What do standards focus on? The Joint Commission standards are updated regularly to reflect the rapid advances in health care and medicine. The hospital accreditation standards number more than , and address everything from patient rights and education, infection control, medication management, and preventing medical errors, to how the hospital verifies that its doctors, nurses, and other staff are qualified and competent, how it prepares for emergencies, and how it collects data on its performance and uses that data to improve itself.
How long does it take The Joint Commission to render an accreditation decision? The Joint Commission typically renders accreditation decisions two weeks to two months after the survey.
How long is an accreditation and certification award? Accreditation is awarded for three years, except for laboratory accreditation, which is awarded for two years.
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To prepare for accreditation, FOH will need to align our current policies and procedures with those outlined in Ambulatory Care. You can see why all of FOH is involved in this initiative. It is time to begin the accreditation process. There will be some policy and procedure development as part of the preparation process as well. Most of these visits were unannounced, however everyone involved was fully prepared with the months of information and training they received from FOH.
Although there may be some differences in how these standards are administered across different healthcare settings hospitals have different standards than pharmacies and nursing homes, for example , TJC expects high levels of competency across all types of healthcare entities. Healthcare organizations must renew their accreditation with TJC every 36 months and laboratories must renew accreditation every 24 months. Organizations are expected to maintain these high standards of quality of care throughout the entire three-year accreditation period.
In other words, organizations should consistently follow these standards to maintain their accreditation. The organization currently known as The Joint Commission credits Ernest Codman, MD, for founding the ideals that would eventually lead to its formation. When ACS began on-site inspections the following year, only 89 of hospitals met those requirements. In , JCAH began offering accreditation to hospitals. Responding to concerns that announced visits might allow healthcare organizations to falsely represent themselves, JCAHO initiated unannounced surveys and reviews in The Joint Commission uses expert advice to determine when new standards should be added.
TJC reviews scientific literature and consults with healthcare professionals, government agencies, subject matter experts, providers, and consumers before considering a new standard. New standards must relate to patient safety or care, improve health outcomes, meet or surpass healthcare laws and regulations, and be measurable. The Board of Commissions is required to review new standards.
The Joint Commission follows these 8 steps in their standards development process :. The Joint Commission requires hospitals and other healthcare entities to conduct Primary Source Verification when verifying the credentials of a provider. The validity of the documentation such as licenses or certifications must be confirmed either directly from the original source or an authorized agent of that source.
This can be done through direct correspondence, documented telephone conversation, secure electronic verification from the source, or reports from qualified credentials verification organizations. Primary source verification must be completed regularly for all your providers.
This process can be lengthy and complex and can require using financial and personnel resources that might be better utilized elsewhere.
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