What is The Joint Commission?

The Joint Commission, previously known as The Joint Commission on Accreditation of Healthcare Organizations or JCAHO, is a nonprofit 501(c) that since 1951 has led the way in accreditation for healthcare organizations in the states and worldwide. 

Although The Joint Commission’s predecessor was focused on hospital care, for more than 50 years, they have operated in the realm of behavioral health, helping organizations understand and adhere to their standards. This aligns with the vision of the company to improve and enhance the quality and safety of healthcare delivery. 

The official mission of The Joint Commission is described as follows:

“To continuously improve health care for 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 Joint Commission provides a service to the public, by establishing standards of practice, and reviewing and vetting organizations that have risen to meet them. Accreditation can be earned by organizations across the spectrum of health care, whether it is a hospital or doctor’s office setting, or a behavioral health treatment facility.

Those who seek accreditation through The Joint Commission will receive practical support and counsel through education on the standards before and during the on-site survey, as well as supplementary tools such as The Leading Practice Library or Targeted Solutions Tools. The latter is comprised of interactive web-based tools that offer a means of performance measurement to organizations that seek them out, along with customizable solutions. 

Those who pass the on-site survey are rewarded with a golden seal of approval and awarded accreditation status for three years. Through this process, organizations learn performance-improvement strategies to address issues of safety and improve the quality of care, reducing the risk of errors and subsequently, the cost of liability insurance coverage.

Why Pursue Accreditation?

While the coveted gold seal of approval is a much sought-after prize, at the outset of any journey to accreditation, obtaining it may appear to be a daunting and intimidating task. It is not uncommon to wonder whether it is worth it or not to venture on such a laborious undertaking. However, there are many reasons to consider that may shift the direction of your thoughts. 

• Helps organize and strengthen efforts to improve patient safety
  Strengthens confidence in the quality and safety of the care, treatment, and services you provide to the community 
• Provides a marketing advantage and a competitive edge in a competitive health care environment and improves your ability to secure new business
• Improves risk management and risk reduction by focusing on performance-improvement strategies, that ultimately can reduce the risk of error or low-quality care
• May reduce liability insurance costs by demonstrating attention to areas of needed improvement
• Provides continuing support and education services through Joint Commission Resources® (JCR®) and The Targeted Solutions Tool®
• Provides a customized, intensive review that will help identify areas of needed growth
• The team of Joint Commission Surveyors offers professional advice and counsel, and education services to staff members during the on-site survey
• Enhances staff recruitment and development, attracting qualified personnel, and providing opportunities for staff to develop their skills and knowledge
• For some organizations, reduces the burden of duplicative federal and state surveys as it may fulfill regulatory requirements in some states and allow organizations to qualify for Medicare and Medicaid certification without undergoing a separate government quality inspection 
• Provides a framework for organizational structure and management and provides guidance to an organization’s quality improvement efforts.

What’s the Difference Between The Joint Commission and CARF?

In the world of behavioral health, there are two big names in the accreditation industry, The Joint Commission and CARF International, or formally, The Commission on Accreditation of Rehabilitation Facilities.

While they perform the same task, the primary difference between them is their individual collection of standards by which they evaluate the organizations applying for accreditation. 

In order to see what’s required by each accrediting body, contact the companies directly, as both CARF and The Joint Commission will allow free access to their standards for a limited time (3-6 months) and have manuals available for purchase. (The Joint Commission provides free access once an organization has officially applied)

Some additional differences between the agencies:

• The Joint Commission is more medically-based, while CARF is more active in the healthcare market
• They may have differing preferential relationships with third-party funders including states and insurance companies
• Accreditation fees vary between the bodies, typically based on the size of the organization seeking accreditation. An estimate can be easily obtained by contacting them directly. 
• Depending on your accreditation needs, whether you are looking to accredit the entire organization or just specific programs, you’ll want to seek out  CARF, which allows for one program’s accreditation at a time, or The Joint Commission accordingly.

Why Choose The Joint Commission?

The Joint Commission has over 65 years of experience, has accredited over 22,000 organizations during their tenure, and brings all of that experience to you when you join them on an accreditation journey. 

For years, they have led the way to shape best practices in the industry and establish the most rigorous performance standards, earning their place as one of the most respected names in health care. In working with these thousands of agencies, they know what works and what doesn’t, and offer their expert perspective when you’re making important decisions about the structure of your organization and treatment practices. 

During the review process, you will be matched with a team of experienced surveyors based on their background and your organization’s needs. Through collaboration and communication, they aim to provide the support needed to navigate this journey, along with practical tools and resources to help you maintain excellence even after accreditation.

What is the Accreditation Process?

Initial steps in the accreditation process begin with learning as much as you can about the accreditation process, both by reading articles by third-party reviewers or accreditation experts, visiting and reviewing the many resources available to you on The Joint Commission website, and contacting them to request free online access, to review their standards and requirements directly. 

Once you’ve chosen to pursue accreditation through The Joint Commission and confirmed your eligibility, the next focus will be conducting an internal review, identifying areas of focus, and aligning your practice to meet standards as described in the manual. During this time, you will have access to a number of tools and experts to question and fully understand the standards and their implementation. 

In order to officially apply and decide upon a survey date, the following steps are recommended:

1. After reviewing the requirements, conduct an analysis to see where there are gaps in your performance. Document and target these areas. 
2. Schedule and conduct a mock survey, with your staff if possible. Consider your service delivery from the vantage point of one of the individuals you serve and walk throughout the entire process. 
3. Develop a timetable to implement changes to areas identified in Step 1. Breaking up large tasks into smaller ones with their own completion date can be helpful in settling on a readiness date for your on-site survey. 

Once your survey is scheduled (up to one year from the application date), spend the rest of your time preparing for the visit from the surveyors. As they undergo the comprehensive review, you will be able to borrow from their perspective and feedback and know where you stand. Drawing from their collaborative approach, they may identify areas for improvement, and suggestions for implementation along the way.

Scoring and The SAFER Matrix

When it comes to the scoring and decision-making process, The Joint Commission takes seriously its mission to hold organizations to a higher standard, especially as it relates to the quality and safety of patient care. 

Requirements for Improvement (RFIs) are scored based on the criticality of the standards, the likelihood of the issue to cause harm, as well as how widespread the problem is. The visual representation on which all RFIs are represented is the SAFER Matrix and is based on the surveyor’s observations. This allows surveyors to perform the on-site evaluations of deficiencies, and denote the timeline for compliance.

• Accurate and Reflective of an organization’s performance 
• Transparent and Easily Understood- The Joint Commission wants to ensure that all applicants are fully aware of each step of the process
• Graded Based on Impact- Some standards are “critical,” or have a more direct effect of the patient than others

The hallmark principles for this process rely on the results to be: 

How Does Alleva Help You Achieve Joint Accreditation Status?

Alleva can help you to elevate your practice no matter if you are considering accreditation from The Joint Commission, CARF, or are not quite ready to make the jump towards either. Whether you’re just beginning the process, have decided to wait to get started, or have been accredited for years, when you partner with Alleva, you will have access to all the tools and software that will grow with you, and this constantly updating industry.

With Alleva, you can get back to doing what you do best. You’ll save yourself the headache of lost forms, the tediousness of compliance checks, and endless paperwork fatigue. When you digitize your practice with Alleva, rest soundly knowing that when you’re ready, we have continued success helping our clients obtain The Joint Commission accreditation.  If you want to learn more about how Alleva can work for you, visit our home page, and request a demo today!