challenges for accreditation

8/6/2019 Challenges for Accreditation

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The Challenges for The Challenges for

Accreditation in a RapidlyAccreditation in a RapidlyChanging Health CareChanging Health Care

EnvironmentEnvironmentQuality and Safety Workshop

September 2008, Delhi, India

Paul Chang MBBS, MPH

Derick P. Pasternak MD, MBAManaging Directors, JCI



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Presentation TopicsPresentation Topics

Short overview of Joint Commission

International (JCI)

Common characteristics of accreditation

programs

Current challenges

How programs must change to meet

those challenges



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Mission of Joint CommissionMission of Joint Commission

InternationalInternational

To improve the safety and quality of

care in the international community through

the provision of education, publications,

consultation, evaluation, and accreditation

services



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Organizational BaseOrganizational Base

Joint Commission International (JCI) is the international arm of The JointCommission (TJC).

TJC and JCI are independent non-profit, non- governmental agencies

Accredit over 17,000 organizations Worldwide

• 143 of those are acute care hospitals in 28 countries



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International AccreditationInternational Accreditation

ProgramsPrograms Hospitals (1999) – 3rd Edition (2007)

Laboratories (2002) *

Medical Transport (2002)

Care Continuum (2003)

Ambulatory Care (2005) *

Disease Condition-Specific Certification (2005) *

Primary Care (July 2008)

* To be revised in 2008* To be revised in 2008



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Usually a voluntary process by which a

government or non-government agency grants

recognition to health care institutions which meet

certain standards that require continuous

improvement in structures, processes, andoutcomes.

Accreditation is often confused with:

• Licensure-governmental activity that sets minimum

standards to protect the public• Certification that evaluates special capability or unique

skills/ability

Accreditation – A DefinitionAccreditation – A Definition


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What is AccreditationWhat is Accreditation

Intended to Accomplish?Intended to Accomplish? Awareness of quality of care issues

Stimulate continuous improvement in patient care

Increase efficiency/reduce costs Strengthen the public’s confidence

Improve the management of health services

Create a learning organization

Enhance staff recruitment and retention

Improve or expand sources of payment



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Drivers for Accreditation in HealthDrivers for Accreditation in Health

Escalating health costs Patient safety & iatrogenic disease

Unexplained variation in clinical practice

• Inequality

• Access to health care

Health outcomes

Workforce shortfall

Desire to improve care Constant change in clinical practice

New technology



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The Changing Health CareThe Changing Health Care

EnvironmentEnvironment

Aging populations with multiple chronic

diseases

Urbanization of population with intense

pressure on urban health care systems-over 50% of worlds population live in urban areas

Movement of patients and health care

practitioners across borders

Globalization of service and manufacturing

sectors



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Globalization’s ImpactGlobalization’s Impact

Multinational companies need to know where

employees can receive quality health care

International insurance companies need to

know where they should pay for services withgood outcomes

Medical travelers need to know the best

health care destinations



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What Questions AriseWhat Questions Arise

Has the health care organization been

evaluated by an external body?

• Licensure, accreditation, certification

Does the organization meet internationalnorms - e.g., patient rights, research, ethics?

Is clinical care guided by the best science –

e.g., practice guidelines



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What Questions AriseWhat Questions Arise

Are the clinical staff qualified andcompetent and the credentials verified?

Is the health care organization low risk

and patient safe? Is the organization efficient and well

managed?

How does the quality compare withother organizations in other countries?



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Standards of PerformanceStandards of Performance

InfrastructureInfrastructure

DesignDesign

Field OperationsField Operations

AccreditationAccreditation

Decision ProcessDecision Process

AccreditationAccreditation

Performance DatabasePerformance DatabaseSources of FundingSources of Funding

Health Care AccreditationHealth Care Accreditation

System Key ElementsSystem Key Elements

Accreditation SystemAccreditation System



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Do Traditional AccreditationDo Traditional Accreditation

Programs Address these Questions?Programs Address these Questions?

Most national accreditation programs address the

laws, regulations, clinical and professional norms of

the particular country.

International accreditation programs, that use one setof standards, can address these questions and

provide comparative results.

http://www.nhs.uk/

http://www.has-sante.fr/portail/index.jsp



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What Do You Find in JCIWhat Do You Find in JCI

Accredited Organizations?Accredited Organizations? A culture of quality and patient safety

An integrated management structure

Qualified staff

Lower risks and data on the risks

Quantifiable outcomes of care

Medical staff use latest science



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How Must AccreditationHow Must Accreditation

Programs ChangePrograms Change

Accreditation must change to meet the

needs of new stakeholders in a global

society.

• On-site evaluation to ensure standards are

met – not just self-evaluation

• Evaluation must look at systems and how

patients move through the systems -tracers



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• Evaluation must be frequent and ongoing

not every few years

• The findings of the evaluation should be

made public• On-site evaluations should be made

without advance notice

• Adverse/sentinel events are reported and

root causes discovered for the organization

to learn



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Objective and comparable quality data on

clinical outcomes is available to public and

stakeholders

Patients and their families are partners inthe clinical care process



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ConclusionsConclusions

Traditional national accreditation programs

are not positioned to provide comparative

information to those new stakeholders with

global needs for quality information. International accreditation programs can

provide the needed information but need to

be structured in a way that ensures

international transparency and accountability.



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ConclusionsConclusions

The methodology of accreditation is

flexible enough to be customized to

meet particular stakeholder needs

• e.g., Patient safety and risk assessments,leadership assessments, infection or

medication risk assessments



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Thank YouThank Youwww.jointcommissioninternational.org

http://www.jointcommissioninternational.org/

http://www.jointcommissioninternational.org/

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