The Trent Accreditation Scheme ( TAS ), now replaced de facto by a number of independent accreditation schemes, such as the QHA Trent Accreditation, was a British accreditation scheme formed with a mission to maintain and continually evaluate standards of quality, especially in health care delivery, through the surveying and accreditation of health care organisations, especially hospitals and clinics, both in the UK and elsewhere in the world.
48-630: The Trent UK Accreditation Scheme, or TAS UK, ceased to operate in May 2010, when a majority of Board members decided to end the scheme. Subsequently, a number of independent accreditation schemes were set up, including the British-based scheme QHA Trent Accreditation. Trent's basic mission resembled that of the USA's Joint Commission International, or JCI, and other major international healthcare accreditation groups, although there were some significant differences in
96-466: A challenging process for any healthcare provider. At a minimum, a hospital must be completely familiar with the current standards; examine current processes, policies, and procedures relative to the standards; and prepare to improve any areas that are not currently in compliance. The hospital must be in compliance with the standards for at least four months prior to the initial survey. The hospital should also be in compliance with applicable standards during
144-606: A joint survey process with state authorities. There are also other healthcare accreditation organizations in the U.S. unrelated to The Joint Commission. These include Accreditation Commission for Health Care , Inc. (ACHC), the American Osteopathic Association (AOA), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Community Health Accreditation Program (CHAP),
192-586: A number of countries fulfil this internationally orientated role, including: No single accreditation scheme enjoys exclusive rights to be seen as an overall world-wide-relevant scheme, and some hospitals are looking towards multiple accreditation to achieve performance credibility in different parts of the world. The Trent Scheme was the first accreditation scheme to survey and accredit a hospital in Asia, in Hong Kong in 2000 [3] . Since then others such as JCI have entered
240-473: A risk of serious injury or death to patients. In 2001, the Joint Commission mandated that health care providers assess every patient's pain during each clinical encounter on a scale of 0 to 10. This created an expectation that health care providers lower the pain of patients, leading health care providers to increasingly use opioids . Critics of the Joint Commission attribute a role for the organization in
288-570: A round of surveys, a joint meeting was held at which the printed reports of all the hospital and clinic surveys conducted in that particular round are discussed jointly and in depth by the Trent Board (which had both local and UK representation) together with senior representatives of the hospital or clinic being surveyed, and a decision was then taken as to whether or not accreditation would be granted unconditionally, or if it would be subject to conditions. The Trent approach to accreditation ensured that
336-494: A time frame that would enable CMS to review and evaluate their submission. CMS would make the decision to grant deeming authority and determine the term. The Joint Commission's predecessor organization grew from the efforts of Ernest Codman to promote hospital reform based on outcomes management in patient care. Codman's efforts led to the founding of the American College of Surgeons Hospital Standardization Program. In 1951
384-487: A vast range of modalities of a hospital's (or clinic's) activities and governance, including management, estates, equipment, clinical audit , research, education and training, as well as clinical/medical activity. In Hong Kong hospitals, survey teams always consisted of 2 or 3 surveyors from the UK working together with (usually) 2 based in Hong Kong and who were actively working in the local hospitals. One surveyor will be nominated as
432-595: A way that schemes which operate da more didactic approach to standards and their assessment would not. It also meant that there were Trent surveyors constantly present in the majority of the scheme's participating hospitals. Trent was a member of the United Kingdom Accreditation Forum (UKAF) [1] and an institutional member of ISQUA [2] . With the advent of medical tourism , international healthcare accreditation has increasingly grown in importance. A number of accreditation organisations sourced from
480-451: Is also a major new component of the NPSGs. The Universal Protocol to reduce surgical errors and existing regulations on medication reconciliation have been modified for 2009, based on feedback received by The Joint Commission. Joint Commission International , or JCI is one group that provides international health care accreditation services to hospitals around the world and brings income into
528-454: Is growing concern, however, over the lack of verifiable progress towards meeting the organization's stated goals. Although The Joint Commission increasingly cites and demands "evidence-based medicine" in its regulatory requirements, there is a relative paucity of evidence demonstrating any significant quality improvement due to its efforts, while there is a growing body of literature showing no improvement or actual deterioration in quality despite
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#1732841640821576-408: Is not a complete monopoly, and while many states in the U.S. make use of their services, they are not used by all. Some states have set up their own alternative assessment procedures; The Joint Commission is not recognized for state licensure in the states of Oklahoma (except for hospital-based outpatient mental health services), Pennsylvania, and Wisconsin. In California, The Joint Commission is part of
624-521: Is to promote specific improvements in patient safety. The NPSGs highlight problematic areas in health care and describe evidence and expert-based solutions to these problems. Recognizing that sound system design is intrinsic to the delivery of safe, high quality health care. The Goals focus on system-wide solutions, wherever possible. The NPSGs have become a critical method by which The Joint Commission promotes and enforces major changes in patient safety or thousands of participating health care organizations in
672-657: The Joint Commission on Accreditation of Hospitals ( JCAH ). The Joint Commission was renamed The Joint Commission on Accreditation of Hospitals in 1951, but it was not until 1965, when the federal government decided that a hospital meeting Joint Commission accreditation met the Medicare Conditions of Participation, that accreditation had any official impact. However, Section 125 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) removed
720-717: The Joint Commission on Accreditation of Hospitals was created by merging the Hospital Standardization Program with similar programs run by the American College of Physicians , the American Hospital Association , the American Medical Association , and the Canadian Medical Association . In 1987 the company was renamed the Joint Commission on Accreditation of Healthcare Organizations (JCAHO, pronounced "Jay-co"). In 2007
768-720: The "Exemplary Provider Program" of The Compliance Team , the Healthcare Facilities Accreditation Program (HFAP), the National Commission on Correctional Health Care, Utilization Review Accreditation Commission (URAC), The National Dialysis Accreditation Commission and the Healthcare Quality Association on Accreditation (HQAA) who are recognised in the state of Ohio. The Healthcare Facilities Accreditation Program (HFAP) has been in operation since 1945. On September 26, 2008,
816-726: The Centers for Medicare and Medicaid Services (CMS) granted deeming authority for hospitals to DNV Healthcare Inc. (DNVHC), an operating company of Det Norske Veritas (DNV), a Norwegian international company that has been operating in the U.S. since 1898. The Center for Improvement in Healthcare Quality (CIHQ), based in Round Rock, Texas, was granted deeming authority for hospitals by the CMS In July 2013. The stated mission of The Joint Commission is: "To continuously improve health care for
864-481: The Joint Commission on Accreditation of Healthcare Organizations underwent a major rebranding and simplified its name to The Joint Commission . The rebranding included the name, logo, and tag line change to "Helping Health Care Organizations Help Patients." The change was part of an effort to make the name more memorable and to assist the commission in its continued responsiveness to the needs of organizations seeking fee-based accreditation. The Joint Commission advocates
912-491: The Joint Commission's statutorily-guaranteed accreditation authority for hospitals, effective July 15, 2010. At that time, the Joint Commission's hospital accreditation program would be subject to Centers for Medicare and Medicaid Services (CMS) requirements for organizations seeking accrediting authority. To avoid a lapse in accrediting authority, the Joint Commission would have to submit an application for hospital accrediting authority consistent with these requirements and within
960-435: The U.S. All member health care organizations are subject to a three-year accreditation cycle, and laboratories are surveyed every two years. The organization does not make its hospital survey findings public. However, it does provide the organization's accreditation decision, the date that accreditation was awarded, and any standards that were cited for improvement. Organizations deemed to be in compliance with all or most of
1008-570: The U.S.-based parent organization. This not-for-profit tax-exempt private corporation (a 501(c) organization ) currently accredits hospitals in Asia, Europe, the Middle East, Africa, and South America and is seeking to expand its business further. The JCI has a small staff which includes principal consultants and a number of other consultants from around the world. JCI quotes an average fee of $ 46,000 per year to maintain accreditation, plus travel and other costs. For hospital to be successful in
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#17328416408211056-470: The United States and around the world. The 2009 NPSGs included regulations targeting the spread of infection due to multidrug-resistant organisms, catheter-related bloodstream infections (CRBSI), and surgical site infections (SSI). The new regulations for CRBSI and SSI prevention apply not only to hospitals, but also to ambulatory care and ambulatory surgery centers. Engaging patients in patient safety efforts
1104-519: The accreditation process, there may be additional costs related to consultancy work prior to accreditation. International accreditors incur different levels of costs with some costing less than JCI. A Harvard University -led research study published in the BMJ found that U.S. hospital accreditation by independent organizations was not associated with lower mortality or with reduced readmission rates for common medical conditions. The authors concluded that there
1152-446: The applicable standards are awarded the decision of Accreditation. The unannounced full survey is a key component of The Joint Commission accreditation process. "Unannounced" means the organization does not receive advanced notice of its survey date. The Joint Commission began conducting unannounced surveys on January 1, 2006. Surveys occur 18 to 39 months after the organization's previous unannounced survey. There has been criticism in
1200-537: The change was given by TJC or COLA. TJC had originally begun recognizing COLA accreditation in 1997. United Kingdom Accreditation Forum The United Kingdom Accreditering Forum (UKAF), founded in June 1998 by a group of leading healthcare accreditation organisations, is a London -based network of healthcare accreditation organisations formed with the intention of sharing experience regarding good practice in accreditation, as well as sharing new ideas around improving
1248-515: The coal face", and in Hong Kong Trent also appoints locally domiciled surveyors (see later). Trent surveyors are drawn from a wide variety of professional backgrounds, but especially from the worlds of medicine, dentistry, nursing, the professions complementary to medicine (e.g. physiotherapy , pharmacy etc.) and healthcare management/administration, so as to ensure an appropriately broad portfolio of knowledge and skills are always present within
1296-554: The end of a survey, the key findings were initially presented by the Lead Surveyor to the hospital or clinic undergoing the survey, this event taking place almost always on the last day. The findings were subsequently digested, analysed and put into a more detailed printed report, with positive virtues being highlighted as well as problems. However, because of the end-of-survey oral presentation, hospitals and clinics could start putting remedial action into place as soon as possible. After
1344-643: The entire period of accreditation, which means that surveyors will look for a full three years of implementation for several standards-related issues. Behavioral health organizations looking to be accredited under the standards outlined in the Comprehensive Accreditation Manual for Behavioral Health Care (CAMBHC) do not have the same requirements around compliance with applicable standards for any period of time leading up to an initial survey for accreditation. The Joint Commission also provides behavioral health organizations that are being surveyed for
1392-734: The first time with a 30-day notice of their survey date, however, future surveys are unannounced. The Joint Commission and JCI employ salaried individuals as surveyors who generally work or have worked within health care services but are able to devote half or less of their time for the accrediting organization. The surveyors travel to health care organizations to evaluate their operational practices and facilities against established Joint Commission standards and elements of performance. Substantial time and resources are devoted by health care organizations ranging from medical equipment suppliers and staffing firms to tertiary care academic medical centers to prepare for and undergo Joint Commission surveys. There
1440-541: The hospital or clinic under survey and to talk to anyone they choose to. Discussion and analysis of the data thus generated, not only by the Trent team but also by the hospital or clinic under survey, represented a major component of Trent's approach to hospital and clinic accreditation, and reflected an underlying philosophy that the whole process was about improving services to patients and the ability of an organisation to work effectively towards that aim. Trent surveyors evaluated
1488-579: The increasingly stringent and expensive requirements. A facility requesting accreditation pays a substantial fee to the Joint Commission (the "accrediting" agency) and, upon receiving a "passing" grade, is able to purchase associated mementos of accomplishment to display to the public. The nonprofit's revenue was $ 147M in 2013, and in that fiscal year, it paid its CEO more than $ 1M. Hospitals pay The Joint Commission up to $ 37,000 in fees annually to maintain their accreditation status. Inspections cost approximately $ 18,000 every three years. The Joint Commission
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1536-431: The industries it inspects, has been the target of criticism about the validity of its evaluations." The Joint Commission over time has responded to these criticisms. However, when it comes to the international dimension, surveys undertaken by JCI still take place at a time known in advance by the hospitals being surveyed, often after considerable preparation by those hospitals. Preparing for a Joint Commission survey can be
1584-435: The lead. The Hong Kong-based surveyors were nominated by the participating hospitals, and after receiving training they always surveyed hospitals other than their own. This approach led to unrivaled opportunity and potential for the sharing of ideas about best practice between hospitals working in the same locality, and the development of camaraderie. Also, patients were spoken to, and their views and experiences also sought. At
1632-412: The local hospitals and clinics enjoyed some ownership over the whole process, which would not be the case if all of the standards, all of the surveyors and all of the decisions regarding who was successful or not in achieving accreditation were imposed unilaterally from outside. It helped to build up the confidence of participating hospitals in their ability to develop ways to maintain and improve quality in
1680-595: The market, with JCI first accrediting Bumrungrad International Hospital in Thailand in 2002. The UK-based Trent Accreditation Scheme (TAS UK) ceased surveying and accreditation activities in 2010. Subsequently, the British-based scheme QHA Trent Accreditation began operating. Joint Commission The Joint Commission is a United States-based nonprofit tax-exempt 501(c) organization that accredits more than 22,000 US health care organizations and programs. The international branch accredits medical services from around
1728-434: The methodology for such programmes. It has an additional role in working to ensure that the general public develop a clearer idea about accreditation, its function, its implications and its execution. The aim of UKAF is to provide an effective network of organisations which operate or have a practical interest in developing standards-based assessment and accreditation programmes in healthcare. The group meets quarterly, and
1776-515: The opioid epidemic. In Dec 2022, TJC announced they would no longer recognize Commission on Office Laboratory Accreditation (COLA) for lab accreditation as of Jan 1, 2023 and facilities would have until Dec 31, 2024 to transition to a CAP or TJC accreditation. With the COVID-driven inspection backlog and a lack of inspectors, the move was criticized as being purely a financially driven attempt to capture additional market share . No reason for
1824-594: The overall standards of a hospital or clinic can be shown to be of acceptable quality, then it is desirable, and even ideal, that local differences related to culture and to legislation should be specifically discussed and incorporated into the assessment standards in an appropriate fashion. That said, Trent was very interested in the medical ethical standards of the hospitals it worked with. To achieve all of this, Trent worked in close partnership with participating hospitals and clinics to generate an appropriate and mutually acceptable set of standards to survey against. Because
1872-622: The past within the U.S. about how The Joint Commission operates. The commission's practice had been to notify hospitals in advance of the timing of inspections. A 2005 article in The Washington Post noted that about 99% of inspected hospitals are accredited, and serious problems in the delivery of care are sometimes overlooked or missed. Similar concerns have been expressed by the Boston Globe who stated "The Joint Commission, whose governing board has long been dominated by representatives of
1920-707: The public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value." The company updates its accreditation standards, expands patient safety goals on a yearly basis, and posts them on its web site for all interested persons to review making the information and process transparent to all stakeholders ranging from institutions and practitioners to patients and their advocates . Residential treatment centers and medical care facilities often share their accreditation status with their patients. The purpose of The Joint Commission's National Patient Safety Goals (NPSGs)
1968-419: The quality of patient care; assisting international health care organizations, public health agencies, health ministries, and others in evaluating, improving, and demonstrating the quality of patient care; and enhancing patient safety in more than 60 countries. International hospitals may seek accreditation to demonstrate quality, and JCI accreditation may be considered a seal of approval by medical travelers from
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2016-571: The right to claim a monopoly viewpoint over what represents acceptable quality and best clinical practice throughout the world, and no one country has the absolute right to tell another how their hospitals should be run. What is vital is that the quality of care which patients receive should be of the highest possible standard, and also that the hospitals and clinics providing that care should be independently capable when it comes to working out how best to maintain those standards and how best to respond to any new challenges which will inevitably come along. If
2064-666: The surveying teams and the wider organisation. Surveyors were all volunteer professionals rather than salaried employees. Trent surveys were not just a matter of working through a “tick-list” of standards, a process which Trent believed might elevate standards to a certain level but nevertheless do little to inculcate a culture of “thinking for oneself” – instead, Trent surveys involved direct face-to-face conversation with all levels of staff, including clinical medical staff and senior management (for this reason, qualified medical doctors are included in all surveying teams organised by Trent) and Trent surveyors expected full freedom to go anywhere in
2112-498: The use of patient safety measures, the spread of information, the measurement of performance, and the introduction of public policy recommendations. Joint Commission International (JCI) was established in 1998 as a division of Joint Commission Resources, Inc. (JCR), a not-for-profit, private affiliate of the Joint Commission. Through international accreditation, consultation, publications, and education programs, JCI extends The Joint Commission's mission worldwide by helping to improve
2160-586: The way the different groups worked. Apart from hospitals in the United Kingdom, Trent also surveyed a large number of private sector hospitals in Hong Kong . and at the time of its demise had been developing links with hospitals in Cyprus. The approach Trent took to Clinic and Hospital Accreditation was based on the axiom that no single healthcare system, whether European, American, Asian or otherwise in origin, has
2208-573: The world of healthcare is constantly changing, the standards were constantly reviewed and up-dated through a system of working jointly with representatives of partner hospitals. Trent developed various ways to ensure local participation, and even ownership, over the accreditation process in a locality. Trent utilised UK-sourced surveyors who were either working in the British National Health Service , or NHS, or had retired in recent times, and hence have valuable experience and insight "at
2256-452: The world. A majority of US state governments recognize Joint Commission accreditation as a condition of licensure for the receipt of Medicaid and Medicare reimbursements. The Joint Commission is based in the Chicago suburb of Oakbrook Terrace, Illinois . The Joint Commission was formerly the Joint Commission on Accreditation of Healthcare Organizations ( JCAHO ) and previous to that
2304-427: Was no advantage for patients to choose a hospital accredited by The Joint Commission over a hospital accredited by another independent accrediting organization. The Wall Street Journal suggested that the underlying reasons for this is the failure of The Joint Commission to revoke or modify the accreditation status of hospitals with major infractions considered to be so significant they caused, or were likely to cause,
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