Fear the All Mighty Joint Commission! But wait, what is the Joint Commission?
Ever watched a Oscar winning movie and wondered how in the world is this movie Oscar worthy? Well, the Oscar's Academy Awards got together and decided that film meets their standards, even though it was total crap, such is the Joint Commission. The Joint Commission, also known as Joint Commission on Accreditation of Healthcare Organizations (JCAHO), offers accreditation to hospitals and healthcare facilities based on their set of "standards" that deem hospitals safe, which may not always be the case.
To become accredited, healthcare facilities must be surveyed by certified Joint Commission surveyors, and be reevaluated every 3 years. After a hospital earns accreditation or any certification by TJC, they receive the The Joint Commission’s Gold Seal of Approval.
Most, but not all, US state governments use and recognize TJC accreditation as a licensure condition for reimbursement by the Centers for Medicaid and Medicare Services. Oklahoma, Pennsylvania and Wisconsin have established their own state alternative to The Joint Commission. In California TJC is used as a joint effort with other state authorities in the survey process.
Since July, 2010, and the rollout of the Medicare Improvements for Patients and Providers Act, some of The Joint Commission's accreditation powers have been restricted. Since then, TJC accreditation is subject to CMS, Centers for Medicare and Medicaid Services, guidelines and requirements for any hospital or healthcare facility seeking accreditation. This makes The Joint Commission submit an application to CMS with the hospital's surveyed records stating that it meets CMS standards and they then will review and grant the accreditation if deemed compliant. So a TJC seal of approval has lost some of its might.
TJC survey specifics are not made public, so if the hospital is not granted an approval, the public which it serves doesn't really know why. The Joint Commission's surveys happens every 3 years, and hospitals will be notified in advance when the inspections will take place. This raises concerns and criticism because hospitals almost always have time to get "Joint Commission Ready". To meet the standards of TJC, the facility has to have been operating under those guidelines for the past 4 months prior to initial accreditation, and facilities have to be in compliance with accreditation for the entire 3 years in between surveys. If any flags are raised during the surveys, they will look back and reassess the entire 3 years.
Hospitals usually receive a notification of timing of survey approximately within 3 months, and many hospitals will actually time the survey window and prepare. This makes for a dreaded and stressful times in the healthcare world. Standards of practice, policies and procedures and overall care are scrutinized and reviewed entirely.
TJC often use "evidence-based medicine" in their requirements and standards, but there is actually little evidence demonstrating significant quality improvement in care due to their efforts. There is actually growing research showing no improvement in quality care at all.
A hospital or care facility that seeks accreditation from The Joint Commission, have to pay a fee to the accrediting body. The average fee for the services and accreditation is $33,000, required every 3 years, and costs may vary depending on hospital sizes and complexity of care provided. No other agency or entity certifies The Joint Commission. Investigations on TJC inspections reported that in 2014 about 350 Joint Commission accredited hospitals were in violation of CMS requirements, and that over one-third of those hospitals had additional violations in the two years following. Reports also shows that TJC withdrew accreditation in only 1% of the hospitals not meeting CMS requirement, over 30 of which had violations that were deemed severe enough to cause serious injury to patients or death under CMS criteria. Based on the investigations, hundreds of hospitals with patient safety issues are still bearing the TJC Golden Seal of Approval.
Joint Commission CEO Mark Chassin, MD, told The Wall Street Journal in September, 2017 that "the organization generally avoids revoking accreditation." And that the group's mission is to "work closely with healthcare organizations to help them improve the care they provide," not punish them for safety incidents. Which is part of the organization's tag line "Helping Health Care Organizations Help Patients."
The Joint Commision also promotes National Patient Safety Goals, to provide healthcare facilities with specific guidelines to improve problematic areas in patient care and offer evidence-based solutions. Offering guidelines such as positive patient identification, improved communication, medication safety, reducing infections and falls, which are excellent and proper nursing practices. But other guidelines put forth such as implementing pain assessment as a fifth vital sign has raised controversy, in that we are treating mainly symptoms, not an actual vital sign, and loading our patients with pain medications, ultimately aiding in the overprescription, and prescription opioid addiction problem in the US.
The Joint Commission has, over their history gained power and acceptance as the leading credentialing agency in the US and they have since began an international branch. The organization is an independent, non governmental agency that sets guidelines, not federal regulations. Both The Joint Commission and CMS adhere to requirements to improve health care by making sure organizations are providing safe and effective care. CMS has recognized The Joint Commission as one of the few organizations who's standards meet national requirements.
The Dude Nurse
Klaus Campos, BSN-RN