Reduction in the Number of JCAHO Standards

Since 1951, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), an independent non-profit organization, has participated in United States health care issues. Today, JCAHO actively evaluates and accredits more than 15,000 health care organizations and health related programs and is recognized as the primary accrediting and standard-setting body in the health care field. JCAHO is governed by a Board of Commissions, comprised of 29 individuals including health care providers, consumers, ethicists and other individuals. Throughout the years, JCAHO has expanded its scope and won support and respect from Congress in several respects. In 1994, JCAHO began to make public evaluation reports of specific organizations.

2004 Accreditation Standards

On June 16, 2003, JCAHO introduced new consolidated accreditation standards streamlining the accreditation process and increasing its focus on high-quality health care. Effective January 1, 2004, the new standards apply to hospitals, home care organizations, ambulatory care clinics, behavioral healthcare organizations, laboratories and long-term care organizations.

In order to create a more effective and less burdensome accreditation process, JCAHO provides a 56 percent reduction in the number of standards by:

• Removing redundant requirements
• Improving the clarity of standards
• Reducing requirements that could lead to unnecessary paperwork
• Identifying common standards in accreditation manuals
• Creating a consistent "standards language" for similar accreditation requirements

The New Format in the 2004 JCAHO Accreditation Manuals

In addition to consolidating separately stated standards into one new chapter, JCAHO also reorganizes the format of the new accreditation manuals to include:

• A brief statement of the standard
• A rationale for and background information about the standard
• Specific elements for how to comply with the standard
• A self-scoring mechanism to permit organizations to measure their level of compliance
• The elimination of compliance tips, which will instead be posted on JCAHO's Web site

2005 National Patient Safety Goals

In July 2004, the Joint Commissioners approved National Patient Safety Goals (NPSG) for 2005. The goals are program-specific and are applicable to all accreditation programs beginning in 2005. Unlike the general Joint Commission standards, the NPSG are more prescriptive. Accredited institutions may, under the supervision of JACHO, modify such rules for program-specific needs. According to JCAHO, the new goals are intended to "promote specific improvements in patient safety... [highlighting] problematic areas in health care and describe evidence and expert-based solutions to these problems."

Notable goals include the following:

• Take precautions to avoid dispersing "look-alike" drugs by identifying specific drugs that look similar to or sound similar to the name of other drugs. This will be done as a precaution against improper drug disbursement.
  
  
• Develop a process to identify all medications prescribed to individual patients. After such lists have been created, it is intended that all health care organizations working with a specific patient, i.e., hospitals, specialists, other physicians, etc., will be notified of such medications.

Numerous other goals have been identified, but not all are applicable to all types of services. For instance, goals created for assisted living providers might not be applicable to other health care organizations, such as those involved in behavioral health care.

Judicial Reaction to JCAHO Standards

At least two state supreme courts have officially recognized JCAHO and support its policies:

• The Wisconsin Supreme Court in 2003 ruled that information accumulated in accordance with JCAHO guidelines is protected from forced dissemination through discovery requests. The court held that a contrary ruling would not only be in violation of Wisconsin statutory law, but would also result in subverting JCAHO's central purpose of encouraging the continued improvement of health care services.
  
  
• The Illinois Supreme Court ruled in 1985 that JCAHO had the characteristics of medical societies allowed certain discovery protections permitting confidential medical surveys. The court denied a discovery request of a hospital's internal surveys conducted at the JCAHO's direction.

Both cases demonstrate that states recognize the importance of permitting JCAHO to collect and analyze medical records for the purpose of encouraging compliance with JCAHO's standards.