1. Fitzpatrick, Melissa A. RN, MSN, FAAN, Editor-in-Chief

Article Content


Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

I've had a love-hate relationship with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for many years. My first accreditation survey was as a staff nurse in 1977: My critically ill patient had "coded" twice, so a colleague and I stayed with him continuously. I looked up from the bedside to find the hospital's administrative team, accompanied by JCAHO surveyors, in the room. They asked me about the fire safety algorithm and asked my colleague to recite the hospital's mission statement. There was no mention of the patient, the care plan, or how the patient was responding. I continued to care for my patient, but couldn't help wondering who these surveyors were and how they defined quality.


Learning from the past

In the past, JCAHO surveys seemed punitive. They were about checking off boxes and speaking the party line. They created mass chaos, as staff prepared for the onslaught. Unfortunately, these surveys caused us to spend an inordinate amount of time "majoring in the minor," failing to focus on elements that front-line clinicians thought would improve patient care.


We questioned the surveyors' currency and their openness to new perspectives from the field. Considering that the survey process is voluntary and costly, countless health care executives reassessed the value of JCAHO accreditation and the relevance of the Joint Commission, itself.


JCAHO has responded favorably to such perceptions by "re-creating itself." Some of its recent initiatives are especially promising:


[white diamond suit] The new survey process, "Shared Visions-New Pathways," considers feedback from health care leaders and key stakeholders. It uses standards-compliance evaluation techniques to better analyze systems and processes, how they affect patient care, and how to improve care.


[white diamond suit] JCAHO is collaborating more than ever with other organizations that have a vested interest in patient care quality. Recently, it partnered with six organizations to launch a national voluntary initiative to collect and report hospital and quality performance information. The intent is to decrease duplication, increase accountability, and to provide information to the public.


[white diamond suit] A partnership with the National Committee for Quality Assurance is geared to protecting the safety and rights of participants in clinical research programs, a laudable goal. Collaboration with laboratory groups is intended to improve laboratory services and proficiency.


[white diamond suit] JCAHO launched its "Speak Up" program to encourage patients to become active and informed members of their health care team. Arming care recipients with better information regarding provider performance will enable them to engage more fully in the care they receive.


[white diamond suit] JCAHO's new staffing-effectiveness guidelines help health care leaders ensure the correct staff ratio and competency, which remains critical to quality outcomes, especially in a shortage era.


[white diamond suit] JCAHO sets six national patient safety goals that focus on patient identification, caregiver communication, wrong-site surgery, infusion pump safety, medication mix-ups, and equipment alarm systems.


[white diamond suit] JCAHO continues to provide educational seminars and to share trends garnered from the 1,900 reports in its sentinel event database.



Looking to the future

My last JCAHO survey went much better than my first. I was the Chief Nurse Executive at one of the top hospitals in the country and had a much broader understanding of quality than I did some 20 years before. The surveyors were dedicated, credentialed health care professionals who willingly and openly shared their knowledge. They were improvement minded, not punitive, and facilitated a survey process that was educational and, believe it or not, enjoyable. We received accreditation with commendation.


We have a long way to go to reduce error, to mitigate risks, and to improve quality-the Joint Commission can play an important role in helping us achieve these goals. JCAHO recently established a Nursing Advisory Council to work with nurse leaders to advance solutions to critical health care issues such as the nursing shortage. This council provides us with another opportunity to partner with JCAHO on issues that benefit patients and staff, one that will continue to broaden JCAHO's perspectives and solidify its importance.