The Joint Commission has changed its longstanding policy against accrediting foreign healthcare organizations and is now preparing to provide accreditation services wherever they are requested around the world.
The change, approved late last year, comes in response to increased interest in accreditation in other countries and repeated requests from those countries for guidance and direct accreditation.
At the same time, people interested in measuring healthcare quality in various countries are working to set up an international association of accrediting bodies. That would be created under the auspices of the International Society of Quality in Healthcare, or ISQua.
Since the late 1970s the Joint Commission on Accreditation of Healthcare Organizations has not accredited facilities outside the U.S. The consensus at the time was that accreditation standards wouldn't be meaningful because value systems differed so greatly in other parts of the world. Even the famous American Hospital in Paris couldn't meet the U.S. standards for compliance. The only exceptions to the policy were Defense Department hospitals at foreign bases.
For at least 20 years the JCAHO has provided a lot of information and technical assistance to foreign governments and independent agencies. The requests for service took a sharp upturn about six years ago.
The U.S. Agency for International Development and the Treasury Department invited the JCAHO to develop accreditation programs in Central and Eastern Europe and Saudi Arabia (Nov. 3, 1997, p. i36).
In May 1996 the policy was liberalized to allow accreditation of organizations in which the healthcare professionals were U.S.-educated and the patient population was 10% American. Under that policy, accreditation has been granted to only one hospital, a small mental health facility in the Caribbean.
K. Tina Donahue, president of the Joint Commission International, said: "I would attribute this interest in accreditation to two factors: One, concern about the escalating cost of healthcare around the world, which leads to a concern about compromising the quality. And two, what tools are in place to manage this cost/quality issue? Inevitably, use of standards is seen as the most likely tool to do both those things."
When people start thinking along those lines, they look at the JCAHO framework and wonder if it can be customized to their locale. In many cases this interest is driven by state-of-the-art hospitals that have relationships with major U.S. medical centers.
It's not really feasible to impose American standards on foreign countries, Donahue said. It's more likely the JCAHO will develop international core principles for accreditation, then partner with local authorities that develop standards compatible with social, political, economic and cultural conditions.
"We respect the fact that they have the knowledge of their system, which we might not have," Donahue said. "What we bring to the table is worldwide experience."
Another alternative might be for the JCI to accredit directly a center of excellence in someplace like Korea or Singapore. By 1999 the JCI hopes to have an international accrediting service, staffed by U.S. nationals, that would accredit the facility using standards developed in that country. "We're building our base of multilingual and country-knowledgeable surveyors," Donahue said.
The ISQua has a membership comprising mostly physicians. Karen Timmons, executive vice president for support operations at the JCAHO, is treasurer of the ISQua's board. "There's been demand on the part of many countries to see whether ISQua could be the umbrella for accrediting organizations," Timmons said. "Could it develop principles for standards that all accreditors internationally could incorporate? The Joint Commission has been supportive of this."
For one thing, principles developed by the ISQua could be used as an underpinning for standards at all accrediting bodies in all countries. The ISQua would become something like a federation of national healthcare accrediting bodies.
In this framework, outsiders from another country's accrediting organization might come to evaluate a third country's accrediting body to make sure it's working within the standard.
The four major accrediting bodies in the world-the Australian Council for Accreditation, the Canadian Council for Accreditation, the JCAHO and the New Zealand Council for Accreditation-all support this program, Timmons said.