Healthcare Infrastructure JCAHO:

The Joint Commission on Accreditation of Healthcare Organizations -JCAHO is among the leading health-care benchmarks setting and accrediting bodies in the world today. To provide for continuous improvement to the safety and quality of health care provided to the general public through the provision of health care accreditation and the related services, which enable performance improvement in organizations that provide healthcare is the mission of JCAHO. The Joint Commission assesses and accredits almost 20,000 health care organizations and programs in the United States. It is an independent and non-profit organization. JCAHO has developed modern and professionally-based benchmarks. The Joint Commission assesses the compliance healthcare organizations using these standards. JCAHO services are provided to the full range of organizations involved or assisting in healthcare in any form. An organization accredited by the Joint Commission is acknowledged all around the country as meeting the performance standards of JCAHO, which is looked upon as a symbol of quality.

To get and maintain this accreditation the organization goes through a rigorous on-site survey by a Joint Commission survey team once at least every three years. The laboratories in contrast have to go through such surveys and tests once in every two years. The standards of the JCAHO look into the performance level of each organization in the critical functional areas including, patient's rights, and home into not just what the organization has, but what it really does. The benchmarks are the performance level expectations for all the activities that come into play in the quality of patient care. The expectation is that adherence to these standards will enable the organization to provide its patients to experience positive results. These standards developed by the Joint Commission are done in consultation with experts in the field of healthcare, health care providers, measurement experts, purchasers and consumers. (JCAHO)

More than half the states in the U.S. depend entirely on JCAHO accreditation for licensure purposes. In another nine states there is partial reliance on JCAHO accreditation. Approximately 80% of the hospitals in the U.S. have sought and received JCAHO accreditation and this amounts to 6,200 hospitals and it is seen that nearly all hospitals seeking it normally do get the accreditation. The rate of rejection is as low as one percent of the surveys done every year. The Joint Commission keeps its findings to itself and the report released for open consumption is very general and does convey any useful information on the performance of the hospitals. Hospitals pay very heavy fees for the accreditation by JCAHO and these fees make up almost 70% of the annual budget of JCAHO standing at $95 million. (JCAHO Quiz -- Answers)

A few years back the release of a report by the Institute of Medicine was to shock the nation in informing them that between 44,000 to 98,000 of people died in U.S. hospitals due to medical errors. The report also noted that these figures reflect medical errors that occur in hospitals. JCAHO as an initial response to this report pronounced the "Patient Safety Standards" for hospitals, which became effective from July 2001. These standards require the hospitals to develop an environment of safety, wherein employees are encouraged to bring out errors in a blame free atmosphere. These standards also required the hospital pharmacy to incorporate processes by which identification and tracking was possible to reduce the likelihood of errors. Focus of employees should be on patient safety issues and they should be provided ample patient education. Subsequently in 2003, JCAHO announced its "National Patient Safety Goals," which focused on the six previously identified areas of concern to prevent healthcare errors. (JCAHO Initiative Seeks to Improve Patients Safety)

These goals were accompanied with recommendations based on evidence to help healthcare organizations reach the prescribed objectives, thereby reducing the number of health care errors. The first goal was to improve the patient identification by the requirement that every healthcare organization...

The second goal was to improve the effectiveness of communication among caregivers by requiring that health care givers insist on verification of verbal and telephonic orders by the person receiving it. In addition the organizations were to use a standardized set of abbreviations acronyms and symbols only and no other within the organization. The third was to improve safety of using high-alert medications and required health caregivers to remove the concentrated electrolytes from patient care units and standardize and reduce the number of available drug concentrates.
The next was to eliminate wrong-site, wrong-patient and wrong- procedure surgery by the use of preoperative identification processes that would confirm the availability of the right documents and to mark the site of surgery, with the patient being involved. The fifth goal was to improve the safety of infusion pumps by ensuring free flow protection on all intravenous infusion pumps whether they are for general use or patient controlled anesthesia. The sixth and final goal was to improve the effectiveness of clinical alarm systems, by ensuring timely maintenance and testing, and the activation and audibility of alarms. These specifications by JCAHO meant that all hospitals having accreditation or seeking accreditation would have to ensure that they were followed for ensuring error free health care to their patients. (JCAHO Initiative Seeks to Improve Patients Safety)

DOH:

The Department of Health and Human Services is the primary agency for the protection of the health of all American people and also provides essential human services for those who cannot help themselves. The Department has a wide range of more than 300 programs that cover a gamut of activities. (HHS: What We Do). The State Department of Health -DOH looks after more than 3,000 facilities in the state of Washington and this includes regulating hospitals, clinics and alcohol treatment centers. It sees whether there are compliances with the state regulations, conducts licensing and looks into complaints. There is an ever increasing demand on the facilities and sites that DOH has to inspect. DOH is implanting plans whereby the focus of its monitoring of facilities will be more on prevention and outcomes to reduce the administrative load.

State law governs the health care licensing in Washington State and it establishes the requirements of the state. Interpreting the laws as written in the Washington Administrative Code enforces these requirements. Medical facilities such as acute care hospitals receive their license on meeting the provisions of these state requirements. DOH checks on health facilities and services by the use of inspections or site surveys and during these they assess whether the standards and laws are being met at these facilities. In case of noncompliance DOH requires that the necessary corrective action is completed in a specified time frame and monitors whether these are effective. Should the corrective action be insufficient, DOH conducts enforcement actions. From 1999 onwards the acute care hospitals in Washington are required to display the DOH facilities and services section 24-hour Complaint Hotline telephone numbers prominently.

In 1999 the federal government also issued a set of fresh health and safety standards for facilities receiving funding from Medicare and Medicaid and these include explicit definitions of abuse, neglect and restraints. DOH receives all such complaints via web site, fax and e-mail. The health facility regulators are looking ways to make it easier for making compliance easier for facilities, so that they can focus attention on priority concerns. The present set of WACs for acute care hospitals differ from the old checklist, since they focus on the results or outcomes of enforcement. There has been a positive response from the hospital community and DOH has been encouraged by this to apply the outcome orientation in all its WAC reviews. In 2000 the Washington Legislature passed legislation that identified medical errors as a reason for death and injury. By this law DOH was required to submit a set of recommendations…