What is JCI?

Join Commission International an independent not for profit organization accredits and
certify healthcare organization and programs across the globe. Joint Commissions
International accreditation and certification is recognized as a global leader for health care
quality of care and patient’s safety.

JCI identifies measures and share best practices in quality and patient safety with the
world. They provide leadership and innovative solutions to help health care organization
across all settings improve performances and outcomes.

What is the history?

Founded in 1951, The Joint Commission seeks 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 Joint Commission evaluates and accredits more than 22,000 health care organizations
and programs in the United States.

An independent, not-for-profit organization, The Joint Commission is the nation's oldest and
largest standards-setting and accrediting body in health care. To earn and
maintain The Gold Seal of Approval® from The Joint Commission an organization must
undergo an on-site survey by a Joint Commission survey team at least every three years.
(Laboratories must be surveyed every two years.)

Complete timeline history:

https://drive.google.com/open?id=1Al7QFfVd-jOz4ncDBkYktUbjtiOA5OFf
How does an institution apply?

Joint Commission International Accreditation and Certification Policies 2015 Joint

Commission International Applying for Accreditation Updated June 21, 2018 1 Applying for
JCI Accreditation and Certification JCI Accreditation An organization seeking JCI
accreditation begins the accreditation process by completing a survey application, or E-
App, available electronically at JCI Direct Connect. The E-App provides detailed
information and key statistics that create an organization profile needed for JCI
accreditation to manage its accreditation process, develop a contract for survey, and plan
the survey agenda and onsite evaluation process. To begin the accreditation process as a
new applicant, go to www.jointcommissioninternational.org/achieve-hospitals and submit
the “Request More Information” webform. You will then receive an email with a link to
register with JCI accreditation. Once your registration has received approval, you will be
sent an email with a login and password to JCI Direct Connect, JCI’s client portal and the
home of E-App. Hospitals requesting an initial survey should request survey dates when
the hospital is confident it will be able to demonstrate a 6-month track record of compliance
with the standards at the time of the on-site survey (read more in “Accreditation
Preparation”). To begin the accreditation process for reaccreditation, go to the JCI website
at www.jointcommissioninternational.org and click on the link “JCI Direct Connect” at the
top of the page. Use your designated login and password. Your user name is always the
email address on file with JCI Direct Connect. JCI requires organizations to submit one
application for each hospital to be surveyed at minimum 6 months prior to the hospital’s
requested survey dates. JCI requests that the hospital provides 5 weeks of preferred dates
in order of preference during which the survey can be scheduled. This allows JCI the
flexibility to assign the most appropriate team of surveyors to your organization.
Certification An organization seeking JCI certification begins the process by completing a
survey application, or E-App, available electronically at JCI Direct Connect. The E-App
provides detailed information and key statistics that create an organization profile needed
for JCI accreditation to manage its certification process, develop a contract for survey, and
plan the survey agenda and on-site evaluation process. As organizations applying for JCI
certification for the first time (known as initial applicants) must also first be accredited by
JCI, initial certification applicants can immediately access a complete certification E-App
and do not need to be approved for application using an initial registration process tool.
Organizations already accredited and certified by JCI apply for continued certification via E-
App on JCI Direct Connect six months prior to the survey dates requested. The
organization must notify JCI accreditation within 15 days—or at least 30 days before the
scheduled survey date—of any change to the information reported in the survey
application.

Any hospital may apply for Joint Commission International (JCI) accreditation if it meets all
the following criteria:

• The hospital is located outside of the United States and its territories.
• The hospital is currently operating as a health care provider in the country, is
licensed to provide care and treatment as a hospital (if required), and, at minimum,
does the following:

o Provides a complete range of acute care clinical services—diagnostic,

curative, and rehabilitative. In the case of a specialty hospital, provides a
defined set of services, such as pediatric, eye, dental, and psychiatry, among
others.
o For all types of hospitals, provides services that are available 365 days per
year; ensures all direct patient care services are operational 24 hours per
day, 7 days per week; and provides ancillary and support services as needed
for emergent, urgent, and/or emergency needs of patients 24 hours per day, 7
days per week (such as diagnostic testing, laboratory, and operating theatre,
as appropriate to the type of acute care hospital).

• The hospital provides services addressed by the current JCI accreditation standards
for hospitals.
 • The hospital assumes, or is willing to assume, responsibility for improving the quality
of its care and services.
• The hospital is open and in full operation, admitting and discharging a volume of
patients that will permit the complete evaluation of the implementation and sustained
compliance with all current JCI accreditation standards for hospitals.
• The hospital meets the conditions described in the current Accreditation Participation
Requirements (APRs).

Academic medical center hospital applicants must meet each of the criteria above in
addition to the following three criteria:

1) The applicant hospital is organizationally or administratively integrated with a medical

school.
2) The applicant hospital is the principal site for the education of both medical students
(undergraduates) and postgraduate medical specialty trainees (for example, residents or
interns) from the medical school noted in criterion 1.
3) At the time of application, the applicant hospital is conducting medical research with
approval and oversight by an Institutional Review Board (IRB) or research ethics
committee.

What institutions should apply?

The health care providers, government ministries, public health agencies, academic
institutions, and businesses to achieve peak performance in patient care. By developing
and maintaining international standards for health care quality and patient safety, we
address the unique challenges of preserving quality care as patients move across the care
continuum. Standards are developed and organized around important functions common to
all health care organizations. In fact, the functional organization of standards is now the
most widely used around the world and has been validated by scientific study, testing, and
application.

To maintain best practices, JCI turns to its Standards Advisory Panel, comprised of
experienced physicians, nurses, administrators, and public-policy experts. The panel
guides the development and revision process of the JCI accreditation standards. Panel
members are from five major world regions: Latin America and the Caribbean, Asia and the
Pacific Rim, the Middle East, Europe, and the United States. The panel’s recommendations
are refined based on an international field review of the standards and input from experts
and others with unique content knowledge.

JCI is committed to keeping pace with the dynamics of global health care while remaining
the standard bearer for The Gold Seal of Approval®, a universally recognized symbol of
quality and patient safety.

How does the institution prepare?

Here are 12 steps that health care organizations typically follow toward accreditation
success.

1. Understand JCI Basics.

• Become familiar with JCI’s accreditation standards and fundamentals of the

accreditation process, which you need to know before you begin.
• Become familiar with JCI’s policies and procedures
• Review the JCI Hospital Accreditation Manual and Survey Process Guide
• Share start-up information with your team
2. Select and Prepare Accreditation Leaders

Leadership engagement in accreditation is vital from the start.

Identifying accreditation leaders as well as other steps to launch the accreditation

preparation process helps ensure that there is organization buy-in at all levels.

3. Commit to the Central Components of Accreditation

Accreditation requires collaboration, communication, a culture of safety, change

management, and continuous improvement.

Explain how to achieve a culture of safety

• Involve physician leaders

• Keep your staff educated and motivated about improving procedures

4. Organize and Educate Chapter Teams

Chapter teams focus on specific chapters of the JCI standards manual.

Choosing your teams and getting them ready for the next steps in accreditation preparation
will promote accountability, create a sense of ownership, and improve overall staff
engagement.

• Build accreditation teams

• Assign staff responsibilities
• Train staff in new procedures*
5. Develop and Manage Policies

Policies guide the care, treatment, and services you provide.

Creating, implementing, monitoring, and maintaining policies in an effective way that also
meets JCI standards will help you sustain compliance.

• Develop a process to create JCI-compliant policies

6. Collect and Evaluate Policies

Most organizations have many and varied policies.

Bringing them all together for review and standardization will help assess your
organization’s baseline compliance.

• Assess your hospital's current policies and procedures by referencing the

Accreditation Preparation Requirements listed in the JCI Hospital
Accreditation Manual

7. Understanding Tracer Methodology

Tracers are a primary tool for risk assessment and gap analysis.

JCI has resources to help you understand what they are and explain the activities and skills
involved in conducting them.

• Conduct patient tracers

8. Find and Analyze the Gaps

A critical part of accreditation preparation is finding the gaps between your current practice
and what JCI requires.
 • JCI can help you plan and carry out that activity, including categorizing the
types of gaps you find.
• Perform a baseline assessment of your hospital’s performance against JCI
standards

9. Leverage Data for Continuous Improvement

Knowing how to manage data is necessary to be able to assess quality and patient safety.

• Data collection, display, and analysis plays a critical role in continuous quality
improvement.

10. Develop and Implement Action Plans

Every organization needs action plans that outline how to address issues found in the initial
gap analysis.

JCI can help you find possible strategies to try.

• Build your accreditation action plan that outlines intended actions towards
performance improvement
•
11. Improve and Document Standards Compliance

Most of your accreditation preparation will involve monitoring, modifying, and documenting
action plans to ensure improvement and compliance.

• Assess your hospital’s risk for adverse events and create a method for
collecting information
 • Use your accreditation team to spot deficiencies using tools from the Survey
Process Guide for Hospitals
• Encourage staff to make corrections

12. Planning and Finalizing Survey Readiness

As your survey date approaches, you want to be ready.

You need to understand the final few things you need to do for a successful survey — and
what you may need to do after the survey is over.

• Prepare your staff for a mock survey*

• Conduct your final mock survey 4-6 months before your actual survey to ensure time
to resolve non-compliance issues
• Spot necessary improvements by identifying areas of noncompliance
• Plan and make final preparations

What are the components?

Patient-Centered Standards

• International Patient Safety Goals (IPSG)

• Access to Care and Continuity of Care (ACC)
• Patient and Family Rights (PFR
• Assessment of Patients (AOP
• Care of Patients (COP)
• Anesthesia and Surgical Care (ASC)
• Medication Management and Use (MMU
• Patient and Family Education (PFE)
Health Care Organization Management Standards

• Quality Improvement and Patient Safety (QPS)

• Prevention and Control of Infections (PCI)
• Governance, Leadership, and Direction (GLD)
• Facility Management and Safety (FMS)
• Staff Qualifications and Education (SQE)
• Management of Information (MOI)

Academic Medical Center Hospital Standards

• Medical Professional Education (MPE)

• Human Subjects Research Programs (HRP)

What are the similarities/differences with ISO?

The Joint Commission International (JCI) Accreditation Program is one of the most widely
recognized all over the world . JCI is the internationalization of the Joint Commission on
Accreditation of Hospitals (JCAH), founded in the USA in 1951. Since 1987 this institution
has evolved towards the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), extending the accreditation model to other health institutions, in addition to
hospitals. JCI was established in 1994 as a division of JCAHO with the goal of facilitating
accreditation services worldwide in more than 90 countries. In 2013, JCI published the 5th
edition of its international accreditation standards for hospitals, which include a section for
academic medical centers.

Joint Commission International (JCI) is one of the world’s leading nonprofit patient safety
organizations. JCI seeks a world where every patient receives the highest quality of care
possible.
The most visible way we pursue this goal is through our accreditation program. To that end,
JCI regularly publishes a demanding set of standards that represent the most current
thinking in patient safety and quality improvement. Health care organizations that are
capable of meeting these standards must undergo a comprehensive and rigorous on-site
survey conducted by JCI in order to achieve accreditation. Once accredited, organizations
must continue to meet our standards and are regularly assessed through periodic re-
survey. JCI is completely independent from the organizations we accredit.

JCI also works to improve the quality of care within all hospitals, not just those that are
capable of meeting our accreditation standards. Our global experts regularly assist
hospitals, municipal governments, and ministries of health as they pursue their own quality
goals and patient care outcomes.

ISO 9001 for the Healthcare Sector

ISO 9001 is a quality management system standard that consists of principles that help
ensure standardized levels of quality are applied across all organizations and sectors of the
Healthcare Industry including Pharmaceutical Companies, Ambulatory Care, Long-term
Care Facilities, Hospitals, among others. Healthcare service providers often choose ISO
9001 as their primary management system registration and then evaluate how other
standards may be of benefit to the organization, possibly through an integrated approach.

With the implementation of a quality management system using ISO 9001, a health service
provider can implement a process for continual improvement, as well as reduce
inefficiencies and waste, thereby experiencing a significant cost savings, while maintaining
a focus on patient/client satisfaction.

ISO 9001 certifications are receiving increasingly greater interest from health institutions.
Specifically in the US, this increased attention has been accelerated since in 2008 the most
influential insurance companies in the United States, the Centers for Medicare and
Medicaid Services (CMS), approved Det Norske Veritas Healthcare (DNV Healthcare) as
the new authority to judge Medicare payments, renewing this condition for six years in 2012
. DNV Healthcare developed a National Integrated Accreditation of Healthcare
Organizations (NIAHO) program, which is being used to accredit hospitals under the CMS
Participation Conditions (CoPs) and combined the CoPs standards with the Requirements
of ISO 9001: 2008. In 2013, DNV and Germanischer Lloyd (GL) merged. In response, the
Joint Commission announced in 2011 its relationship with Société Générale de
Surveillance SA –SGS – (Switzerland) to offer ISO 9001 certification as part of the service
it offers. In this way, the ISO 9001 system has become a model to follow to achieve
hospital accreditation and maintain the standards necessary to preserve it.

The implementation of an ISO 9001 quality management system in a health institution

provides confidence that the health service meets the needs and expectations of patients
and other stakeholders, including established legal and regulatory requirements. It also
gives management confidence that the expected quality is being achieved and is a tool for
managing risks and improving performance. ISO 9001 certification provides external
recognition that the organization complies with a number of internationally recognized
requirements and good quality management practices.

With the ISO 9001 standard the health institution can obtain benefits such as: • Well-
defined areas of responsibility and greater knowledge of top management of how the
institution works.

• Well-defined and documented procedures ensuring consistency of process results

and minimizing errors.
• Continuous monitoring of processes and results, which allows corrective action at
the moment the problems occur.
• Timely recording of events, as a source of organizational learning and improvement.
• Focus on risk management, which facilitates action to prevent quality flaws,
including patient safety.
• Training employees to ensure their competence and knowledge of what to do in
each situation and how to do it.
• Focus on improvement, which has a better service to patients
 • A better image for patients and society in general, creating new market
opportunities.

Among other added values that the ISO 9001 implementation brings to the health
institution, Nolan includes internal audits and periodic reviews of the quality management
system by management, monitoring and control of suppliers and customer satisfaction
(patients and their families), taking corrective actions, better information, communication
and motivation of employees and, finally, risk management and improvement. ISO 9001:
2015 is based on seven quality management principles (customer focus; leadership;
engagement of people; process approach; improvement; evidence-based decision making;
relationship management), which allow managers to take a holistic view of the
management of their organization, managing risks in a timely manner and using different
quality improvement tools.

There is no antagonism between ISO 9001 quality certification and hospital accreditation,
on the contrary, they complement each other in the search for excellence in the delivery of
health services. Both represent a third-party recognition of compliance with quality
standards, strengthening the image of the health institution to society and contributing to
the satisfaction of all stakeholders. Both tools are expected to provide patients with better
quality health care. The joint application of both standards generates a favorable framework
for the improvement of the organization’s processes and for patients to receive a better
service.

Both ISO 9001 certifications and hospital accreditations are fundamental instruments to
improve the quality of the health service and to give credibility to the health institution in
front of the society regarding the efficiency in its processes. Both guide efforts to improve
patient safety and elevate the culture with respect to quality, including safety aspects.

However, there are some differences between these instruments. The hospital
accreditations, being a sectoral mechanism, have a more technical character and are
based on the best practices of the quality of the medical assistance, oriented directly to the
attention of the patients. The ISO 9001 standard is more process-oriented and is designed
to help organizations anticipate the risks in their management and take the necessary
actions to manage them.

Hospital accreditation audits are performed by professionals who know the medical field in
depth, while ISO 9000 standards are generic and audits of certification involve auditors of
quality management systems, qualified to meet internationally agreed criteria by an
organization Independent, in conjunction with medical experts. Another difference between
accreditation and certification is that certification is the health institution that defines the
scope of the same, while in the scope is defined by the accreditation standard itself. Many
health institutions attest to ISO 9001 their support processes, such as the management of
medical equipment and engineering systems. Notwithstanding the undeniable advantages
of ISO 9001 certification, some authors consider that the standard is difficult to understand
and interpret in the health sector, and requires a significant effort in overtime of personnel,
resources, external training courses and consulting and the own cost of the certification
process. It is noteworthy that these same authors, even after achieving ISO 9001:2000
certification of three hemodialysis centers, maintain nomenclature errors in their own
accreditation and certification activities.

Instruments for external evaluation of hospitals and for their internal quality management
analyzed are useful for improving the health services and they serve as tools to give
confidence to the society regarding the quality level of institutions that make up national
health systems. Both the accreditation standards and the ISO 9001 standard serve as
strategic guidance to improve the quality of service including the patient safety. Patient-
centered accreditation standards guarantee the technical quality of the service while the
ISO 9001 quality management system is the guarantor for the sustained success of the
health organization. The joint implementation of both standards allows to achieving and
maintaining the high quality standards of medical care required by society.
REFERENCES:

Accreditation and certification of hospital quality: different or similar?

Revista Ingeniería Biomédica ISSN 1909-9762 / Volumen 11 / Número 21 / Enero-junio de

2017 / pp. 35-41 Universidad EIA-Universidad CES / Envigado, Colombia. R. M. Guerra
Bretaña1, ψ, Y. A. Marín Álvarez2

Joint Commission International Accreditation Standards for Hospitals 6th Edition | Effective
1 July 2017 Including Standards for Academic Medical Center Hospitals

https://www.jointcommissioninternational.org/accreditation/pathway-to-accreditation/