization is then deemed accredited. Does JCI collect safety data (mortality rates, hospital acquired infections, etc.) for international hospitals, benchmarked to U.S. averages? If not, does any other organization collect such information so that consumers can check the track record of an international hospital? We do collect data and we intend to do even more collection in the future. JCI introduced the Hospital Quality Indicator project in January 2006 in response to accredited hospitals expressing an interest in performance measurement to support quality improvement efforts and to provide a valid base for local, national, and international comparisons. This initiative focuses on data collection for seven standardized performance indicators currently in use in the United States: For Acute Myocardial Infarction: For Heart Failure: Measures are assessed for interpretability, applicability, and usefulness to the international community, feasibility of data collection, data collection effort, and overall resource use. In addition to indicator evaluation, assessment of the potential limitations related to electronic data transmission, preferences for data feedback mechanisms, expectations regarding support services, and data use by JCI in accreditation activities are also being addressed. Evaluation findings are being used to assist in planning for a voluntary, automated, standardized indicator set. Accredited hospital organizations, which volunteer to participate, collect indicator data using tools provided by JCI. These tools include a data dictionary, data elements, and Indicator Information Forms for the seven indicators. Although these data are not currently available to the public, we envision a future public-reporting scenario similar to The Joint Commission’s Quality Check Web portal, which provides public access to United States hospitals’ performance on The Joint Commission’s National Patient Safety Goals and National Quality Improvement Goals. The latter goals allow hospitals to report quarterly on key quality of care indicators in up to five treatment areas: heart attack, heart failure, community acquired pneumonia, pregnancy and related conditions, and surgical infection prevention. In your presentation, you mentioned that JCI has a policy about “truth and admission.” Could you elaborate? Patient safety has made significant strides in some parts of the world during the past 10 years, thanks to a willingness to acknowledge that adverse events occur in health care and that a systematic approach must be employed to reduce the very real risk of patient harm. We feel that honesty from all parties—caregivers, patients, and patients’ families—is an essential aspect of safe heath care. Just as caregivers expect patients to provide honest answers in order to discern the proper course of the patient’s care, patients and their families have the right to honest communication with caregivers to help the patients or loved ones make informed decisions. There is a growing body of research indicating that patients and families will forgive medical errors more readily if the caregiver will admit them. Likewise, with increased public reporting of medical errors—in the United States, The Joint Commission has required its accredited organizations to report their adverse events since 2001, which are then compiled into what is called the Sentinel Event Database—and infection control data and the like, there is a positive trend toward more open and honest communication between caregiver and patients. We agree wholeheartedly, and our standards reflect this. One JCI hospital standard states that the hospital must inform patients and families about how they will be told about the outcomes of care and treatment, including unanticipated outcomes, and who will tell them. With that sort of communication model in place, patients and families can be assured that they know exactly what’s going on with their care and treatment at all times. You are CEO of both JCR and JCI, which handle consulting and accreditation respectively. Can you address the relationship between the two organizations? Are the people who do the consulting the same people who do the accreditation inspections?
From a consumer’s (or patient’s) standpoint, what is the difference between JCI accreditation and other accreditations, such as ISO? As long as a hospital has some sort of accreditation, is that a reasonable assurance of quality and safety? ISO is not truly a health care accreditation body; it is more of a federation of national standards bodies. While concepts within ISO requirements may apply to health care, many of the concepts do not easily apply, especially to the clinical aspects of health care. ISO requirements are more focused on manufacturing, and ISO standards concentrate on adhering to a specified process of quality management designed to consistently produce a product (or service) that meets pre-established specifications and on assessing that conformity. Although I think it’s safe to say that some sort of accreditation is better than none, we are convinced that JCI’s accreditation process provides the best organizational available path to health care excellence. What is the function of JCI’s Center for Patient Safety? The Joint Commission International Center for Patient Safety (ICPS) is virtual organization that allows The Joint Commission, JCR, and JCI to further its patient safety mission: to continuously improve patient safety in all health care settings. The Center’s Web site is a valuable online resource for health care professionals, patients, and their families. Nearly 1,000 articles and Web links covering topics ranging from adverse events and product safety to the National and International Patient Safety Goals are available for download, free of charge. A monthly electronic newsletter, Patient Safety Links, is available at no cost to subscribers. The Center is also the operational arm for the World Health Organization (WHO) Collaborating Centre on Patient Safety, the world’s first such organization dedicated solely to patient safety. The Collaborating Centre focuses worldwide attention on patient safety solutions and best practices with the intent of reducing safety risks to patients, and it helps coordinate international efforts to share, develop, and disseminate these solutions as broadly as possible. Tell me more about your collaboration with the WHO? Since its launch in August 2005, the WHO Collaborating Centre for Patient Safety has been building an international network to identify, evaluate, adapt and disseminate patient safety solutions worldwide. The Collaborating Centre is identifying existing solutions that would be applicable to a wide variety of countries and health-care settings. Patient safety solutions are any system design or intervention that has demonstrated the ability to prevent or mitigate patient harm stemming from health care processes. Solutions disseminated by the Collaborating Centre will be evidence-based, and presented in a standard format. In order to facilitate the accurate identification of solutions and the adaptation of solutions to different needs, an international steering committee composed of recognized leaders and experts in patient safety was convened. At the inaugural meeting of the International Steering Committee in June 2006, the following nine solutions were prioritized for further development:
Three Regional Advisory Groups were also established to review the priority draft solutions and provide feedback on how the solutions need to be adapted for different regions of the world. A large international field review via electronic survey was undertaken to determine the relevance, adaptability, feasibility, and barriers to acceptance of the solutions in different regions of the world. The field review audience includes leading patient safety entities, accrediting bodies, Ministries of Health international health professional associations, and WHO and Joint Commission International network of contacts. The target date for dissemination of the initial set of Solutions is May 2007. Another one of the exciting programs spawned
through the WHO Collaborating Centre on Patient Safety is the
“Action on Patient Safety (High 5s) Initiative," a
seven-country collaborative project that leverages the implementation
of five standardized patient safety solutions to prevent avoidable
catastrophic events in hospitals. The overall goal of the initiative
is to achieve significant, sustained, and measurable reduction
or elimination of five highly prevalent patient safety problems
in selected hospitals worldwide over a five-year period—hence
“High 5s.” The solution areas selected for the High 5s initiative were drawn from a broader set of patient safety solutions that are being developed by the WHO Collaborating Centre for Patient Safety for distribution to all of the WHO member nations later in 2007. These include:
The Collaborating Centre will work with the participating countries to refine the current draft solutions through the development of standardized operating protocols similar to those used in high reliability industries such as aviation and nuclear energy. We are excited about the innovative programs we have developed with WHO to date and we are open to more such alliances with WHO in the future. You are chair of ISQua’s ALPHA council. Can you explain what ISQua is, and how your role there relates to JCI? ISQua is The International Society for Quality in Health Care, and, simply put, is the “accreditor’s accreditor.” I’m proud of my role with ISQua and am so convinced of that organization’s value to the health care quality issue that JCI is currently undergoing ISQua accreditation. ISQua’s mission and ours are similar—excellent health care delivery for everyone—and we support that undertaking completely. Thank you very much, Karen, for providing
our readers with more insight into JCI. |
The need to focus on safety is at the center of all of JCI accreditation
activities. All accreditation standards support quality and safety
efforts, whether a person is seeking services from a JCI–accredited
hospital, ambulatory care organization, clinical laboratory, across
the care continuum, at a medical transport organization, or via
a JCI–certified disease-specific care provider. More specifically,
standards related to safety and to reducing adverse events provide
a framework for helping to reduce the risk to and ensure the safety
of individuals who receive care, treatment, and services in a
health care organization.
We tell organizations that preparing for their initial JCI accreditation
survey is likely to take 12 to 24 months. Leaders who insist on
setting an achievable time frame communicate the importance of
taking a steady, comprehensive approach to accreditation. This
approach seeks systems improvements that require thoughtful analysis
to establish, implement, and sustain. Organizations perform a
baseline assessment, measure the gap between their performance
and JCI standards, and then spend the ensuing months refining
their policies and procedures to make certain they are in compliance.
Rushing through the accreditation preparation misses the point
that quality and safety standards must become part of routine
operations in order to have a meaningful, lasting impact that
improves quality and safety.
The easiest way to explain the relationship between Joint Commission
International (JCI), Joint Commission Resources (JCR), and The
Joint Commission is that The Joint Commission is the parent organization
of both JCR and JCI. JCR is an educational unit, disseminating
information regarding accreditation, standards development and
compliance, good practices, and health care quality improvement
around the world. JCI is the international accreditation division
of the organization. JCR consultants are never JCI surveyors,
and JCI surveyors are never JCR consultants. There is a virtual
firewall between JCI’s accreditation personnel and JCR that
is strictly enforced. JCI accreditation personnel are never permitted
to discuss or otherwise communicate about accreditation operation
or decisions with JCR personnel, and, conversely, JCR representatives
must never convey any ongoing or past consulting or education
arrangements regarding present or future accredited organizations
with JCI accreditation personnel. We believe that maintaining
that level of privacy is essential to preserving the value of
JCI accreditation.