The Joint Commission is staying busy. The accrediting organization is in the process of overhauling its standards, with the aim of refocusing hospital safety and quality goals and decreasing administrative burden on providers. So far, it has retired 14% of its quality standards, with more revisions set to be announced this week. President and CEO Dr. Jonathan Perlin joined Modern Healthcare to discuss the ongoing review process.
Why are the changes to the standards being made?
We need to better demonstrate the standards’ value proposition, which means they have to have a clear trajectory from evidence, to data, to outcomes. We also want to help organizations better integrate their own aspirations and needs with the standards’ requirements. We don’t want the standards to be an exercise done in preparation for a survey, but rather for them to be part of the ongoing course of the usual work so that quality and safety are much more durable and hardwired.
We also want to make sure organizations can focus on things that are evidence-based, data-driven and outcomes-oriented.
What changes have you made so far?
The first change was the reduction and revision of 182 standards in December 2022. In the next week or so, we will announce changes to a substantial number of standards, effective Aug. 22. They will largely concern removing redundancy in standards related to non-hospital environments. Healthcare is increasingly integrated, and we don't want to have differences in standards among the environments.
You’ve said that cleaning up these standards allows the Joint Commission to add standards related to health systems’ broader goals. Which do you plan to add?
We’re always providing technical updates on standards or revisions to comport with current evidence or practice changes. But this year, the focus has been on one new health equity standard with six elements of performance.
For those of us who were at the front lines during the peak of the COVID-19 pandemic, what was always unacceptable in terms of the disparities and dislocations from care became intolerable. I'm proud of the team's work on the health equity standard and even more proud of what we're hearing about accredited organizations’ ability to focus on better meeting the needs of patients, families and communities.
You’ve mentioned adding standards related to environmental initiatives. Are those still on the table?
Environmental sustainability is a challenging area. People in healthcare are bound by our mission to serve fellow human beings and their communities. Yet as an inadvertent consequence of what we do, we are harming the environment. Our younger colleagues are asking why we don’t have standards in these areas.
We’re working with a variety of constituents to identify standards that allow us to orient toward greater environmental responsibility in a way that’s tenable, given the challenges in healthcare we’re all aware of today.
The irony is that many of the things that we can do are not only cost-neutral, but at times cost-saving. But there has to be a great deal of work done to help colleagues across all health settings understand the mechanisms for cost-neutrality and cost-savings that also contribute favorably to the environment.
What do you think about mandating standards for things like environmental sustainability versus building consensus?
Accreditation is mandatory for participation in federal programs, but seeking accreditation through the Joint Commission is voluntary. We applaud the organizations that challenge themselves to a higher level of accountability through using the Joint Commission standards.
Environmental sustainability has clearly been a very challenging and, frankly, polarizing area. We need to bring together constituents across healthcare to find a path that allows us to address what’s absolutely necessary. We’re trying to thread what turns out to be a very delicate needle.
Returning to the topic of health equity, the Joint Commission recently announced a new health equity certification program. How is it different from the standard, and how do you expect them to evolve?
The standard is foundational. It helps organizations begin asking questions about why certain disparities exist, and given their own organizational, community- and patient-specific circumstances, helps them address the highest-priority opportunities.
The certification is a much more robust program that begins to engage at the governance and leadership level, and which requires integration of community- and patient-level assessments into the strategic plan. It requires demonstration of a real commitment to the examination of data on the use of improvement protocols to address opportunities, as well as collaboration with stakeholders across the organization. The accreditation is the 101- and the certification is the 401-level college course in achieving healthcare equity.
The accreditation standard came out Jan. 1. On July 1, we upgraded it to a National Patient Safety Goal, and through the course of this year we will begin to see what activities organizations are taking on. So it’s a learning phase.
The certification launched July 1, and similarly, we’ll see the sorts of activities that organizations are taking on over the next year. We’ve seeded the environment based on lots of input from technical and subject matter experts, as well as practitioners and operators, to guide the structure of the program. This will be a period of looking at the data, then coming back to see what’s working.
What about accountability? You have these standards and goals that you’re making in conjunction with the industry. How do you make sure organizations meet them?
The Joint Commission wears two hats. We have incredible convenient capacity of subject-matter expertise so we can collect and disseminate best practices. And simultaneously, we do have a responsibility to patients and communities, families, and the Centers for Medicare and Medicaid Services and the Health and Human Services Department to ensure accountability to standards that are required for participation in federal programs or standards we ask providers to support, because they are associated with safer, higher-quality, more equitable outcomes.
This interview has been edited for length and clarity.