Each administration around the globe usually allots more budgets in the field of health care and development especially now that techniques change per technology invented for the field. In the United States, they have developed various systems that would allow them to criticize and monitor each aspect of healthcare from staff to the services offered by each health care facility. It is crucial for the US government to have a well-rounded and organized staff that would facilitate inside the hospital and deliver proper services. With the development happening in the medical industry, patients find it to be necessary to keep seeking medical attention as they cannot afford to be sick unlike before. Today, the requirement of having an efficient and well-organized staff is included in hospital accreditations around the world. In the United States, the Joint Commission on Accreditation of Healthcare Organization or the JCAHO is in charge accrediting hospitals around the country. But how exactly does the JCAHO work? This paper explains the inner workings of the JCAHO from its history to how it helps in improving health care in the United States.
According to Finch (2004), hospital standardization began in 1917 when the American College of Surgeons created the Hospital Standardization Programme which would become the only standard that medical facilities must follow to gain accreditation. The programme itself was also created to develop a healthy and stable environment to enable doctors and other medical practitioners to practice their expertise. The medical sector of the country had supported this programme and followed the standards set by the ACS. Since the budget of the program was being handled by the College themselves through the membership fees it receives, they found it to be expensive to do it on their own. In 1950, the College of Physicians and the American Hospitals Association with other health organizations established with the College of Surgeons the Joint Commission on Accreditation of Hospitals. After almost three decades, the JCAH was renamed to the Joint Commission on Accreditation of Health Care Organizations or the JCAHO. After 12 years, the JCAHO has accredited and evaluated almost 15,000 different healthcare organizations and facilities throughout the country whether they may be providers of long-term health care or home-care .
Puckett, Byers, and Green (2004) noted that the mission statement of the organization continuously emphasizes the importance in improving the quality in both care and patient safety. Over the years, the JCAHO has continuously revised its mission to improve health care and service for the public through their hospital accreditation and related services that promote performance improvement. Most health care organizations seek the JCAHO because it enables the community to trust their services and provides items to help in improving all of their services and staff. Once accredited by the JCAHO, a health organization proves to the community that they have promised and proven their commitment to serve the public under the same standards set to them by the organization. The standards set by the organization have been decided upon by the members of the board consisting of doctors, administrators, nurses and even consumers into how health care can be measured. The American Dietetic Association and other professional organizations have also included their set of standards.
Accreditation done by the JCAHO is done every three years wherein a selected team will visit the institution applying for accreditation and do on-site surveys. This team is usually trained by the JCAHO administration and thus are selected to understand each standard the organization is pursuing. Surveys usually depend on the scale of the institution or organization and would thus include additional members in the team. For example in large organizations, the surveyors would usually include a clinical laboratory expert, a behavioural health care practitioner and an out-patient member. Most of these surveyors will do preliminary observations upon entering the facility, interview patients and review paperwork detailing the organization’s dealings and patient records. With this survey, they will easily identify the strengths and weaknesses of the applicant especially in the fields of patient care and rights, ethics and procedures. However, the main focus of the survey is to check the applicant’s improvement in terms of its performances and the possibilities of improving other points especially if they see it from the patient’s point of view. The survey is extremely flexible thus it can be applied in any organization. At every end of the surveys done, the team provides a preliminary report and would then be announcing if the accreditation is given to the applicant. Recommendations done by the JCAHO must also be followed once the organizations receive the report to improve the areas the team has cited.
In accrediting an organization, the JCAHO has applied various procedures such as the ORYX or the Next Evaluation in Accreditation and the CQI or the Continuous Quality Improvement. The ORYX was used by the organization in 1997 which provides the JCAHO data regarding “outcomes” which shows the patterns and trends in improving aspects of health care. Under the ORYX, it measures “quantitative tools that provide an indication of an organization’s performance in relation to a specified process or outcome”. This aspect motivates applicants to improve their facilities and how they treat their clients. The ORYX also includes the identification of the care performance measures to enable the organization to check and compare performances of various hospitals in the area. The CQI, on the other hand, was introduced in 1992 in the JCAHO Accreditation Manual for Healthcare in 1992. Through this procedure, the JCAHO’s problem structuring and solutions can be improved and enable other institutions to follow suite. Teams from the organization advice other health care facilities and organizations to learn the CQI method while using traditional methods of improvement .
Each aspect of health and hospital accreditation is studied closely by the JCAHO and specifies what must be done in each sector. One aspect closely monitored by the organization is the medical staff function of each institution. Aghababian (2006) explained that it is most often that medical staff are usually concerned of quality care in the hospital which cannot be done by doctors and nurses in the facility. It is the medical staff which arranges and organizes the hospital to enable the practitioners to do their responsibilities. It is also the medical staff’s responsibility to make sure their doctors and nurses do their work in accordance to the standards set by the hospital and organizations which have accredited them. JCAHO for this instance lays down a set of standards for medical staff to function. These standards included leading the development of the whole organization they represent and the assurance of providing patient care in its highest standards. The medical staff must also be active as well in observing and analyzing patient records and their satisfaction when it comes to the services they provide. This can be done by the staff through reviewing medication charts and other procedures in administration and organization. Four more standards have been raised by the JCAHO in terms of medical staff responsibilities: 1. Identification of the privileges for doctors and other practitioners, 2. Provide oversight in care quality and services for those with special privileges, 3. Lead in improving performances and safety activities for patients and finally, participate in assessment especially within the organization.
Aside from identifying what the medical staff must be in charge of doing, the JCAHO determines how the structure and function of the medical staff and have it included in the bylaws of the organization. One of the most significant JCAHO requirements that must be included in each bylaw of medical institutions is the fact that amending the bylaws must not be done by either the staff or the governing body without reason. This law preserves autonomy within the institutions. For the JCAHO, this provision and the bylaws they have set will support their other requirements such as a justifiable mechanism that would enable the committee to select and remove staff and how to function. The organization also configures the bylaws depending on the importance of such regulations. It is necessary to have a mechanism that would maintain and observe patient care standards, privilege oversight and identification of medical privileges. They along with the medical staff believe that creating a bylaw filled with specific policies rather than general concepts will enable the institution to function .
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Finch, J. (2004). Evaluating mental health services for older people. Oxon: Radcliffe Publishing.
Puckett, R., Byers, B., & Green, C. (2004). Food service manual for health care institutions. San Francisco: John Wiley & Sons.