Medical Tourism Blog

Couple of weeks back, we interviewed Brian Gooch, JCI consultant, who explained how he helps international hospitals plan and prepare for JCI accreditation. Today, we bring you Karen H. Timmons, president and chief executive officer of Joint Commission Resources, Inc. (JCR) and Joint Commission International (JCI).

Under her leadership, JCI is developing an international collaborative network to improve patient safety. Ms. Timmons is also the primary liaison with the World Health Organization (WHO) and is a past board member and Treasurer for the International Society of Quality Assurance (ISQua).

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Question : ISO also concentrates on organization-related standards. How does JCI add to that, specifically in terms of standards related to patients, and their safety?
Karen Timmons : We believe that JCI’s combination of patient- and organization-centered standards helps assure that all aspects of a patient’s journey through a health care organization are as safe and of favorable quality as possible. JCI’s standards also account for proper education, not only of caregivers, but of the patients they treat and the too-often-forgotten patients’ families. Accreditation is a risk-reduction activity. By compliance with standards, organizations are in fact performing to “evidence-based” practices and have a greater likelihood of good outcomes, with less risk to patients.

Patient-focused standards are included in seven chapters of our current hospital standards manual: “Access to Care and Continuity of Care”; “Patient and Family Rights”; “Assessment of Patients”; “Care of Patients”; “Anesthesia and Surgical Care”; “Medication Management and Use”; and “Patient and Family Education”. Health Care Organization Management Standards are covered in six chapters: “Quality Improvement and Patient Safety”; “Prevention and Control of Infections”; “Governance, Leadership, and Direction”; “Facility Management and Safety”; “Staff Qualifications and Education”; and “Management of Communication and Information”.

Question : JCI is a subsidiary of the Joint Commission, which accredits U.S. Hospitals. What are the differences in the standards for U.S. hospitals and those outside? Is the bar set lower, or do you need to take into consideration other factors?
Karen Timmons : With the release of the 3rd edition of the JCI Hospital Standards in July 2007 (effective 1 January 2008), our most comprehensive and stringent to date, JCI’s standards are different from, but comparable to, Joint Commission standards. Our standards account for countries’ and regions’ specific legal, religious, and cultural factors, whereas The Joint Commission’s standards reference United States federal requirements (such as the National Fire Protection Association’s and others). We consider JCI’s standards to be optimal, achievable criteria for organizations dedicated to improving the quality of patient care, ensuring a safe environment, and continually working to reduce risks to patients and staff.

Question : JCI accreditation is purely voluntary and there are currently approximately 130 hospitals which are JCI accredited. Do you think that this is limiting the impact that you are having on improving standards of hospitals worldwide? Do you think hospitals which cater to international patients need a little prodding to get themselves accredited?
Karen Timmons : JCI’s accreditation process is indeed voluntary. We launched JCI’s international accreditation program in 1999 in response to the increasing global demand for valid external evaluation of health care quality and safety.

To date, more than 130 organizations have achieved JCI accreditation and the numbers are growing at a rate that exceeds our forecasts. JCI standards are viewed as the international health care standards and their impact is significant and lasting.

Additionally, JCI has working public-private partnerships with a number of Ministries of Health and other governmental and non-governmental agencies across the globe in which JCI standards are serving as the foundation for national accreditation programs. The most recent example of this type of arrangement is our agreement with the People’s Republic of China’s Ministry of Health, in which JCI is assisting the Ministry in improving the safety and quality of patient care through a series of initiatives in Chinese hospitals, clinics, laboratories, and other health care settings. JCI is helping create strategies to further strengthen qualifications and training of hospital staff, as well as collaborating with medical facilities, research institutes, and non-governmental organizations to establish standards-based guidelines for blood safety, medication management and information management.

Question : I understand you review accreditations once in three years. What happens if a hospital adds a new specialty in between, with new staff and new equipment? Do you have agreements in place to make it necessary for the hospitals to either stick to the standards, or request an emergency review of the new facilities?
Karen Timmons : We require that organizations notify us in writing within 30 days of any significant changes to their organization or facility during the course of their 3-year accredited status. If and when that happens, JCI schedules what we call an “extension survey”—a survey that makes certain that this new “extension” of an organization’s service meets JCI standards.

Question : I take it that JCI accreditation involves implementing changes in the way that the hospitals and their staff treat and manage patients, in addition to infrastructural requirements. Do you provide them with any help for that, or just explain the requirements?
Karen Timmons : When an organization approaches JCI about accreditation, they are given the following:
a) One of our brochures, describing JCI accreditation process
b) A list of for-purchase publications and education conferences, including the JCI accreditation manuals and other accreditation- or patient safety–related publications, audio conferences, etc.
c) Web links, including a link to the most recent JCI standards applicable to their organization
If an organization requests more technical assistance, we provide it by giving the organization a phone number to contact the international consulting division of Joint Commission Resources. We do that because of our self-imposed “firewall” between JCI’s accreditation and consulting; accreditation cannot and will not know which organizations seek or use JCI consultants and JCI consultants do no know an organization’s accreditation status prior to a public announcement is made. That division works completely independently of JCI’s accreditation operations; neither organization is aware of the other’s clientele (until an organization is publicly acknowledged as accredited). Although consultants may assist an organization with preparing for JCI accreditation, consultation in itself is by no means a required or even recommended step in the accreditation process.

Question : What information about an accredited hospital can a prospective patient expect to get from JCI? You must be collecting a lot of data from each hospital on a regular basis. So if someone contacts JCI regarding a particular hospital, what would you be saying to them?
Karen Timmons : We envision a time when JCI will provide an international service similar to The Joint Commission’s Quality Check Web portal (http://www.qualitycheck.org/), a wide-ranging guide to the 15,000 Joint Commission-accredited health care organizations and programs in the United States. As JCI continues to grow, we see that sort of quality-monitoring service as a patient-centric priority. Today, though, we are able to tell prospective patients who contact JCI whether or not a health care organization is accredited or not.
Question : Are you seeing an improvement recently in the numbers of hospitals applying for JCI accreditation? If so, why?
Karen Timmons : As I described earlier, we have seen an upswing in interest in JCI accreditation, and we believe that the surge in interest is an indication that our message is being heard by a larger audience. Eight years into its existence, JCI is becoming more widely known around the world as an accreditor of choice. We believe our patient-centric focus is a big part of the growing acceptance of JCI everywhere, in addition to the growing consensus across borders that there is a business case for patient safety. More and more, patients are taking control over their searches for quality health care, and the stamp of approval that JCI accreditation provides is becoming a “gold standard” for knowledgeable patients and care givers alike.

Question : Does JCI get involved in partnerships or collaborations? Do you have any programs other than accreditation which deal with improving health care and patient safety?
Karen Timmons : JCI has several patient-safety collaborations separate from its accreditation activities, including the following:

WHO Collaborating Centre for Patient Safety. Since its launch in August 2005, the World Health Organization (WHO) Collaborating Centre for Patient Safety has been building an international network to identify, evaluate, adapt and disseminate patient safety solutions worldwide. A WHO collaborating centre is “a national institution designated by the Director-General of the World Health Organization to form part of an international collaborative network carrying out activities in support of WHO's mandate for international health work and its programme priorities.”3 This specific Collaborating Centre, a cooperative endeavor of WHO, JCI, and The Joint Commission, is operationalized by The Joint Commission International Center for Patient Safety (see below) through the establishment of a collaborative network of leaders in developing, transitional, and developed countries, who are helping to identify health care safety needs and match these with known best practices and solutions. Specific projects of the Collaborating Centre include the following:

Patient Safety Solutions. Announced in May 2007, the basic purpose of the Patient Safety Solutions is to guide the redesign of care processes to prevent inevitable human errors from actually reaching patients. The Solutions include any system design or intervention that has demonstrated the ability to prevent or mitigate patient harm stemming from health care processes. Solutions disseminated by the Collaborating Centre are evidence-based, presented in a standard format, and will be updated at regular intervals. The inaugural Patient Safety Solutions address the following issues:
· Look-alike, sound-alike medication names
· Correct patient identification
· Hand-over communications
· Correct procedure at the correct body site
· Control of concentrated electrolyte solutions
· Medication accuracy
· Catheter and tubing misconnections
· Needle reuse and injection device safety
· Hand hygiene

Additional solutions for 2008 release are currently under development.

High 5s. Drawn from a broader set of patient safety solutions, the overall goal of the initiative is to achieve significant, sustained, and measurable reduction or elimination of five highly prevalent patient safety problems in selected hospitals in each country over a five-year period (hence “High 5s”). The High 5s build on the partnership established by the Commonwealth Fund with Australia, Canada, New Zealand, the United Kingdom, and the United States, and the more recent expansion of this international program to include Germany and the Netherlands. These solutions are the following:
· Prevention of patient care hand-over errors
· Prevention of wrong-site, wrong-procedure, wrong-person surgical errors
· Prevention of continuity of medication errors
· Prevention of high concentration drug errors
· Promotion of effective hand hygiene practices

In March 2005, The Joint Commission and JCR announced the establishment of the Joint Commission International Center for Patient Safety, a virtual organization which leverages the expertise, resources, and knowledge of the Joint Commission and JCR toward its mission of continuously improving patient safety in all health care settings. The Center does the following:
. Collaborates with other leading patient safety organizations around the globe to achieve its goals, including the identification, development and sharing of patient safety solutions
. Serves as a credible source of valid and meaningful information and education about patient safety
. Engages patients, families, practitioners, and providers in improving patient safety
. Advocates for public policy that promotes patient safety
. Conducts research related to patient safety