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The Joint Commission (TJC), formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is a United States-based not-for-profit organization^[1] that accredits over 19,000 health care organizations and programs in the United States.^[2] A majority of state governments have come to recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement. Surveys (inspections) typically follow a triennial cycle, with findings made available to the public in an accreditation quality report on the Quality Check Web site.

The declared mission of the organization is "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value".^[3]

The Joint Commission was renamed Joint Commission on Accreditation of Hospitals in 1951, but it was not until 1965,^[4] that accreditation had any official impact. In 1965 the federal government decided that a hospital that met Joint Commission accreditation met the Medicare Conditions of Participation. Recently, Section 125 of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) removed The Joint Commission’s statutorily-guaranteed accreditation authority for hospitals, to be effective July 15, 2010. At that time, The Joint Commission’s hospital accreditation program will be subject to Centers for Medicare & Medicaid (CMS) requirements for organizations seeking accrediting authority. To avoid a lapse in accrediting authority, The Joint Commission must submit an application for hospital accrediting authority consistent with these requirements and within a time frame that will enable CMS to review and evaluate their submission.^[5] CMS will make the decision to grant deeming authority and determine the term.

In 2008, the Joint Commission collected $165 million in revenue, mainly from the fees it charges U.S. health care organizations for evaluating their compliance with federal regulations. Its expenses during this period were $162 million. Its total return on investments in 2008 was -$27 million (loss), and the total value of its investments was $83 million. In 2007, its collected revenue was $149 million. Its expenses were $148 million. Its total return on investments was $5 million, and the total value of its investments was $107 million. The Joint Commission's primary investments in 2007 and 2008 were in stocks (about 50% of investments) and trusts (about 40% of investments).^[6]

History[link]

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 Hospital Standardization Program. In 1951, a new entity, the Joint Commission on Accreditation of Hospitals was created by merging the Hospital Standardization Program with similar programs run by the American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association. In 1987, the company was renamed the Joint Commission on Accreditation of Healthcare Organizations (JCAHO, pronounced "Jay-co").^[7] In 2007, the Joint Commission on Accreditation of Healthcare Organizations underwent a major rebranding and simplified its name to The Joint Commission. The rebranding included the name, logo, and tag line change to "Helping Health Care Organizations Help Patients."

The name change was part of an overall effort to make the name easier to remember and to position the commission to continue to be responsive to the needs of organizations seeking fee-based accreditation. The Joint Commission advocates the use of patient safety measures, the spread of information, the measurement of performance, and the introduction of public policy recommendations.^[8]

Joint Commission International (JCI) was established in 1997 as a division of Joint Commission Resources, Inc. (JCR), a private, not-for-profit affiliate of The Joint Commission. Through international accreditation, consultation, publications and education programs, JCI extends The Joint Commission's mission worldwide by helping to improve the quality of patient care by assisting international health care organizations, public health agencies, health ministries and others evaluate, improve and demonstrate the quality of patient care and enhance patient safety in more than 60 countries.^[9] International hospitals may seek accreditation to demonstrate quality, and JCI accreditation may be considered a seal of approval by medical travelers from the U.S.^[10]

TJC is based in Oakbrook Terrace, Illinois.^[11]

Operation[link]

All health care organizations, other than laboratories, are subject to a three-year accreditation cycle. With respect to hospital surveys, the organization does not make its findings public.^[12] However, it does provide the organization's accreditation decision, the date that accreditation was awarded, and any standards that were cited for improvement. Organizations deemed to be in compliance with all or most of the applicable standards are awarded the decision of Accreditation.

The unannounced full survey is a key component of The Joint Commission accreditation process. "Unannounced" means the organization does not receive an advance notice of its survey date. The Joint Commission began conducting unannounced surveys on January 1, 2006. Surveys will occur 18 to 39 months after the organization's previous unannounced survey.^[13]

There has been criticism in the past from within the U.S. of the way the Joint Commission operates. The Commission's practice had been to notify hospitals in advance of the timing of inspections.^[14] A 2007 article in the Washington Post noted that about 99% of inspected hospitals are accredited, and serious problems in the delivery of care are sometimes overlooked or missed.^[15] Similar concerns have been expressed by the Boston Globe, stating that "The Joint Commission, whose governing board has long been dominated by representatives of the industries it inspects, has been the target of criticism about the validity of its evaluations".^[12] The Joint Commission over time has responded to these criticisms. However, when it comes to the international dimension, surveys undertaken by JCI still take place at a time known in advance by the hospitals being surveyed, and often after considerable preparation by those hospitals.

Preparing for a Joint Commission survey can be a challenging process for any healthcare provider. At a minimum, a hospital must be completely familiar with the current standards, examine current processes, policies and procedures relative to the standards and prepare to improve any areas that are not currently in compliance. The hospital must be in compliance with the standards for at least four months prior to the initial survey. The hospital should also be in compliance with applicable standards during the entire period of accreditation, which means that surveyors will look for a full three years of implementation for several standards-related issues.^[16]

As for the surveyors, the Joint Commission and JCI employ salaried individuals, people who generally work or have worked within health care services but who may devote half or less of their time for the accrediting organization. The surveyors travel to health care organizations to evaluate their operational practices and facilities (i.e., structure/input and process metrics) against established Joint Commission standards and elements of performance.

Substantial time and resources are devoted by health care organizations ranging from medical equipment suppliers and staffing firms to tertiary care academic medical centers to prepare for and undergo Joint Commission surveys. There is growing concern, however, over the lack of verifiable progress towards meeting the organization's stated goals. Although the Joint Commission increasingly cites and demands "evidence-based medicine" in its regulatory requirements, there is a relative paucity of evidence demonstrating any significant quality improvement due to its efforts, while there is a growing body of literature showing no improvement or actual deterioration in quality despite the increasingly stringent and expensive requirements.^{[citation needed]}

Alternatives in the US[link]

The Joint Commission is not a complete monopoly and while many states in the U.S. make use of their services, not all do. Some states have set up their own alternative assessment procedures, and the Joint Commission is not recognized for state licensure in the states of Oklahoma (except for hospital-based outpatient mental health services), Pennsylvania, and Wisconsin. In California, The Joint Commission is part of a joint survey process with state authorities.^[17]

There are also other healthcare accreditation organizations in the U.S. unrelated to the Joint Commission.^[18] These include the American Osteopathic Association,^[19] or AOA, Healthcare Facilities Accreditation Program (HFAP),^[20] Commission on Accreditation of Rehabilitation Facilities (CARF),^[21] Community Health Accreditation Program (CHAP),^[22] the Accreditation Commission for Health Care, Inc. (ACHC),^[23] Utilization Review Accreditation Commission (URAC),^[24] the "Exemplary Provider Program" of The Compliance Team^[25] and the Healthcare Quality Association on Accreditation (HQAA), who are recognised in the state of Ohio.^[26] HFAP is older than the Joint Commission, having been in operation since 1945.^[19]

On September 26, 2008 the U.S. Centers for Medicare & Medicaid (CMS) granted deeming authority for hospitals to DNV Healthcare Inc (DNVHC, Inc.) DNVHC is an operating company of Det Norske Veritas (DNV), an international company that has been operating in the U.S. since 1898.

Goals and initiatives[link]

The stated mission of The Joint Commission is: "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value"

The company updates its accreditation standards and expands patient safety goals on a yearly basis, and posts them on its Web site 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.^[27] The NPSGs have become a critical method by which The Joint Commission promotes and enforces major changes in patient safety in thousands of participating health care organizations in the United States and around the world. The 2009 NPSGs include new regulations targeting the spread of infection due to multidrug-resistant organisms, catheter-related bloodstream infections (CRBSI), and surgical site infections (SSI). The new regulations for CRBSI and SSI prevention apply not only to hospitals, but also to ambulatory care and ambulatory surgery centers. Engaging patients in patient safety efforts is also a major new component of the NPSGs. The Universal Protocol to reduce surgical errors and existing regulations on medication reconciliation have also been modified for 2009, based on feedback received by The Joint Commission.^[28]

International healthcare accreditation[link]

With the advent of medical tourism, international healthcare accreditation of hospitals located in countries around the world has increasingly grown in importance.

This section appears to contradict itself. Please see the talk page for more information. (April 2012)

Joint Commission International, or JCI, is one of the groups providing international healthcare accreditation services to hospitals around the world and brings income into the U.S.-based parent organization. This not-for-profit private company currently accredits hospitals in Asia, Europe, the Middle East and South America, and is seeking to expand its business further).^[29]

JCI also offers a variety of educational programs, especially "Practicums" – more information, including attendance costs, is available through their Web site.^[30]

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

• Accreditation Canada^[31]
• The Australian Council on Healthcare Standards or ACHS^[32]
• QHA Trent Accreditation (based in the United Kingdom)^[33]

• In INDIA National Accreditation Board for Hospitals and Healthcare Providers or NABH^[34]

Cost of accreditation[link]

JCI publishes an average fee of $46,000.00 USD for a full hospital survey.^[35] Reimbursement for surveyors' travel, living expenses and accommodations is required in addition to the fee.

There may be additional costs related to consultancy work etc. directed towards assisting a hospital to be successful in the accreditation process.

Other international accreditors incur different levels of costs, some costing less than JCI.

See also[link]

• List of healthcare accreditation organisations in the USA
• Hospital
• Patient safety
• Patient safety organization
• URAC
• Hospital accreditation
• List of International Healthcare Accreditation Organizations
• Evidence-based medicine
• Medical ethics

Notes[link]

• African Society for Quality in Healthcare ASQH

External links[link]

• The Joint Commission
• Joint Commission International

Clara Louise Maass (June 28, 1876 – August 24, 1901) was an American nurse who died as a result of volunteering for medical experiments to study yellow fever.^[1][2]

Early life[link]

Clara Maass was born in West Orange, New Jersey to German immigrants Hedwig and Robert Maass. She was the oldest of 10 children in a devout Lutheran family.^[3]

In 1895 she became one of the first graduates of Newark German Hospital's Christina Trefz Training School for Nurses. By 1898, she had been promoted to head nurse at Newark German Hospital, where she was known for her hard work and dedication to her profession.^[3]

Army service[link]

In April 1898, during the Spanish-American War, Maass volunteered as a contract nurse for the United States Army (the Army Nurse Corps did not yet exist). She served with the Seventh U. S. Army Corps from October 1, 1898 to February 5, 1899 in Jacksonville, Florida, Savannah, Georgia, and Santiago, Cuba. She was discharged in 1899, but volunteered again to serve with the Eighth U.S. Army Corps in the Philippines from November 1899 to mid-1900.^[4]

During her service with the military, she saw few battle injuries. Instead, most of her nursing duties came in providing medical aid to soldiers suffering from infectious diseases like typhoid, malaria, dengue and yellow fever. She contracted dengue in Manila and was sent home.^[4]

Yellow fever studies[link]

Shortly after finishing her second assignment with the army, Maass returned to Cuba in October 1900 after being summoned by William Gorgas, who was working with the U.S. Army's Yellow Fever Commission. The commission, headed by Major Walter Reed, was established during the post-war occupation of Cuba in order to investigate yellow fever, which was endemic in Cuba. One of the commission's goals was to determine how the disease was spread: by mosquito bites or by contact with contaminated objects.^[4]

The commission recruited human subjects because they did not know of any animals that could contract yellow fever. In the first recorded instance of informed consent in human experiments, volunteers were told that participation in the studies might cause their deaths. As an incentive, volunteers were paid US$100, which was a large amount at the time, with an additional $100 if the volunteer became ill.^[4]

In March 1901, Maass volunteered to be bitten by a Culex fasciata mosquito (now called Aedes aegypti) that had been allowed to feed on yellow fever patients. She contracted a mild case of the disease from which she quickly recovered. By this time, the researchers were certain that mosquitoes were the route of transmission, but lacked the scientific evidence to prove it because some volunteers who were bitten remained healthy. Maass continued to volunteer for experiments.^[3]

Death[link]

On August 14, 1901, Maass allowed herself to be bitten by infected mosquitoes for the second time. Researchers were hoping to show that her earlier case of yellow fever was sufficient to immunize her against the disease. Unfortunately, this was not the case. Maass once again became ill with yellow fever on August 18 and died on August 24. Her death roused public sentiment and put an end to yellow fever experiments on humans.^[3]

Maass was buried in Colon Cemetery in Havana with military honors. Her body was moved to Fairmount Cemetery, Newark, New Jersey, on February 20, 1902.^[5]

Legacy[link]

A 13¢ US postage stamp in Maass' honor. The caption reads "She gave her life".

• In 1951, the 50th anniversary of her death, Cuba issued a postage stamp in her honor.
• On June 19, 1952, Newark German Hospital (which had since moved to Belleville, New Jersey) was renamed Clara Maass Memorial Hospital, and it is now known as Clara Maass Medical Center.
• In 1976, the 100th anniversary of her birth, Maass was honored with a 13¢ United States commemorative stamp.
• Also in 1976, the American Nurses Association inducted her into its Nursing Hall of Fame.
• The Calendar of Saints of the Lutheran Church honors Maass and British nurse Florence Nightingale on August 13 as a "Renewer of Society."

See also[link]

• Human experimentation in the United States

References[link]

External links[link]

• American Nurses Association Hall of Fame retrieved 2010-04-26
• Clara Maass entry at Find A Grave with photos of her headstone, both before and after vandalism.