Joint Commission On The Accreditation Of Healthcare Organizations Research Articles

Quality Oversight: Why Are Rural Hospitals Less Likely to be JCAHO Accredited?

There is a large rural-urban disparity in the proportion of hospitals that are accredited by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO). Several factors can influence whether a hospital participates in the accreditation process. A few of those factors include the hospital's size, case mix and ownership. However, even after controlling for many of these factors, hospitals in the most rural locations are less likely to be accredited by the JCAHO than urban hospitals. A survey was conducted to explore why rural hospitals are not participating in the accreditation process. Survey results show that the largest factor contributing to rural hospital deterrence to seeking accreditation is cost. Without accreditation by the JCAHO and compliance with their movement into performance measurement, quality monitoring of rural hospitals will fall further behind that of urban hospitals. Policy initiatives that make accreditation more financially feasible should be considered.

New End-of-Life Guidelines

149 IN 1996 REPRESENTATIVES from American medical specialty societies convened to share their organizations’ existing or proposed policies concerning decision-making at the end of life and the quality of clinical management of dying patients. From this meeting emerged a consensus document, Principles for Care of Patients at the End of Life: An Emerging Consensus Among the Specialties of Medicine, published by the Milbank Memorial Fund.1 Fourteen societies and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) have adopted policies that embrace the Core Principles. The Joint Commission reported that its standards for care at the end of life are aligned with the Core Principles. The following organizations have formally adopted the Core Principles exactly as written: the American Medical Association, Academy of Psychosomatic Medicine, American Academy of Hospice and Palliative Medicine, American Board of Hospice and Palliative Medicine, American College of Chest Physicians, American Pain Society, and the National Kidney Foundation. Four societies have formally adopted the Core Principles with modifications: the American Academy of Pediatrics, the American College of Surgeons, the American College of Physicians— American Society of Internal Medicine, and the American Geriatrics Society. In addition, the American Society of Bioethics and Humanities unanimously agreed that its members would support these principles, although the organization does not officially support specific policy statements. Moreover, both the American Academy of Neurology (AAN) and the American Society of Clinical Oncology (ASCO) drafted their own specific statements on palliative care and/or end-oflife care that embody all the Core Principles. The AAN statement, drafted by its Ethics and Humanities Subcommittee, was approved by the AAN executive board in July 1995; the final version was published in the Academy’s journal the following spring, reinforced by an editorial that appeared in the same issue.2,3 The ASCO statement was adopted in February 1998 and published in May as a special article in its journal.4 Special Article

Build institutional commitment to improving pain management.

In 1997, the University of Wisconsin began working collaboratively with the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) to integrate pain assessment and treatment into the JCAHO standards and accreditation processes. Pain care committees are an effective mechanism for implementing these changes. The authors discuss the critical role nurse managers can play in the development and success of these committees' activities.

Disaster management in hospitals

A disaster situation for a hospital occurs when the need for medical treatment overwhelms the actual hospital treatment capacity. 1 This may be defined by numerical or situational means; the threshold must always be the result of an individual assessment of the given health care unit. A disaster situation may also be defined as the point of no return to normal standard operating procedures in a certain hospital. In case of a disaster, health care units are required to have and activate a disaster management plan (DMP). In the USA the requirements of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) are trend-setting; in European countries, regulations are normally set by state requirements or by-laws. According to the location of the disaster, it is regarded useful to discriminate the DMP for external disasters (e.g. road accident, air crash), internal disasters (e.g. fire in the hospital) and finally external disasters that have an impact on the hospital as well (e.g. earthquake, hurricane)) '2 The JCAHO requires US hospitals to have such a divided DMP; in other countries this prerequisite is only recommendedY

JCAHO mental health care network accreditation as a performance improvement project.

In June 1995 the Southeastern Area of the Massachusetts Department of Mental Health became the third health care network, and first mental health care network, to be accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) under its new network standards. This paper provides a brief overview of how the Southeastern Area network prepared for and went through the JCAHO survey. The author shows how the effort undergoing the accreditation procedure helped improve the performance of the network. To help other organizations considering JCAHO network accreditation, specific aspects of the survey process are presented, including preparing documents, understanding key concepts emphasized by JCAHO, and preparing staff for participation in the survey interviews.

Putting the 1996 Joint Commission on the Accreditation of Health Care Organizations (JCAHO) Standards into Clinical Practice:: Applications for Cross-training and Automation

LEARNING OUTCOME: To comply with the 1996 JCAHO standards using computerization and cross-training.Prior to automation, the department maintained three separate areas within Clinical Services: a hostess program, the diet office, and the clinical staff. From April 1994 to August 1995, an automated diet office system was developed and fully implemented, which streamlined the technical aspects of both the diet office and the hostess program. Hence, these areas were combined and existing support personnel were cross-trained as nutrition care assistants (NCAs). Their expanded roles included: delivering meals and snacks, completing meal rounds, calculating calorie counts, assisting patients with menu selections, entering such selections into the computer system, and screening all hospitalized patients within 24 hours of admission. The NCAs completed screens by assigning points for high risk indicators, which, in turn, triggered the clinical pathway appropriately for the professional staff. There were several positive outcomes: 1) it improved patient service and satisfaction, 2) it created a departmental reduction in full-time equivalents (FTEs), 3) it improved working relations between production and clinical services, and 4) it adequately satisfied the 1996 JCAHO standards for nutrition assessment. With the current, tenuous health care environment, clinical nutrition managers must investigate methods to streamline processes and standardize procedures, while impacting the bottom line and improving patient care.

Inter-Rater Reliability Regaining Credibility with Your Staff and Financial Officer While Meeting JCAHO Standards

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), in Standard NC 3.4.2., currently requires that our method for determining staffing has both face validity and inter-rater reliability. Furthermore, in LD.1.3, they require a plan to provide services in response to identified patient needs. In LD.2.1.4, the standards require that the leaders recommend a sufficient number of qualified persons consistent with the assessed needs of the population served and planned care/services. Every area must have process to determine the level of care required by patients being served in that specific area. The burden of proof that the required number and mix of staff members are provided will fall to patient care leadership.

Knowledge-based information management: implications for information services.

The 1994 Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) standards for information management will change the way health care librarians respond to JCAHO accreditation surveys and may affect the way libraries are managed. This article will highlight the changes in the standards and the new opportunities they offer. Implications for library operations and the challenges inherent in working with the new Accreditation Manual for Hospitals (AMH) are also explored. The long-awaited 1994 Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) Accreditation Manual for Hospitals (AMH) is now on most hospital library shelves. As expected, librarians will find that the section on Professional Library Services (the PR chapter) has disappeared and that the standards previously in that section are now incorporated in part into the new Management of Information, or IM chapter. Although this method of grouping standards may be new to many health sciences librarians, the incorporation of library services into IM may actually provide many more opportunities for librarians than the previous method of addressing library services separately.

Application of the FOCUS-PDCA model to home care equipment management.

Issuing durable medical equipment to patients for use at home is a costly and complex process. Selection, delivery, setup, and maintenance of home care equipment and the education of patients in its use are currently included in Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) accreditation surveys for those health care organizations that issue equipment. In this Department of Veterans Affairs teaching hospital, the process was complicated by eligibility regulations and frequently rotating housestaff. We organized a team who studied the process and identified opportunities for improvement in three areas: the selection of equipment items ordered, management of equipment-related data, and standardization of equipment delivery contracts. We produced a reference manual for staff, developed a simple database, and incorporated JCAHO home care equipment management standards into equipment delivery vendor contracts. The results of the team's efforts were an increase in efficiency, a decrease in discharge delays, and improved continuity of care. We chose to use the FOCUS-PDCA model to illustrate our approach to improving these processes.

Hospital pharmacy compliance with JCAHO standards and ASHP guidelines for reporting adverse drug reactions

The extent to which institutional pharmacies comply with the accreditation standards of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and the ASHP guidelines for reporting adverse drug reactions (ADRs) was evaluated. A survey was mailed to directors of pharmacy at 444 randomly selected hospitals to collect information on their institutions' ADR programs; the survey addressed each point in the JCAHO accreditation standards and the ASHP guidelines. The 176 usable responses indicated that 89.8% of the institutions met all three of the JCAHO standards and 98.9% met at least two of them; 28.4% of the institutions complied with all 11 of the ASHP guidelines, and 89.2% complied with at least eight of them. Approximately 97% of the institutions had policies for ADR reporting. Respondents reported an average of 70.5 ADRs per hospital during 1989, of which 6.8 per hospital were reported to the FDA. More than 95% of all respondents indicated that they most frequently identified ADRs through voluntary reporting by health-care professionals. Respondents indicated methods and individuals responsible for reporting ADRs, notifying the physician and the FDA, and assessing severity and causality. Sixty-seven percent of the respondents indicated that they did not have a formal ADR committee for monitoring and evaluating ADRs. Almost 90% of the surveyed hospitals complied with all of the JCAHO standards for ADR reporting programs and at least 8 of the 11 ASHP guidelines for ADR monitoring and reporting.

Continuous quality improvement.

heard the cannonk report or seen the handbills announcing the new order.. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) announced its Agenda for Change in 1986, and has stated that the philosophical context for the Agenda for Change is set by the theories of Continual Quality Improvement (CQI).1 During the past six years, the JCAHO has convened a number of expert panels to develop the necessary tools to systematically review and revise the standards by which hospitals are accredited, and to develop methods for the implementation of CQI in hospitals. Many of these efforts are expected to be reflected in the 1994 Accreditation Manual for Hospitals, to be published in less than two years. What is CQI, and why is it being promoted? For many years, efforts to assure the quality of hospital care depended on simple, predominantly structural standards that gauged whether hospitals were organized in such a way that quality care could be provided. The second era, incorporating the 1970s and 1980s, has been marked by the enumeration of complex standards by the government, insurers, and others. When these procedural standards were met, care was considered to be of acceptable quality and no further action was indicated. When a standard was not met, the response often was to seek a miscreant who could be punished for the transgression. Attention was directed almost exclusively to the performance of physicians, with little recognition given to the roles of other participants in the process or to the organization of the process itself. The definitions of quality rarely encompassed such considerations as patient satisfaction or the needs of families, employers, or other healthcare providers. An alternative approach to attaining quality has achieved widespread use and acceptance over the past 50 years, although it remains unknown to most healthcare workers. This alternative approach is often referred to as continuous quality improvement, total quality management, total quality control, or industrial quality control.

Quality Assurance to Quality Improvement: The Impact of the Agenda for Changes

Health care professionals are committed to the continual improvement of the quality of patient care. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has launched a major research and development project intended to improve its ability to evaluate health care organizations and encourage greater attention to the quality of daily patient care. This chapter describes JCAHO's challenge to evaluate capability and performance of health care organizations and practitioners. The intent of JCAHO's agenda for change is to focus on patient outcomes and quality improvement through a more precise and objective evaluation of both clinical and managerial performance. Through the agenda for change, JCAHO and the health care organization will participate in a continuous-flow monitoring system in which clinical and organizational data are transmitted from the field to JCAHO, analyzed, and fed back to the health care organization.

Standards of Care and Practice: A Vital Link in Quality Assurance

In the critical care unit setting, a quality assurance program is based on the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) ten-step model for monitoring and evaluation. The addition of nursing standards of patient care and standards of nursing practice to that ten-step model provides the vital link between patient expectations, staff performance, and quality assurance in that unit.

Guide to Hospitals

Guide to Hospitals. Washington, D.C.: Consumers' Checkbook (Center for the Study of Services), 2002. www.checkbook.org/hospital. $19.95 for two years of online access. Guide to Top Doctors. Washington, D.C.: Consumers' Checkbook (Center for the Study of Services), 2002. www.checkbook.org/cgi-bin/health/topdoctors/ default.cfm. $19.95 for two years of online access. Requirements: Internet Explorer 4.0 or higher, AOL 4.0 or higher, or Netscape 5.0 or higher. The Center for the Study of Services is, per its Web site, an independent, nonprofit consumer organization founded in 1974 with the help of funding from the U.S. Office of Consumer Affairs. Supported entirely by subscriptions, donations, and fees, it does not accept advertising. It publishes a number of guides including the two under review. There are a number of free Web sites that rate hospitals, including U.S. News and World Report (www. usnews.com/usnews/nycu/health/ho sptl/tophosp.htm), which ranks 205 medical centers. The American Hospital Directory (www.ahd.com) contains rating information for more than six thousand hospitals, but detailed reports are available by subscription only, at a cost of $395 per year for a single-user license. The Leapfrog Group (www.leapfroggroup.org) rates hospitals on three quality measures and contains information on only 672 hospitals. Free information on hospital quality will soon be available via Medicare (www.medicare.gov). Guide to Hospitals is a very easy-to-use site that rates 4,500 American acute care hospitals. It includes comparisons by death or adverse outcome from more than twenty types of procedures, and diagnoses include kidney failure, stroke, and heart attack; a rating of more than 1,300 acute care hospitals for such topics as high-risk delivery and low-risk adult surgery; JCAHO (Joint Commission on the Accreditation of Healthcare Organizations) scores; and a detailed report on each hospital including accreditation, medical school affiliation, and number of beds. The user starts by either displaying all hospitals within a two- to seventy-five-mile radius of any zip code, or if a broader geographic range is desired, choosing to compare hospitals in different parts of the country (including U.S. territories), and then as many hospitals as desired. Listings can be sorted in a variety of ways including alphabetically or by scores in such categories as Desirability Scores for High-Risk Delivery of a Baby or Desirability Scores for Complex Adult Medical Care. …