The Joint Commission is eliminating an additional 200 standards for ambulatory and behavioral care centers, critical-access hospitals, laboratories and nursing homes as part of an ongoing review of its accreditation requirements.
The announcement marks the second major tranche of revisions the nonprofit organization has made to its accreditation programs. In December, the Joint Commission retired 14% of its quality standards for the 22,000 healthcare organizations and programs it accredits.
The revisions are designed to refocus quality and safety goals while reducing the administrative burden on health systems, said Dr. Jonathan Perlin, president and CEO of the Joint Commission.
Perlin said he hopes to align Joint Commission standards with those of other reporting agencies and cut down on its requirements that go “above and beyond.”
The standards being retired effective Aug. 27 go beyond state and federal requirements and reflect a major reduction in mandates for provider organizations. In total, 28% of standards for laboratories, 26% for nursing facilities and 25% for behavioral care centers were removed. Critical-access hospitals, home health providers and ambulatory care centers will see a 15% reduction.
Major standards being removed include those mandating that facilities report and investigate injuries to staff and patients; evaluate medication management effectiveness; and document certain discharge criteria. All of those are already covered under different aspects of the accreditation process, Perlin said.
For healthcare leaders, consolidating and revising standards makes the remaining requirements more meaningful and helps with ensuring compliance at every level of the organization, said Nidia Williams, vice president of quality and safety for Providence, Rhode Island-based Lifespan Health System.
The Joint Commission has "added additional clarity about what the expectations [are],” Williams said. “It makes our lives easier and we can spend more time doing other things to help improve quality and safety outcomes.”
The accreditor is also adding new standards based on broader industry goals concerning health equity, workplace violence and environmental sustainability, Perlin said. In January, it established a health equity standard and later designated it a National Patient Safety Goal. The standard requires organizations to designate an officer to lead strategies focused on reducing health disparities and screening patients for social determinants of health.
“The standard recognizes that each hospital is different and has different expertise at their disposal,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. “It allows enough flexibility for people to understand what's really important in their community and make that happen.”
Last month, the Joint Commission launched an optional Health Care Equity Certification program in which participants focus on more robust work in leadership, data collection, community collaboration and patient care.
The organization briefly considered mandating requirements focused on environmental sustainability earlier this year, but made the standards voluntary after receiving industry feedback.
“While accreditation of hospitals, for example, is mandatory, accreditation with the Joint Commission is not,” Perlin said. Instead, the agency is attempting to build consensus through education and promoting available resources for environmental sustainability initiatives.
“The above and beyond standards really seek to inspire improvement in areas that go beyond [Centers for Medicare and Medicaid Services] requirements. In order to build the most momentum toward the types of improvements in safety, quality and equity that we want to see, we have to introduce them in a way that lifts all boats,” Perlin said. “We can’t lead without followers.”
The decision not to require environmental standards underlines a lapse in accountability for providers to reduce emissions and curb their role in the climate crisis, said David Introcaso, an independent healthcare policy consultant. While the Health and Human Services Department could also make such requirements, the Joint Commission had an opportunity to push the envelope, yet backed down to industry demands, he said.
“What the Joint Commission is explicitly saying is that our margin or [return on investment] is more important than the health of the planet,” Introcaso said.
Hospitals and organizations created to hold them accountable should consider the repercussions of climate change a top patient safety priority, Introcaso said. For example, all healthcare facilities should be required to report their energy star rating as a requirement for participating in government insurance programs, he said.
“It would have been a total light lift, it would have been meaningful, not greenwashing, and it would have only taken one measure under patient safety,” Introcaso said. “This is the gravest threat to patient safety in history.”
Instead, the Joint Commission launched advisory panels on environmental sustainability to review current standards and recommend new ones. As a result of that review, the Joint Commission revised wording in several of its quality and safety standards to ensure they do not force health systems to produce unnecessary waste, Perlin said.
The accrediting agency also conducts regular surveys of health systems and collects feedback from experts, clinicians and other industry stakeholders as part of its ongoing review process.
“We're always looking at revising,” Perlin said. “The mantra is really, ‘Evidence-based, data-driven, outcomes-oriented.’”