Joint Commission International Standards Research Articles

Exploring the rate and reasons for same-day cancellation of cardiac surgery after implementing joint commission international standards: a retrospective cross-sectional study

BackgroundSame-day cancellation of cardiac surgery significantly impacts operating room management efficiency, which can be mitigated by taking preventive measures. This study aimed to explore the same-day cancellation rate of elective adult cardiac surgery, as well as the reasons for those cancellations. A retrospective cross-sectional study reviewed the records of 581 scheduled elective adult cardiac surgical cases at a single cardiac center from June 2017 to May 2018. The same-day cancellation reasons were grouped into four broad categories: nonclinical cancellations, clinical cancellations, patient-related cancellations, and 'other reason' cancellations. A case was considered canceled when it was not performed on the same day as the planned surgery.ResultsA total of 581 elective adult cardiac surgeries were scheduled during the study period, and 56 (9.63%) of these were canceled. The highest cancellation rate was due to nonclinical cancellations, with 39% of scheduled cases, followed by clinical cancellations, with a 34% cancellation rate. Patient-related cancellations accounted for 23% of cancellations, while the lowest rate was due to ‘other reasons,’ which accounted for 4% of total cancellations. The most common reason for nonclinical cancellations was the inclusion of emergency cases (n = 8; 14%). The most common reason for clinical cancellations was changes in the patient’s medical condition (n = 8, 14%). The common reason for patient-related cancellations was the refusal of surgery (n = 9; 16%). The lowest rate was for menstruating female patients (n = 2; 4%).ConclusionsThe same-day cancellation rate was 9.36%, and most of the cancellation reasons could be mitigated by implementing preventive strategies to improve the efficiency of the operating room. Preoperative preparation clinics and paying particular attention to female patients scheduled for surgery might reduce the rate of elective cardiac surgery cancellation.

Perceptions of Chinese hospital leaders on joint commission international accreditation: a qualitative study.

Joint Commission International (JCI) accreditation plays a significant role in improving the quality of care and patient safety worldwide. Hospital leadership is critical in making international accreditation happen with successful implementation. Little is known about how Chinese hospital leaders experienced and perceived the impact of JCI accreditation. This paper is the first study to explore the perceptions of hospital leaders toward JCI accreditation in China. Qualitative semi-structured interviews were used to explore the perceptions of the chief operating officers, the chief medical officers, and the chief quality officers in five JCI-accredited hospitals in China. Thematic analysis was used to analyze the interview transcripts and identify the main themes. Fifteen hospital leaders participated in the interviews. Three themes emerged from the analysis, namely the motivations, challenges, and benefits related to pursuing and implementing JCI accreditation. The qualitative study found that eight factors influenced hospital leadership to pursue JCI accreditation, five challenges were identified with implementing JCI standards, and eight benefits emerged from the leadership perspective. Pursuing JCI accreditation is a discretionary decision by the hospital leadership. Participants were motivated by prevalent perceptions that JCI requirements would be used as a management tool to improve the quality of care and patient safety in their hospitals. These same organizational leaders identified challenges associated with implementing and sustaining JCI accreditation. The significant challenges were a clear understanding of the foreign accreditation standards, making staff actively participate in JCI processes, and changing staff behaviors accordingly. The top 5 perceived benefits to JCI accreditation from the leaders' perspective were improved leadership and hospital safety, improvements in the care processes, and the quality of care and the learning culture improved. Other perceived benefits include enhanced reputation, better cost containment, and a sense of pride in the staff in JCI-accredited hospitals.

Patient safety culture plays an essential role to ensure safe patient care and quality in healthcare services

Patient Safety is a global health priority. Every year, millions of patients suffer or die because of unsafe and poor- health care service. There are several factors which compromise patient safety and cause potential harm in health care settings. In developed countries, it is estimated that one in every 10 patients is harmed while receiving care in hospital. In developing countries, there is inadequate information on adverse event due to poor quality of health care service. Despite recent developments in Bangladesh, there is still great concern about the quality of care in healthcare sector. Evercare Hospital Dhaka is one of the leading private health care organizations in the country and committed towards patient safety from the very beginning. The purpose of this article is to discuss the importance of patient safety culture at healthcare service and how it is nurtured at Evercare hospital Dhaka by following the joint commission international standards.
 Pulse Volume 12-14 2020-2022 p.53-61

Using the SLIPTA checklist to assess laboratory readiness for Joint Commission International accreditation.

The Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) helps prepare laboratories in low- and middle-income countries to achieve international accreditation aligned with the ISO 15189:2012 standards. Accreditation by the Joint Commission International (JCI) is among the highest sought by hospitals worldwide. While the readiness of laboratories with a five-star SLIPTA score to undergo ISO 15189:2012 accreditation was recently assessed, the compliance of the SLIPTA checklist with JCI is still unknown. The study evaluated the SLIPTA checklist's utility in assessing laboratories to meet the JCI standards. We conducted a detailed gap analysis between SLIPTA and JCI laboratory standards from January 2021 to January 2022. We cross-matched the JCI standard requirements to SLIPTA clauses and categorised each standard into 'met', 'partially met', and 'not met'. We highlighted similarities, discrepancies, and improvement areas. A total of 109 JCI standards were included. The SLIPTA checklist completely met 61 standards, partially met four, but did not meet 44. The unmet JCI standards focused on the quality planning, control, and improvement sections. Healthcare organisation management and quality control processes, including selecting an accredited reference laboratory, collecting quality management data, creating of post-analytical policies and procedures, and validating monitoring systems, constitute the basis of this preparation. The SLIPTA checklist covers major quality management system elements of the JCI standards for laboratories. However, some components should be addressed to assure readiness for JCI accreditation. This study identified additional areas not covered by the SLIPTA checklist that are required for JCI accreditation.

An Exploratory Study on Adherence to Joint Commission International Standards on Facility Management and Safety at a Tertiary Care Hospital in Dubai, United Arab Emirates

Introduction: According to the International Society for Quality in Healthcare, accreditation is a process in which "trained external peer reviewers evaluate a healthcare organisation's compliance with pre-established performance standards. Unlike licensure, accreditation focuses on continuous improvement strategies and achievement of optimal quality standards, rather than adherence to minimal standards intended to assure public safety".1,2 This study aims to observe and identify gaps in adherence to Facility Management and Safety Standards as prescribed by the Joint Commission International (JCI). Methodology: A time-bound single-centre observational study was carried out using the JCI Accreditation Standards for Hospitals (Sixth Edition). Questionnaires were shared with 20 purposively and conveniently (based on consent) selected participants after obtaining signed informed consent. Following the questionnaire examination, one-on-one interviews with management were held to acquire the necessary data for the study, including the reasons for non-compliance with specific requirements. This research closely examined JCI-recommended policies (Chapter: Facility Management and Safety) and the hospital's compliance with them. Results and Conclusion: Based on the study, it can be concluded that the hospital has complied with most of the standards on Facility Management and Safety Standards of the Sixth Edition of JCI. However, the clauses FMS.2:ME.3, FMS.6:ME.4, FMS.9.2.1:ME.3, and FMS.9.2.1:ME.4 were not met.

A case study exploring the impact of JCI standards implementation on staff productivity and motivation at the laboratory and blood bank.

Background and AimsQuality of care has transformed to become an essential element of healthcare service delivery, which caused decision makers in Health Care Organisations (HCOs) to seek methods to evaluate the level of care provided. The field of accreditation is under massive development, especially in healthcare organizations. Joint Commission International (JCI) accreditation is one of the accreditation bodies that require a lot of documentation and quality improvement to guarantee proper standard application. The process of accreditation is known to be demanding and requires staff involvement to guarantee successful implementation.MethodsThis study focuses on the impact of JCI standards implementation on staff productivity and motivation in a 350‐bed hospital. An interpretive approach was used to collect empirical data by interpreting the population's behavior, which is represented in this study by the questionnaire. The study is considered an emergent study that identified, explained, illustrated, and developed a model of staff motivation. In this type of study, the process of inquiry, supporting arguments, and questions of interest is developed after the launching of the study and during the process of data collection. Thus, the researcher relied on the social constructive paradigm, whereby the grounded theory (GT) is used to build the research model of staff motivation during the process of accreditation.ResultsBy studying the Turn Around Time (TAT) performance indicator, the study showed that TAT of tests decreased by 3% after JCI standards implementation, which was reflected at two different laboratory sections. The trainings conducted throughout the process of standards implementation also resulted in enhancing the quality of samples, which was demonstrated by the decrease in the percentage of rejected samples.ConclusionStaff productivity increases when JCI standards are implemented. However, staff motivation is dependent on their involvement with management decisions and the smooth transition through change management, which ensures staff retention and therefore increase productivity.

A Qualitative Assessment of People-Centeredness of Inpatient Tuberculosis Treatment Services in Armenia

Background: People-centered tuberculosis (TB) care promotes treatment adherence and outcomes. TB patients’ and families’ health education and protection of their rights are among the core components of people-centered care. We aimed to assess the level of people-centeredness of TB care as a proxy to quality in the largest inpatient unit of the National Pulmonology Center (NPC) in Armenia. Methods: We conducted a qualitative study by interviewing clinical and administrative staff, TB patients, and family members to learn their experiences about patient and family education and rights (PFE&R) protection practices focusing on two Joint Commission International (JCI) Standards for Hospital Accreditation. Mixed-conventional inductive and directed deductive content approach guided the analysis of data. Results: The study revealed various gaps in the provided services. According to the TB physicians and nurses, they routinely educated patients and families and took actions to protect their rights. However, practices reported by TB providers varied across clinical departments and professionals and did not meet the recommendations of the JCI standards. The document review revealed that no written policies or procedures existed in the NPC inpatient unit to guide the implementation of PFE&R. Lastly, patients’ inconsistent experiences were also indicative of the lack of standardization and issues with PFE&R implementation. Conclusion: Bridging the gap between existing and recommended practices by establishing and enforcing new people-centered policies and procedures is a pledge for improving operations and patients’ experiences with a potential nationwide impact in Armenia.

Implementation of an Antimicrobial Stewardship Program in Five Colombian Hospitals in 2018

Background: More than 50% of antibiotics used in hospitals are unnecessary or inappropriate. The antimicrobial stewardship programs (ASPs) are coordinated efforts to promote the rational and effective use of antibiotics including appropriate selection, dosage, administration, and duration of therapy. When an ASP integrates infection control strategies, it is possible to decrease the transmission of multidrug-resistant pathogens. Methods: In 2018, 5 Colombian hospitals were selected to implement an ASP. Private and public hospitals from different cities were included in the study, ranging from 200 to 700 beds. Our team, consisting of an infectious disease and hospital epidemiologist, visited each hospital to establish the baseline of their ASP program, to define the ASP outcomes according to each hospital’s needs, and to set goals for ASP outcomes in the following 6–12 months. Follow-up was scheduled every 2 months through Skype video conference. The baseline diagnosis or preintervention evaluation was done using a tool adapted from previous reports (ie, international consensus and The Joint Commission international standards). Documentation related to ASPs, such as microbiological profiles, antimicrobial guidelines (AMG) and indicators for the adherence to them as well as antimicrobial resistance (AMR) prevention through protocols, were written and/or updated. Prevention and infection control requirements and protocols were also updated, and cleaning and antiseptic policies were created. Training in rational use of antibiotic, infection control and prevention, and cleaning and disinfection were carried out with the healthcare workers in each institution. Results: Before the intervention, the development of the ASP according to the tool was 27% (range, 5%–47%). The lowest institutional scores were the item related to ASP feedback and reports (11% on average), followed by education and training (14%), defined ASP responsibilities (23%), ASP function according to priorities (26%), and AMR surveillance (27%). After the intervention, the ASP development increased to 57% (range, 39%–81%) in the hospitals. The highest scores achieved were for education and training (90%), surveillance (75%), and the activities of the infection control committee (70%). The items that made the greatest contribution to ASP development were the individual antibiogram, including the bacteria resistance profile, and the development of the AMG based on the local epidemiology in each hospital. Conclusions: The implementation of an ASP should include training and education as well as defining outcomes according to the hospital’s needs. Once the strategy is implemented, follow-up is key to achieving the goals.Funding: NoneDisclosures: None

Challenges in meeting patient assessment international standards in ambulatory tuberculosis services

Abstract Background Limitations of tuberculosis (TB) diagnostic tools and measures restrict proper TB control in places with high drug-resistant TB prevalence. This study aimed to explore gaps in the primary health care (PHC) TB services in Armenia compared to international standards on Assessment of Patients (AOP). Methods We applied mixed methods to assess the AOP standards in 30 outpatient TB centers using observational and documents/medical records review's standardized checklists, in-depth interviews, and focus group discussions. Evaluation was conducted in all 10 regions of Armenia and the capital city Yerevan. Joint Commission International Standards for Ambulatory Care, International Standards for TB Care, and WHO framework, served as a guideline for this assessment. Results PHC physicians are qualified for a set of examinations to diagnose TB. Planned reassessments are conducted continuously, though defined writings for the scope and content of reassessments administered by each clinical discipline is absent. Laboratory departments provide high quality services to the TB patients with the defined timeframes for reporting the results. Laboratory and radiology services staff is qualified and experienced. The biosafety rules are compliant with local and international standards. However, the location and conditions of the laboratory departments are mostly non-compliant with the standards. Lack of modern equipment restricts maintaining proper environmental controls, including ventilation systems. Laboratory technicians have little knowledge of the organization's safety management program and its relation to the laboratory safety program. The facilities have neither formal quality control programs regulated by documents and policies nor an identified radiation safety program protocol. Conclusions On the level of AOP standards, the PHC TB services in Armenia have satisfactory performance. However, assessed standards for this function required certain improvements. Key messages In Armenia, the tuberculosis care in PHC facilities presents high level of compliance for patient assessment international standards. To fully meet the standards, facilities need to reconstructed/renovated laboratories and establish the radiology and diagnostic equipment management, quality control and radiation safety programs.

Practice of nosocomial infection management in burn department based on the American hospital evaluation standard of the Joint Commission International

Objective: To explore the role of continuous quality improvement measures based on the American hospital evaluation standard of the Joint Commission International (JCI) in prevention and control of nosocomial infection in Burn Department of the Second Affiliated Hospital of Zhejiang University School of Medicine (hereinafter referred to as the author' s department). Methods: From 2013 to 2018, based on 11 JCI standards related to infection prevention and control and the current situation of the author' s department, more than 50 doctors, nurses, and nursing assistants from the author' s department participated in continuous improvement of the three-level management system of nosocomial infection in the author' s department, focusing on implementing of management of patient with multidrug resistant bacteria infection, optimizing the infection control management of instrument and cloth, and implementing target management on 5 indicators such as hand hygiene implementation rate, and carrying out inspection, quality management, and improvement on 11 items of prevention and control of nosocomial infection. The implementation rate of hand hygiene from 2013 to 2018 and the accuracy rate of hand hygiene from 2016 to 2018 of medical staff in the author' s department, and incidences of catheter-related bloodstream infection (CRBSI) of central venous, catheter-associated urinary tract infection (CAUTI), and ventilator associated pneumonia (VAP) of burn intensive care unit in the author's department from 2013 to 2018 were monitored.The following 7 indicators were monitored from 2013 to 2018, including false negative rate of nosocomial infection, incidence of hyperglycemia during intensive insulin treatment for severely burned patients, the implementation rate of CRBSI preventive measures, the specification rate of surface fixation of indwelling catheter, the implementation rate of VAP preventive measures, the accuracy rate of bed temperature during the use of suspended bed, and the implementation rate of hand hygiene of standardized training medical staff in the author' s department before and after improvement. Data were statistically analyzed with chi-square test. Results: The implementation rate of hand hygiene of medical staff in the author' s department was 88.0%-89.5% from 2013 to 2018, the correct rate of hand hygiene of medical staff in the author' s department was 95.10%-97.35%, and both reached the target values. The incidences of CRBSI in 2015, VAP in 2017, and CAUTI in 2013, 2014, and 2017 of burn intensive care unit failed to reach the respective target value and reached the respective target value after quality improvement, and the above-mentioned 3 indicators reached the respective target value in other years. From 2013 to 2018, the false negative rate of nosocomial infection and the incidence of hyperglycemia during intensive insulin treatment of severely burned patients in the author' s department after improvement were significantly lower than those before improvement (χ(2)=24.50, 4.74, P<0.05 or P<0.01), the implementation rate of CRBSI preventive measures, the specification rate of surface fixation of indwelling catheter, the implementation rate of VAP preventive measures, and the accuracy rate of bed temperature during the use of suspended bed after improvement in the author' s department were significantly higher than those before improvement (χ(2)=13.78, 6.50, 20.37, 13.92, P<0.05 or P<0.01), and the implementation rate of hand hygiene of standardized training medical staff in the author' s department after improvement was similar to that before improvement (χ(2)=1.71, P>0.05). Conclusions: The introduction of JCI standard can improve the implementation rate and accuracy rate of hand hygiene of medical staff in burn department, reduce the incidences of CRBSI, CAUTI, and VAP, and improve the effect of prevention and control of nosocomial infection in burn department.

Health Care Providers’ Compliance to Joint Commission International Patient Safety Goals during the Pre and Post Accreditation Period (2015-2016) in Public Hospitals in the United Arab Emirates

Background: Preparing for JCI accreditation is a complex task. The work has to be based on JCI standards and requirements and usually lasts for two years. Patient safety is considered a fundamental principle of excellence in healthcare. However, the International Patient Safety Goals (IPSG) are considered as the most important chapter in the Joint Commission International standards and staff compliance is extremely required. Purpose: The purpose of the study is to assess the compliance of healthcare providers to the JCI Patient Safety Goals during the pre and post JCIA survey period (2015-2016) and to develop a model to assist healthcare providers to have better compliance with the JCI standards. 2015 represents the period within 2 years post accreditation and 2016 represents the period of one-year pre-accreditation. Methods: This is a descriptive, cross-sectional study. Two convenience samples from two governmental hospitals in the United Arab Emirates. The participants were selected at two points of time (2015 and 2016). The sample consisted of nurses, doctors and other healthcare providers who were questioned and observed to check their compliance to JCI Patient Safety Goals. Results: In terms of IPSG survey, the results reflected a decline in healthcare providers’ awareness post-JCIA survey from mean of (88.48) to (76.48), with (p&lt; 0.001). Regarding health care providers’ compliance to IPSG documentation in patients’ files, the mean of compliance decreased from (M=94.6) to (M=84.39) post JCIA survey, (p&lt; 0.001). Moreover, healthcare provider’s adherence to hospital policies related to JCI safety goals declined from (M= 100) pre JCIA to (M=45) post JCIA with (p&lt; 0.001). Thus, the overall compliance and knowledge to JCI safety goals shows significant decline during the period of post survey (2015) compared to pre-survey (2016). Conclusion and Recommendations: The study found increase in compliance and adherence to International Patient Safety Goals standards prior to the accreditation surveys and with a marked decline in compliance and knowledge post accreditation. The author suggested a model of recommendations that emphasizes on the need for unannounced surveys by JCI after the accreditation and reaccreditation to ensure that compliance is not just for the purpose of the accreditation but is embedded in the daily routine and culture of the organization. It is extremely important to change from a survey preparation approach to continual readiness.

Implementation of appointment scheduling based on Joint Commission International standards for patients undergoing elective cesarean section

Implementation of appointment scheduling based on Joint Commission International standards for patients undergoing elective cesarean section

Improvement of education for clinical nutrition interns based on Joint Commission International standards

Huashan Hospital became the first Academic Medical Center Hospital accredited by Joint Commission International (JCI) in 2013. The Department of Clinical Nutrition has constantly improved internship education through the introduction of JCI standards. Based on the flexible combination of teaching and practicing modules, clinical nutrition knowledge is closely integrated with professional dietitian skills, and in-depth practical training helps students to acquire much more experience of the occupation as a dietitian. Teachers think highly of students' initiative and knowledge conversion ability, and in the recent five years, undergraduate projects have been enhanced in both quantity and quality. Key words: Joint Commission International standards; Clinical nutrition; Intern education

Factors Affect to Relationship Marketing for Creating Customer Loyalty in Hospital Services Business

Manuscript type: Research paper. Research Aims: The purpose of this paper is to understand and answer problems from the variables of service quality (interaction quality, physical environment quality, & outcome quality), customer trust, customer value, and customer loyalty to hospital consumer that has applied JCI standard accreditations through green hospital concept. Design/methodology/approach: The study uses a descriptive research design, with 209 valid respondents. SPSS is used to pretest the variables that well construct variables, and SEM to analyze significant construct variables and influence the construct variables. Research Findings: There study findings are: 1) interaction quality, physical environment quality, and outcome quality positively influences customer trust; 2) customer trust positively influences customer value; 3) customer value positively influences customer loyalty; 4) customer trust negatively influences customer loyalty; and 5) the mediating effect of customer value positively influences customer trust and customer loyalty in high to a great extent, so it can have a full mediating effect. Originality/value: The study is one of the few empirical investigations into service quality based on customer trust, customer value, and customer loyalty in the healthcare industry that implements the green hospital concept, builds long-term relationships between customers and medical staff, and the healthcare is doing the examining the mediating effects of customer value on customer trust and customer loyalty. Practitioner/Policy Implications: This study can explain customer trust, customer value, customer loyalty based on hospital services quality through relationship marketing. Hospital has been applied JCI standard accreditation through green hospital build long-term relationship for their customer and good businesses for its hospital. Research limitation/Implications: The research results indicate that service quality is the basic step in increasing customer trust, customer value and customer loyalty in hospital management. The findings of the study will help hospital management to 1) build relationships between medical staff and their customers, and create customer loyalty in long-term relationships, 2) to develop and implement the green hospital concept based on Joint Commission International standards within a green marketing framework.

Illegitimate HIS access by healthcare professionals: scenarios, use cases and audit trail-based detection model

Abstract Healthcare institutions face serious security challenges, namely confidentiality, integrity and availability of patient’s data due to the amounts of sensitive data collected on Health Information Systems (HIS) and the complex data management processes in health care. This paper describes scenarios of undue HIS access by staff in healthcare institutions, use cases (UC) that model the activities on HIS and identify the variables on audit trails (AT) logs that can be used to detect illegitimate actions on patients’ data. Firstly, a survey was conducted through discussion meetings with Information Systems Director (ISD), Data Protection Officer (DPO) and a jurist to discuss their concerns about patient data access, followed by interviews to professionals from healthcare institutions to gather information about their routines and HIS access practices. Then, undue access scenarios were described and UC of activities on HIS which allow their detection were modelled. Lastly, necessary log variables were identified in order to produce algorithms for illegitimate accesses detection. UC and variables selected were matched with the specific requirements of Ministers Council Resolution (MCR) nr.41/2018 which provides guidelines for technology to be compliant with General Data Protection Regulations (GDPR). Discussions with ISD, DPO and the jurist, and professionals’ interviews allowed us to describe nine scenarios of undue access. For each scenario we modelled one UC. 32 variables from different type of logs were identified for illegitimate access detection, of which 14 are mandatory according to MCR nr. 41/2018. Despite we might have some limitations related to poor HIS log quality, the mandatory data that logs must comply will be very useful for the development of UC presented. In addition, it is possible to request systems’ vendors the improvement of logs’ data to meet the detail we propose for this model, which may be very useful to comply not only with GDPR requirements but also with the Standard “Management of Information” (MOI.11) of Joint Commission International Standards for Hospitals (JCI) certification. As future work, we intend to develop the algorithms for the UC modelled, that will detect suspicious activities and produce alarmistic in their presence, testing them in real environment of a hospital to help Information Systems department and DPO on investigation and prevention of data breaches.

Automated Management System for Accreditation of Clinical Engineering Department in Hospitals

The primary objective of clinical engineering department (CED) in hospitals is to provide a broad-based engineering program that addresses all aspects of healthcare technology. However, accreditation of this department is rarely considered in the literature. In this study, we attempted to identify systematic differences in quality management between the Joint Commission International (JCI)–accredited and non–JCI-accredited CED by designing a specific automated evaluation system depending on the technology of cloud computing. Understanding the similarities, dissimilarities, and factors that sustain accreditation within hospitals is the main aim of this work. Another goal is to investigate, describe, and prioritize the measurements and requirements demanded to achieve a minimum accepted level that qualifies nonaccredited ones to be JCI accredited. A questionnaire that targeted the clinical engineering department was developed. It comprises CED roles and the corresponding JCI standards to differentiate accredited from nonaccredited CEDs. A score index has been developed using answering rates of questionnaire to assess CED roles and overall performance of the department. Based on the score index, the CED is classified into 4 classes. System verification was carried out using a data set of 9 Egyptian hospitals. The results revealed the minimum benchmark level of acceptance for JCI accreditation. The system proves its consistency and correctly separated JCI-accredited from nonaccredited CEDs.

An experience in integrated management of clinical risks

BackgroundManage clinical risks under the integrated risk management model of the BUPA organization (British United Provident Association). Materials and methodsBUPA is an international group that provides health insurance and healthcare services. The project has been limited to Europe and Latin America (ELA) and this article presents the results related to hospitals.The integral risk management model was based on a governance structure, a risk management framework and the risk management itself (continuous process of identification, evaluation, management, monitoring and reporting).For the latter, a catalog of potential clinical risks was drawn up, using the Joint Commission International (JCI) standards as a reference and applied to a hospital to identify the risk to which they were exposed in their daily activity. An evaluation was conducted, based on its impact and probability of occurrence and depending on the residual and inherent score obtained, the action on each risk and the effectiveness of the controls were determined.A continuous monitoring of the risk profile and the information to share with the Board was defined. ResultsThe catalog consisted of 126 risks and 479 controls, divided by areas of application.In the assessment of the inherent risk, 84% of the risks were at an acceptable and assumable level, and in 16% it was necessary to establish an action plan. ConclusionsUnder the conditions of the study, we believe the benefits of implementing an integrated management of clinical risk system consisted in providing services that meet the legal requirements and standards of good practice (in our case, the JCI's standards). They allowed us to advance in the organization's management of, improving its efficiency in the allocation of resources for risk management and adaptation to the environment and the patient. In addition, this strategy can facilitate decision-making and encourage the organization's transformation capacity.

Nurses' and Patients' Perceptions of the Quality of Psychiatric Nursing Care in Jordan.

The quality of care provided for patients in mental health-care facilities remains a challenge for health-care providers in general and for nurses in particular. Identifying the level of quality of care provided for patients in mental health-care facilities as perceived by nurses and patients may help health-care providers improve the quality of care and improve patients' outcomes. The purpose of the study was to assess the perceptions of nurses and patients of the quality of nursing care, and explore the differences in their perceptions of quality of care in mental health-care facilities in Jordan. A cross-sectional study was conducted using two convenience samples of 123 nurses and 150 patients. The nurses completed the Karen-personnel instrument, a self-administered questionnaire; One hundred and fifty patients from several mental health-care facilities in Jordan were interviewed using the Karen-patient instrument. The interviews were structured. Sixtyfour percent of nurses rated the quality of psychiatric nursing care as satisfactory, and 47.6% of patients perceived the quality of nursing care as satisfactory. Male nurses, who attended courses in mental health nursing, chose to work in a psychiatric unit, committed to work in the future in a psychiatric unit, and were providing indirect care have significantly higher perception of quality of psychiatric nursing care than their counterparts. Patients in military hospitals have significantly higher perception of quality of psychiatric nursing care than those in governmental ones (p < .05). To improve the quality of care in psychiatric units, patients and nurses need to be educated about the quality indicators set by Joint Commission international standards related to mental health-care facilities.

The Joint Commission vs Joint Commission International

Accreditation of healthcare organizations is used by government agencies and insurance companies in some countries to determine acceptable quality level and thus ability to receive reimbursements. Even when not required by law, achieving accreditation helps a healthcare organization to attract more patients and earn higher reimbursement rates. Among the healthcare accreditation organizations, The Joint Commission (TJC) and Joint Commission International (JCI) are known for their longevity, wide scope, and prestige, with the former being the dominant player in the United States and the latter highly recognized elsewhere. A previous article examined the differences and similarities of their standards, whereas this article compares their survey practices. Through a worldwide survey of approximately 1% of their accredited hospitals, the questions most frequently asked by their surveyors and their focus topics were uncovered and compared. Despite the inevitable similarities imposed by the common goal of ensuring patient safety and the adoption of the same tracer methodology, some differences were apparent. Joint Commission International surveyors tend to focus more on equipment planning and selection and scheduled maintenance, whereas TJC surveyors tend to focus more on maintenance strategy. Both asked for scheduled maintenance records, but JCI surveyors concentrated more on safety, national laws/regulations, inventory inclusion, staff training/qualifications, and incident reporting. Although some of these differences can be traced to local laws and regulations, most are apparently derived from previous survey lessons learned. Surprisingly, a large portion of the JCI-accredited hospitals are not strictly following JCI standards and have actually adopted some of the more flexible standards allowed by TJC. It is hoped that this comparison can help clinical engineering professionals worldwide to prepare themselves better for future surveys.

The Joint Commission Versus Joint Commission International

Healthcare organizations around the world seek accreditation as a means to prove that their services meet established standards of practice and quality. In some countries, accreditation is a prerequisite for participation in public or private health insurance programs, whereas in others it helps to earn higher reimbursement rates. Among the healthcare accreditation organizations, The Joint Commission and Joint Commission International are known for their longevity, wide scope, and prestige, with the former being the dominant player in the United States, whereas the latter being highly recognized elsewhere. Although both have a common origin, their standards have evolved separately. This article compares The Joint Commission and Joint Commission International standards and specific requirements for medical equipment management and maintenance. While most of the standards are similar, some clear differences exist. Some of these differences are traceable to national laws, regulations, and standards, whereas others are caused by lessons learned by prior surveys in respective geographies or simply tradition. In-depth discussion of these differences helps clinical engineering professionals understand the rationale—or the lack of—behind those requirements, thereby allowing them to better prepare themselves for future surveys.