Joint Commission International (JCI) was established in 1998 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. 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.
All member health care organizations are subject to a three-year accreditation cycle, while laboratories are surveyed every two years. With respect to hospital surveys, the organization does not make its findings public. 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.
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. 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. 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.” 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 with. 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.
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. Indeed, a facility requesting accreditation pays a substantial fee to the Joint Commission (the “accrediting” agency) and, upon receiving a “passing” grade is able to purchase associated mementos of accomplishment to display to the public. No other entity certifies the Joint Commission.
Alternatives in the United States
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; 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.
There are also other healthcare accreditation organizations in the U.S. unrelated to the Joint Commission. These include the Accreditation Commission for Health Care, Inc. (ACHC), the American Osteopathic Association (AOA), the Commission on Accreditation of Rehabilitation Facilities(CARF), the Community Health Accreditation Program (CHAP), the “Exemplary Provider Program” of The Compliance Team, Healthcare Facilities Accreditation Program (HFAP), HFAP is older than the Joint Commission, having been in operation since 1945. the National Commission on Correctional Health Care, and the Healthcare Quality Association on Accreditation (HQAA), who are recognised in the state of Ohio. and Utilization Review Accreditation Commission (URAC). Due to increases in state insurance reform initiatives led by national nonprofit advocacy group, Autism Speaks, the need to develop quality benchmarks and recognize quality in behavioral health service providers include accrediting organizations such as [http://www.bhcoe.org The Behavioral Health Center of Excellence and Credentialing Of Ethical Behavioral Organizations.
On September 26, 2008 the Centers for Medicare and Medicaid Services (CMS) granted deeming authority for hospitals to DNV Healthcare Inc. (DNVHC), an operating company of Det Norske Veritas (DNV), a Norwegian international company that has been operating in the U.S. since 1898.
The Center for Improvement in Healthcare Quality (CIHQ), based in Round Rock, Texas, was granted deeming authority for hospitals by the CMS In July 2013.
Goals and initiatives
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. 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.
International healthcare accreditation
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 tax-exempt private corporation (a 501(c) organization) currently accredits hospitals in Asia, Europe, the Middle East, Africa and South America, and is seeking to expand its business further.
The JCI has a small staff which includes principal consultants  and a number of other consultants from around the world such as John Wocher of the Kameda Medical Center in Japan ,Dr.Mahboob ali khan from India,.
Cost of accreditation
JCI publishes an average fee of US$ 46,000 for a full hospital survey. 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.