What is JCI Accreditation for Healthcare organisation


How JCI Standards are playing vital role in Patient and Employee Safety:
Joint Commission International (JCI) is one of the world’s leading non-profit 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.

History
Founded in 1994 by The Joint Commission, JCI works with health care organizations from more than 100 countries. Today, JCI fields a well-trained team of international accreditation surveyors and consultants who work in five continents.

Mission
The mission of JCI is to continuously improve the safety and quality of care in the international community through education, advisory services, and international accreditation and certification.
JCI Accredited Organization in India:

Only 34 Hospitals and 4 ambulatory centres in India are JCI accredited.

What is accreditation?
Accreditation is a process in which an entity, usually nongovernmental, assesses the health care organization to determine if it meets a set of requirements (standards) designed to improve the safety and quality of care.

Types of JCI Accreditation programs:
  1. Hospitals
  2. Academic Medical Centre Hospitals
  3. Ambulatory Care Facilities
  4. Clinical Laboratories
  5. Home Care Facilities
  6. Long Term Care Facilities
  7. Medical Transport Organizations
  8. Primary Care Centres
What are the benefits of accreditation?
  • Accreditation has gained worldwide attention as an effective quality evaluation and management tool.
  • Improve public trust that the organization is concerned for patient safety and the quality of care;
  • Provide a safe and efficient work environment that contributes to worker satisfaction;
Does it make a difference?
  • Most Prestigious Healthcare Accreditation in the World
  • Ensure that we are doing the right things and doing them well
  • Significantly reduce the risk of harm in the delivery of care
  • Continuous Learning for Staffs
  • Competent and privileged healthcare staff
  • International Identity
  • What are the benefits to patients?
  • A patient who chooses a facility that has received one or more CCPCs can have confidence that the facility has met strict criteria in patient safety, delivery of clinical care, overall patient support, and more.
Why Patient seek out a JCI-accredited hospital:
  • When you choose a health care organization that is JCI accredited, you know you are receiving care from a leading practice organization.
  • Here are five major reasons to select a JCI-accredited facility. They have all demonstrated:
  • A deep commitment to high-quality care
  • A culture of safety for patients, visitors, and staff
  • A willingness to undergo rigorous preparation and a survey
  • Care delivery based on leading, evidence-based practices
  • Leadership in continuous compliance with exacting standards
How frequently will the standards be updated?

The standards will be revised and published at least every three years.

JCI Accreditation Surveys: 
  • survey team consists of a physician, nurse, and administrator
  • Interview with staff and patients and other verbal information;
  • On-site observations of patient care processes by surveyors;
  • Policies, procedures, clinical practice guidelines, and other documents provided by the organization
  • Surveyors evaluate various units within an organization and meet to discuss their finding
  • Surveys conduct a complete system analysis on integration and coordination of care processes
  • Surveyors evaluate various units within an organization for 5 days Surveyors shall review 1294 measurable elements in your hospital
  • One to One Interview with Clinical Department Directors/HODs
JCI 6th Edition: Consists of four sections:

Section 1: consists of accreditation participation requirements APR

Section 2: Patient cantered standards
  • IPSG (International Patient Safety Goals)
  • ACC (Access to care and continuity of care)
  • PFR (Patient and Family Rights)
  • AOP (Assessment of Patients)
  • COP (Care of Patients) ambulatory
  • ASC (Anaesthesia and Surgical Care)
  • MMU (Medication Management and Use)
  • PFE (Patient and Family Education)
Section 3: consists of Health care organization management standards
  • QPS (Quality improvement and Patient Safety)
  • PCI (Prevention and Control of Infections) laboratory
  • GLD (Governance, Leadership and Direction) for hospitals and academic medical institutions
  • FMS (Facility Management and Safety)
  • SQE (Staff qualification and education) 
  • MOI (Management of Information) 
Section 4: academic medical centre hospitals standards
  • MPE (Medical profession education) 
  • HRP (Human subjects research Programs) 

Information about JCI 6th edition:
  • 6th edition of the Hospital Standards contains
  • 323 Standards
  • 1294 Measurable Elements criteria measured during the survey/evaluation process

JCI Requirement Categories: JCI requirements are described in these categories:
  • Accreditation Participation Requirements (APR)
  • Standards
  • Intents
  • Measurable Elements (MEs)
Accreditation Participation Requirements (APR):

The Accreditation Participation Requirements (APR) chapter is composed of specific requirements for participation in the accreditation process and for maintaining an accreditation award. Hospitals must be compliant with the APRs at all times during the accreditation process. However, APRs are not scored like standards during the on-site survey; hospitals are considered either compliant or not compliant with the APRs.
When a hospital is not compliant with a specific APR, the hospital will be required to become compliant or risk losing accreditation.

Standards:

JCI standards define the performance expectations, structures, or functions that must be in place for a hospital to be accredited by JCI. JCI’s standards are evaluated during the on-site survey.

Intents:

A standard’s intent helps explain the full meaning of the standard. The intent describes the purpose and rationale of the standard, provides an explanation of how the standard fits into the overall program, sets parameters for the requirement(s), and otherwise “paints a picture” of the requirements and goals. The bulleted lists in the intent statement are considered advisory and serve as a helpful explanation of practices that might meet the standard. Numbered or lettered lists in the intent statement include required elements that must be in place in order to meet the standard.

Measurable Elements (MEs):

Measurable elements (MEs) of a standard indicate what is reviewed and assigned a score during the on-site survey process. The MEs for each standard identify the requirements for full compliance with the standard.

The MEs are intended to bring clarity to the standards and help the organization fully understand the requirements, educate leadership, department/service leaders, health care practitioners, and staff about the standards, and guide the organization in accreditation preparation.

Other Sections Included in This Manual:
  • General Eligibility Requirements
  • Summary of Changes to the Manual
  • Summary of Key Accreditation Policies

Scoring Pattern for the JCI Accreditation Survey Results:
  • Each standard must have a scoring of at least 5
  • Each chapter must have a score of at least 8
  • All standards must together average for at least 9
  • All measurable elements are averaged to obtain the score for the standard


JCI Tracer Methodology:
  • Patient tracer methodology is what makes JCI different from NABH
  • In Patient Tracer Surveyor assesses an organization’s system and processes by following the treatment path an individual patient has taken in the hospital from admission to discharge Or Following a process in the hospital from a beginning to an endpoint.





Written by:

Dr. Praveen Bajpai

Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi


MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards 

www.skillsathi.in 



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