My watch list  

Joint Commission

The Joint Commission is a private sector United States-based non-profit organization with a mission to maintain and elevate the standards of health care delivery through evaluation and accreditation of health care organizations. Many erroneously believe the Joint Commission to be a public authority because of its 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)". [1]

The Joint Commission is 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 telling them whether they comply with federal regulations [2]. There are concerns about this, and there have been recent legislative attempts to remove the deeming authority of the Joint Commission by repealing this unique statutory protection. [3]

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. [4] 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 [5].

Much more recently, an international offshoot called Joint Commission International, or JCI [6], has been founded (1997) [7]. 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.

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, 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. The new entity was named the Joint Commission on Accreditation of Hospitals. From 1981 onwards it was known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO, pronounced "jay-co").[1]

The standards applied to hospital accreditation by the Joint Commission within the USA and overseas are different [8]. 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 [9].

With respect to hospital surveys, the organization does not make its findings public. [10] 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 [11], with working practices allowing hospitals to pass that should not do so, and it has been commented upon that hospitals pass Joint Commission audits at a 99 percent rate [12], leading many, including the Washington Post,[2] to analyze and report on conflicts of interest at the Joint Commission. The Joint Commission has over time responded to these criticisms, and in the USA, all hospital surveys have since January 1 2006 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 untertaken by JCI still take place at a time known in advance by the hospitals being surveyed, and often after considerable preparation.

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 (ie. structure/input and process metrics).

It is not part of the remit of JCI surveyors to assess the quality of performance of individual doctors.

The 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 [13] and utilising a system firmly based upon ISO 9001 and NIAHO Standards was introduced in 2005 [14]. 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 [15].


The Joint Commission 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 accrediting body 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.[3]

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" [16].

Patient safety goals for 2007[4]

Missing numbers indicate that a previous goal is a current standard.

  • Goal 1: Improve the accuracy of patient identification.
  • Goal 2: Improve the effectiveness of communication among caregivers.
  • Goal 3: Improve the safety of using medications.
  • Goal 7: Reduce the risk of health care-associated infections.
  • Goal 8: Accurately and completely reconcile medications across the continuum of care to prevent medication errors.
  • Goal 9: Reduce the risk of patient harm resulting from falls.
  • Goal 10: Reduce the risk of influenza and pneumococcal disease in institutionalized older adults.
  • Goal 11: Reduce the risk of surgical fires.
  • Goal 12: Implementation of applicable National Patient Safety Goals and associated requirements by components and practitioner sites.
  • Goal 13: Encourage patients’ active involvement in their own care as a patient safety strategy.
  • Goal 14: Prevent health care-associated pressure ulcers (decubitus ulcers).
  • Goal 15: The organization identifies safety risks inherent in its patient population.

International accreditation and JCI

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" (JCI) is one of the groups providing international healthcare accreditation services to hospitals around the world. It currently accredits hospitals in Asia, Europe, the Middle East and South America, and seeks to expand further.[5]

International hospitals seek accreditation of this type to openly demonstrate quality, and JCI accreditation is considered a seal of approval by the United States. Costs for surveys are obtained by approaching JCI directly.

JCI also offers a variety of educational programs, especially "Practicums" - more information, including attendance costs, is available through their website.

  • [17]

There are other accreditation organisations based in other countries which fulfill a similar internationally-orientated role to JCI. These include:

  • The Canadian Council on Health Services Accreditation or CCHSA
  • The Trent Accreditation Scheme (TAS) in the United Kingdom and Hong Kong
  • 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

See also

  • Hospital
  • Patient safety
  • Patient safety organization
  • URAC
  • Hospital accreditation
  • International healthcare accreditation


  1. ^ The Joint Commission Launches New Brand Identity. The Joint Commission. Retrieved on 2007-07-17.
  2. ^ Gaul, Gilbert M. (2005-07-25). Accreditors Blamed for Overlooking Problems A01. The Washington Post. Retrieved on 2007-07-17.
  3. ^ Introduction to the National Patient Safety Goals. The Joint Commission. Retrieved on 2007-07-17.
  4. ^ 2007 National Patient Safety Goals. The Joint Commission. Retrieved on 2007-07-17.
  5. ^ Joint Commission International (JCI) Accredited Organizations. Joint Commission International. Retrieved on 2007-07-17.
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Joint_Commission". A list of authors is available in Wikipedia.
Your browser is not current. Microsoft Internet Explorer 6.0 does not support some functions on Chemie.DE