Joint Commission International (JCI) recently held its first
Advanced Practicum on Building on accreditation strategies and quality
improvement in Chicago.
Building on JCI’s series of International Practica which have been
held in Singapore, Prague and Abu
Dhabi in December, the conference was an advanced
exploration of accreditation strategies, quality improvement methodologies, and
patient safety initiatives.
IMTJ spoke to Anne Rooney, vice president of Consulting
Services, Joint Commission Resources and JCI about both the conference and how
accreditation is playing a part in medical travel...
IMTJ: Who attended the advanced practicum?
JCI: There were about 80 people from 17 countries, coming
from all regions of the world: Senior leaders in the medical field, people
involved in direct patient care in some way or in the leadership of the
hospital at an executive management level. This was an advanced practicum, so a
number of attendees were representing organizations and hospitals that are
already JCI-accredited, though some are preparing to begin accreditation. The
common thread is that they are all interested in deepening their knowledge of
safety and quality.
What is stimulating this interest in accreditation?
There is increasing globalization in healthcare and
medical travel with patients travelling outside their home country or being
located away from their home country. Medical travel is part of this process, but
it is also because of the increased number of people working abroad for
multinationals, and leisure travellers as well. What all of these people need
is quality medical care, and so you need standards for the continuity of care
as the patient seeks practitioner.
What do you think are the main accreditation issues are for medical travel?
It’s something we are frequently asked - how our standards* address the needs of medical travellers. If the
patient seeks care outside their own country, do clinicians know some of the
background issues for the patient? This requires quality continuity at both
ends. If someone goes to Thailand for a knee replacement and then comes back to
Chicago, what kind of follow up care will they receive, how are complications
handled, what is the communication with the primary physician, will the primary
physician accept care? We are trying to raise those issues, because medical
tourism is such a hot topic, and organisations around the world are interested
in welcoming patients from outside their country, and so they want to think through
their systems so they can reduce some of those risk points.
We feel that accreditation is a rigorous process and we want
it to have some integrity to the public and to the insurers and decision makers.
We realize this is a part of what accreditation often signifies, even though
it’s not our primary motivation which remains patient safety and care.
Is there an insurance requirement on facilities before they
No, we don’t require that in our process. One of the things we
are frequently asked is, “If I’m a medical traveller, what should I know ahead
of time?” Of course we would like them to recognise and understand what JCI
accreditation means in terms of some of the standards the facilities would have
to address - medication safety, infection control, the competency of the medical
staff, patient care processes and improved safety. We’ve had organizations that
have said they’ve reduced medication errors by 75 per cent by meeting the
standards we have for medication safety, for instance. So we want patients to
understand and use that as one of the criteria they would look for in seeking
We’ve been working in the international environment for
about 15 years, even before we had international standards. So we can build on
the experience of the Joint Commission over the last fifty years to devise standards
that fit in an international environment.
Are there standards when it comes to medical data?
We have a standard of confidentiality of the data, and it’s
important to realize that this standard applies regardless of whether the
patient is actually going to a hospital or remaining in their home country.
With outsourcing of radiology the same is true, particularly electronic transmission
of digital imagery to make sure there are really strong security systems.
What about drugs?
If someone comes in with their own medications to a
hospital, we require that the hospital has a process for verifying those medications.
There is a whole process for procuring of medications and in the next edition
of the standards* we have an entire chapter devoted to medication management – looking
at the procurement, dispensing, monitoring, in a lot of detail. Medication
management has been the most challenging standard to meet for many
organizations. What we are looking for is a uniform level of care for all
patients, regardless of if they were local, international, paying or non-paying,
so there may be some difference in some of the hospitality services, but not in
the actual clinical care.
Will there be further practica?
Yes there will. Practica next year will include an overview
of the standards and also a survey simulation so that particpants can have an
idea of what the accreditation process is like. These will take place,
probably, in Singapore, Prague, Abu Dhabi and Mexico, though
we are still finalizing details. We have had requests for others to be held next
year in India, Chile and Brazil. [for an up to date list,
The purpose of the practica is to provide ongoing education.
For organisations that go through the accreditation for the first time, there’s
a really high level of motivation to keep the enthusiasm going, in terms of
continued training of staff. So we are developing more web-based courses around
topics of great interest such as patient safety.
Part of our mission is to share best practice, continue to
support organisations that have been accredited and help them improve.
Are more facilities seeking accreditation?
There is a pipeline. We have accredited in 26 or 27
countries and we get requests from all over. There is increasing interest,
partly because there are starting to be some market forces, insurers are using
it as a differentiator and multi-national corporations and places like the
International Finance Organisation have shown interest.
What sort of feedback have you had from participants?
They like to have the opportunity to see best practice in
some of the leading hospitals in Chicago.
we simulated a survey, taking the participants around for two days and giving a
demonstration of what an accreditation process would be like. Here in Chicago we take the participants
to top hospitals for two days.
Anne Rooney’s speech at the conference was entitled “Safe
Care of the Global Patient: Quality considerations for medical travel.”
*The 3rd edition of the JCI Accreditation Standards for
Hospitals, scheduled for release in July 2007, will be used as the foundation
for this program. These new standards become effective on 1 January,