The Joint Commission: Role, Authority, and Impact on Healthcare

Introduction

Many people are familiar with the role that accrediting agencies play in institutions of higher learning. Whether it is a state board of regents, a national organization, or another body, these agencies serve as impartial reviewers and accreditors of whether a school meets certain standards. When it comes to healthcare, the Joint Commission on Accreditation of Healthcare Organizations — commonly abbreviated as JCAHO — performs much the same function. Healthcare, of course, involves far higher stakes than a typical educational setting.

This paper covers several facets of JCAHO's structure and function, including its effect on healthcare, an example of the organization executing its duties, what regulatory authority means in the context of healthcare, and how agencies deal with negligence and intentional torts that could compromise quality or patient safety. While JCAHO is by no means a perfect organization, it does a good to great job overall, and its work is necessary.

History and Evolution of JCAHO

JCAHO has been in existence for a considerable amount of time, though it has evolved significantly over the decades. It was first formulated and created in the 1950s. However, it did not carry much regulatory "teeth" until 1965, when its accreditation decisions — or the withholding of accreditation — had direct bearing on the standing or continued existence of the healthcare organizations it oversaw. Things expanded further when the review process became fully intertwined with Medicare and the Centers for Medicare and Medicaid Services (CMS). The federal government periodically reviews the standing and performance of JCAHO, and JCAHO in turn monitors and solicits data from the healthcare organizations it accredits and oversees (Tabrizi, Gharibi & Wilson, 2011).

JCAHO's Effect on Healthcare Organizations

JCAHO's effect on healthcare is both clear and significant. Just as many healthcare organizations must answer to state regulatory agencies, they must also contend with what federal accrediting bodies like JCAHO — and their overseers — determine about them. Third-party accreditation and endorsement is common across many industries, whether required by law or pursued for the competitive advantages it confers. A poor Better Business Bureau (BBB) rating, for instance, is damaging to a firm's reputation, while ISO 9001 certification is typically a source of credibility and authority. In healthcare, the stakes are considerably higher.

For hospitals in particular, there is a two- to three-year review cycle during which JCAHO evaluates whether a hospital's practices, procedures, and organizational structure meet the required standards. The specific details of what is found — whether deficiencies or areas of strength — are not openly revealed to the public. Nevertheless, gaining or losing accreditation from JCAHO is a consequential outcome that carries significant professional and operational weight.

It should be noted that JCAHO's authority is not universal across the United States. Some jurisdictions and states do not recognize JCAHO's authority and instead use their own mechanisms for monitoring and policing healthcare organizations. Regardless of which regulatory body is involved, these agencies serve as additional checkers and verifiers of whether healthcare organizations are progressing appropriately and delivering the necessary level of care. Some healthcare organizations will strive to do the right thing regardless of external oversight. However, the presence and power of JCAHO and similar agencies serves as a consistent reminder that healthcare organizations must be able to demonstrate that they are following established rules and keeping patient safety and quality of life at the forefront. Those organizations that cannot or will not meet minimum standards will typically be identified and addressed by JCAHO — and that accountability is precisely why the organization exists (Tabrizi, Gharibi & Wilson, 2011).

One concrete example of JCAHO discharging its duties is the periodic review and reaccreditation process described above. To be more specific, a detailed report is issued directly to the healthcare organization in question so that leadership can review the findings and correct any identified deficiencies. The affected hospital or other organization may contest findings, though JCAHO is expected to base its conclusions on documented evidence. Even the appearance of impropriety — such as incomplete or missing documentation — is itself cause for concern and may carry legal liability, and therefore must be addressed. The ethical bar is understandably higher for organizations that serve the public, and hospitals fall squarely into that category (Holloway & Kusy, 2011).

Conclusion

No regulatory agency is perfect in how it carries out its mission. However, an established framework must exist to regulate healthcare and require that consistent standards be met across similar situations and different locations. Just as a consumer expects consistency from a national brand regardless of which location they visit, patients deserve the same standards of care and safety whether they are treated at a hospital in one city or another. Allowing inconsistency due to inadequate oversight is a disservice to patients in the affected jurisdictions, and it can literally put lives at risk if left unchecked for too long. JCAHO, for all its imperfections, plays an essential role in ensuring that healthcare accreditation remains a meaningful and enforceable standard.

References

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Tabrizi, J. S., Gharibi, F., & Wilson, A. J. (2011). Advantages and disadvantages of health care accreditation models. Health Promotion Perspectives, 1(1), 1–31. doi:10.5681/hpp.2011.001