Facts About The Joint Commission
on Accreditation of Healthcare Organizations

Mission

The mission of the Joint Commission on Accreditation of Healthcare Organizations is to improve the 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.

Description

The Joint Commission evaluates and accredits more than 18,000 health care organizations and programs in the United States. An independent, not-for-profit organization, the Joint Commission is the nation's predominant standards-setting and accrediting body in health care. Since 1951, the Joint Commission has developed state-of-the-art, professionally based standards and evaluated the compliance of health care organizations against these benchmarks.

Joint Commission evaluation and accreditation services are provided for:

· General, psychiatric, children's and rehabilitation hospitals;

· Health care networks, including health plans, integrated delivery networks and preferred provider organizations;

· Home care organizations, including those that provide home health services, personal care and support services, home infusion and other pharmacy services, durable medical equipment services, and hospice services;

· Nursing homes and other long term care facilities, including subacute care programs, dementia programs and long term care pharmacies;

· Behavioral health care organizations, including those that provide mental health, chemical dependency, and mental retardation/developmental disabilities services for patients of various ages in various organized service settings; and managed behavioral health care organizations;

· Ambulatory care providers, including outpatient surgery facilities, rehabilitation centers, infusion centers, group practices and others; and

· Clinical laboratories.

Accreditation by the Joint Commission is recognized nationwide as a symbol of quality which indicates that an organization meets certain performance standards. To earn and maintain accreditation, an organization must undergo an on-site survey by a Joint Commission survey team at least every three years.

The Joint Commission's standards address the organization's level of performance in key functional areas, such as patient rights, and the standards focus not simply on what the organization has, but what it actually does. Standards set forth performance expectations for activities that affect the quality of patient care -- if an organization does the right things and does them well, there is a strong likelihood that its patients will experience good outcomes. The Joint Commission develops its standards in consultation with health care experts, providers, measurement experts, purchasers and consumers.

In February 1997, the Joint Commission launched ORYX--The Next Evolution In Accreditation to integrate the use of outcomes and other performance measures into the accreditation process. To date, hospitals, long term care organizations, health care networks, home care organizations and behavioral health care providers have been incorporated into the initiative. Ambulatory care organizations and clinical laboratories will be incorporated into the plan in the future.

The Joint Commission sponsors a variety of education programs and provides relevant publications for health care professionals. It is committed to offering standards-related educational support for the organizations it accredits, and to advancing provider understanding of current concepts in performance measurement and improvement.

The Joint Commission provides a comprehensive guide on the Internet designed to help individuals learn more about the quality of health care organizations. Quality Check™, located on the Joint Commission’s Web site, provides a list of the nearly 18,000 Joint Commission-accredited health care organizations and programs throughout the United States. The Quality Check listing includes each organization’s name, address, telephone number, accreditation decision, accreditation date, and current accreditation status and effective date. For more in-depth quality information, consumers can check the individual performance reports available for many accredited organizations that were surveyed after January 1, 1996. Performance reports provide detailed information about an organization’s performance and how it compares to similar organizations. Single, printed copies of performance reports for organizations surveyed before January 1, 1996, are available for free by calling the Joint Commission’s Customer Service Center at (630) 792-5800.

The Joint Commission is governed by a 28-member Board of Commissioners which includes nurses, physicians, consumers, medical directors, administrators, providers, employers, labor representatives, health plan leaders, quality experts, ethicists, health insurance administrators and educators. They bring to the Joint Commission countless years of diverse experience in health care, business and public policy.

The Joint Commission’s corporate members are the American College of Physicians, the American College of Surgeons, the American Dental Association, the American Hospital Association and the American Medical Association.

Health care organizations seek Joint Commission accreditation because it:

· Assists organizations in improving their quality of care;

· May be used to meet certain Medicare certification requirements;

· Enhances community confidence;

· Enhances medical staff recruitment;

· Provides a staff educational tool;

· Expedites third-party payment;

· Often fulfills state licensure requirements;

· May favorably influence liability insurance premiums;

· Enhances access to managed care contracts; and

· May favorably influence bond ratings and access to financial markets.

More than 500 physicians, nurses, health care administrators, medical technologists, psychologists, respiratory therapists, pharmacists, durable medical equipment providers and social workers are employed by the Joint Commission to perform the surveys. In addition, nearly 500 people are employed in the Central Office in Oakbrook Terrace, IL. A small office is also maintained in Washington, D.C.

Joint Commission History

1910

Ernest Codman, M.D., proposes the "end result system of hospital standardization." Under this system, a hospital would track every patient it treated long enough to determine whether the treatment was effective. If the treatment was not effective, the hospital would then attempt to determine why, so that similar cases could be treated successfully in the future.

1913

American College of Surgeons (ACS) is founded at the urging of Franklin Martin, M.D., a colleague of Dr. Codman. The "end result" system becomes an ACS stated objective.

1917

The ACS develops the "Minimum Standard for Hospitals." Requirements fill one page.

1918

The ACS begins on-site inspections of hospitals. Only 89 of 692 hospitals surveyed meet the requirements of the "Minimum Standard."

1926

The first standards manual is printed consisting of 18 pages.

1950

The standard of care improves over time and more than 3,200 hospitals achieve approval under the program.

1951

The American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association join with the ACS to create the Joint Commission on Accreditation of Hospitals, an independent, not-for-profit organization whose primary purpose is to provide voluntary accreditation.

1952

The ACS officially transfers its Hospital Standardization Program to the Joint Commission, which begins offering accreditation to hospitals in January 1953.

1953

The Joint Commission publishes "Standards for Hospital Accreditation."

1959

The Canadian Medical Association withdraws from the Joint Commission to form its own accrediting organization in Canada.

1964

The Joint Commission begins charging for surveys.

1965

Congress passes the Medicare Act with a provision that hospitals accredited by the Joint Commission are "deemed" to be in compliance with most of the Medicare Conditions of Participation for Hospitals and, thus, able to participate in Medicare and Medicaid.

1966

Long term care accreditation begins.

1969

The Joint Commission establishes four accreditation councils to develop standards and survey accreditation procedures. The Accreditation Council for Services for the Mentally Retarded and Other Developmentally Disabled Persons is appointed and accreditation for organizations serving developmentally disabled persons begins.

1970

Standards are recast to represent optimal achievable levels of quality, instead of minimum essential levels of quality.

The Accreditation Council for Psychiatric Facilities is established and accreditation for psychiatric facilities, substance abuse programs and community mental health programs begins.

Registered nurses and hospital administrators join physicians in conducting accreditation surveys.

Accreditation for hospitals and long term care facilities is reduced to a maximum of two years from three. Where survey findings indicated that necessary improvements have not been made or completed, accreditation is given for one year.

1971

The Accreditation Council for Long Term Care is established.

1972

The Social Security Act is amended to require that the Secretary of Department of Health and Human Services (DHHS) validate Joint Commission findings. The law also requires the Secretary to include an evaluation of the Joint Commission's accreditation process in the annual DHHS report to Congress.

The first issue of "Perspectives on Accreditation" is published.

1975

The Accreditation Council for Ambulatory Health Care is established and accreditation for ambulatory health care facilities begins.

Instead of receiving one year accreditation, hospitals with deficiencies are awarded two year accreditation contingent on the correction of the deficiencies and forwarding proof of such corrections to the Joint Commission.

1979

The American Dental Association becomes a Joint Commission corporate member.

A Professional and Technical Advisory Committee (PTAC) is established for each accreditation program and the Accreditation Councils are disbanded.

1982

The first public member begins service on the Board of Commissioners, the Joint Commission's governing body.

The accreditation cycle is changed from two years to three years for hospitals, psychiatric facilities, alcoholism and substance abuse programs, and community mental health centers.

1983

The accreditation cycle is changed from two years to three years for long term care organizations.

Accreditation for hospice care organizations begins. (Folded into the Home Care Accreditation Program in 1990.)

The Joint Commission establishes a tailored survey approach.

1986

Quality Healthcare Resources (QHR), Inc., is formed as a not-for-profit consulting subsidiary of the Joint Commission.

1987

The organization name changes to the Joint Commission on Accreditation of Healthcare Organizations to reflect an expanded scope of activities.

The Agenda for Change is launched with a set of initiatives designed to place the primary emphasis of the accreditation process on actual organization performance.

1988

Development of the Indicator Measurement System (IMSystem)--an indicator-based performance monitoring system--gets underway.

Accreditation for home care organizations begins.

1989

Accreditation for managed care begins. (Folded into the Ambulatory Care Accreditation Program in 1990.)

1990

The Joint Commission Headquarters and Conference Center opens in Oakbrook Terrace, IL, approximately 20 miles west of downtown Chicago.

Two additional public members begin service on the board.

1992

The "Accreditation Manual for Hospitals" begins the multiyear transition to standards that emphasize performance improvement concepts.

An at-large nursing representative and another public member begin service on the board.

The Joint Commission issues a standard requiring all accredited hospitals to have a policy prohibiting smoking in the hospital.

1993

The "Accreditation Manual for Hospitals" is reorganized around important patient care and organization functions to shift the focus from standards that measure an organization's capability to perform to those that look at its actual performance.

The number and nature of confirmed substantive complaints filed against accredited facilities and the existence of type I recommendations becomes public information.

Provisional Accreditation is established as a new accreditation category for organizations newly seeking accreditation.

The Joint Commission begins conducting mid-cycle, random, unannounced surveys of 5 percent of accredited organizations across the nation.

The federal government announces that home health agencies accredited by the Joint Commission after an unannounced survey will be "deemed" to meet the Medicare Conditions of Participation.

1994

The first organization-specific performance reports are released in December for health care organizations surveyed after January 1, 1994. The reports provide useful and understandable information about the performance of organizations accredited by the Joint Commission and include performance area scores and national comparative information.

The "1995 Accreditation Manual for Hospitals," "1995 Accreditation Manual for Home Care" and "1995 Accreditation Manual for Mental Health, Chemical Dependency, and Mental Retardation/Developmental Disabilities Services" are published, completing the transition for these programs to performance-focused standards organized around functions important to patient care.

A new survey process is implemented that utilizes a systemwide, cross-department orientation.

The Indicator Measurement System (IMSystem) is launched with obstetric and perioperative indicator sets.

Accreditation for health care networks begins.

The Joint Commission forms the Work Group on Accreditation Issues for Small and/or Rural Hospitals.

The federal government recognizes Joint Commission laboratory accreditation services as meeting the requirements for Clinical Laboratory Improvement Amendments of 1988 (CLIA) certification.

Quality Healthcare Resources, Inc. and the Joint Commission form Joint Commission International to provide education and consulting services to international clients.

Two additional public members begin service on the Board of Commissioners, bringing the total number of public members to six.

1995

Joint Commission implements an Action Plan to improve its services to accredited organizations.

As part of the Action Plan, the Orion Project (suggested by the Work Group on Accreditation Issues for Small and/or Rural Hospitals) is launched in Pennsylvania and Arizona. The Orion Project is a series of experiments designed to test innovations to improve the delivery of accreditation services. Its objective is to create a continuous accreditation process at the local level that supports a health care organization's ongoing efforts toward improving its performance.

The IMSystem introduces 15 cardiovascular, oncology and trauma indicators.

For the first time, a public member serves as an officer of the Board of Commissioners.

The "1996 Accreditation Manual for Ambulatory Health Care," "1996 Accreditation Manual for Health Care Networks," "1996 Accreditation Manual for Long Term Care" and "1996 Accreditation Manual for Pathology and Clinical Laboratory Services" are published, completing the transition for all programs to performance-focused standards organized around functions important to patient care.

1996

Laptop technology is introduced for use on-site during hospital surveys and a preliminary report is discussed during the exit conference. As a result, analysis of hospital findings is shorter, with improved consistency between the exit conference and final report.

The Orion Project is extended into Georgia and Tennessee.

The IMSystem introduces eight medication use and three infection control indicators.

The Joint Commission launches its Home Page on the World Wide Web -- http://www.jcaho.org.

The Joint Commission establishes cooperative accreditation agreements with the Community Health Accreditation Program for home care and the Commission on Office Laboratory Accreditation to reduce redundancy in the accreditation of health care organizations.

The creation of "Accreditation Watch," a new designation for organizations that have experienced a sentinel event, is approved.

Preliminary Nonaccreditation is added as a new accreditation category. The decision means the organization has met one or more criteria for nonaccreditation, but acknowledges the potential existence of additional information which may bear upon the final accreditation decision.

The Home Care Accreditation Program becomes, by volume, the Joint Commission's largest accreditation program.

1997

The Joint Commission launches "ORYX--The Next Evolution In Accreditation" to integrate the use of outcomes and other performance measures into the accreditation process for hospitals, long term care organizations and health care networks.

In January, the board approves the business plan for establishing the Academy for Healthcare Quality, a corporate "university without walls" that will offer a graduate-level certification program in health care quality assessment, management and improvement for health care professionals.

The laptop technology is introduced for use on-site during long term care accreditation surveys.

Accreditation for preferred provider organizations is launched as a separate accreditation track under the Network Accreditation Program.

The Joint Commission publishes the first edition of the "National Library of Healthcare Indicators (NLHI): Health Plan and Network Edition," the nation’s first comprehensive compendium of validated performance measures for health plans and networks. An on-line version is posted in the Joint Commission Web site.

Accreditation for managed behavioral health care organizations is launched as separate accreditation service under the Behavioral Health Care Accreditation Program and the "1997 Comprehensive Accreditation Manual For Managed Behavioral Health Care" is published.

The Joint Commission’s Ernest A. Codman Awards are created to recognize outstanding achievement by health care organizations and individuals in the use of performance measurement to improve organization performance.

Quality Check, a directory of Joint Commission accredited organizations and performance reports, becomes available on the Internet.

The Business Advisory Group is created to provide counsel to the Joint Commission on employer priorities in the evaluation of health care quality.

The board approves a revised Sentinel Event Policy effective April 1, 1998, to promote self-reporting of medical errors and encourage health care providers to more closely examine the root causes of these events.

The Joint Commission conducts three public hearings across the country on the use of physical restraint in acute care hospitals, particularly non-psychiatric units, to provide the public and clinicians an opportunity to discuss their perspectives on the issue.

A revision to the Public Information Interview Policy permits organization employees and other individuals to meet privately with the survey team if such a request is made.

The Joint Commission establishes cooperative accreditation agreements with the American Society for Histocompatibility and Immunogenics (ASHI) for laboratories and CARF...The Rehabilitation Accreditation Commission for free-standing rehabilitation hospitals and rehabilitation units in hospitals. The Joint Commission also expands its cooperative agreement with COLA for laboratories affiliated with hospitals and ambulatory care settings.

The board approved a plan to offer accreditation services outside the United States. Under the plan, Joint Commission International will offer accreditation services to individual organizations outside the U.S. and will partner with indigenous entities to establish accreditation programs in other countries.

1998

ORYX requirements are introduced for home care, behavioral health care and managed behavioral health care organizations.

The Joint Commission, the American Medical Accreditation Program (AMAP) and the National Committee for Quality Assurance (NCQA) establish the Performance Measurement Coordinating Council (PMCC) to coordinate performance measurement activities across the entire health care system.