Challenges For Accreditation

The Challenges for Accreditation in a Rapidly Changing Health Care Environment
Quality and Safety Workshop

September 2008, Delhi, India
Copyright, Joint Commission International
Paul Chang MBBS, MPH Derick P. Pasternak MD, MBA Managing Directors, JCI
Presentation Topics
Short overview of Joint Commission International (JCI) Common characteristics of accreditation programs Current challenges How programs must change to meet those challenges
Mission of Joint Commission International

To improve the safety and quality of care in the international community through the provision of education, publications, consultation, evaluation, and accreditation services
Organizational Base
Joint Commission International (JCI) is the international arm of The Joint Commission (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
International Accreditation Programs

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
Accreditation A Definition
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, and outcomes. 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
What is Accreditation Intended to Accomplish?

Awareness of quality of care issues Stimulate continuous improvement in patient care Increase efficiency/reduce costs Strengthen the publics confidence
Improve the management of health services Create a learning organization Enhance staff recruitment and retention Improve or expand sources of payment
Drivers for Accreditation in Health

Escalating health costs Patient safety & iatrogenic disease Unexplained variation in clinical practice
Inequality Access to health care
Desire to improve care Constant change in clinical practice New technology
Health outcomes Workforce shortfall
The Changing Health Care Environment

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
Globalizations 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 with good outcomes
Medical travelers need to know the best health care destinations
What Questions Arise

Has the health care organization been evaluated by an external body?
Licensure, accreditation, certification
Does the organization meet international norms - e.g., patient rights, research, ethics? Is clinical care guided by the best science e.g., practice guidelines
What Questions Arise

Are the clinical staff qualified and competent 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 with other organizations in other countries?
Health Care Accreditation System Key Elements

Standards of Performance Infrastructure Field Operations
Accreditation System
Design
Sources of Funding
Accreditation Performance Database
Accreditation Decision Process
Do Traditional Accreditation 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 set of standards, can address these questions and provide comparative results.
What Do You Find in JCI 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
How Must Accreditation Programs 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

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

Objective and comparable quality data on clinical outcomes is available to public and stakeholders Patients and their families are partners in the clinical care process
Conclusions
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.
Conclusions
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
Thank You
www.jointcommissioninternational.org

Challenges For Accreditation

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The Challenges for Accreditation in a Rapidly Changing Health Care Environment

Quality and Safety Workshop

Copyright, Joint Commission International

Mission of Joint Commission International

Copyright, Joint Commission International

International Accreditation Programs

What is Accreditation Intended to Accomplish?

Drivers for Accreditation in Health

Desire to improve care Constant change in clinical practice New technology

Copyright, Joint Commission International

Health outcomes Workforce shortfall

The Changing Health Care Environment

Copyright, Joint Commission International

Medical travelers need to know the best health care destinations

What Questions Arise

Copyright, Joint Commission International

What Questions Arise

Copyright, Joint Commission International

Health Care Accreditation System Key Elements

Accreditation Performance Database

Copyright, Joint Commission International

Accreditation Decision Process

Do Traditional Accreditation Programs Address these Questions?

What Do You Find in JCI Accredited Organizations?

Copyright, Joint Commission International

How Must Accreditation Programs Change

Copyright, Joint Commission International

How Must Accreditation Programs Change

Copyright, Joint Commission International

Copyright, Joint Commission International

How Must Accreditation Programs Change

Copyright, Joint Commission International

Copyright, Joint Commission International

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