Ne Functions the Joint Commissions Accreditation Healthcare

ne functions the Joint Commissions Accreditation Healthcare Organizations (JCAHO) place a stamp approval accredits health care organizations participate Medicare/Medicaid program. Overall -- JCAHO a filter functions ensure compliance rules, regulations, standards multiple regulatory agencies.

How do they ensure that performance of their standards occur at the point of care and how do these standards impact nursing leadership and practice at the point of care? Explain your answers!

The JCAHO (Joint Commissions Accreditation Healthcare Organizations) requires that participating hospitals be recertified every three years to receive accreditation. Over the years, it has accumulated more and more power to do so, sometimes in a way that has proven to be controversial. "Under Medicare rules, any hospital meeting the joint commission's standards automatically is eligible to participate in the federal health program and receive government reimbursements. Over the years, to save money and avoid duplicating federal efforts, all but a handful of states have abandoned their separate procedures for licensing hospitals and now rely on the joint commission" (Gaul 2005). The JCAHO has no formal regulatory authority. It cannot fine or close hospitals, merely refuse accreditation. Its focus is on collaboration between accreditors and hospital administrators. The JCAHO is given the ability to educate facilities so they can learn to uphold JCAHO's standards. However, there are allegations that the JCAHO's power has gone unchecked. "Medicare officials say they are required by law to accept the joint commission's congressionally-mandated accreditation system" (Gaul 2005).

There has also been criticism of the close a relationship between the JCAHO and the hospitals it evaluates. The JCAHO "operates a thriving subsidiary that charges hospitals thousands of dollars for coaching on how to pass its reviews," and "about 99% of the hospitals reviewed by the joint commission win accreditation" even some, critics allege, with well-publicized, serious incidents resulting in the injury or death of patients (Gaul 2005). The JCAHO, in other words, is not truly independent because of its financial interest in promoting educational programs to help hospitals pass its reviews. And nurses must participate in these 'reeducation' programs, regardless of their perceptions of the individual needs of the facility.

Q2. If you work for an organization that is not accredited by the JCAHO - describe the accrediting agency that accredits, regulates, and influences your organization and how do these standards impact nursing leadership and you at the point of care?

The Healthcare Facilities Accreditation Program (HFAP) is an older organization than the JCAHO. In contrast to JCAHO, it stresses the clarity and accessibility of its quality audits, which it conducts for accreditation. For example, "HFAP standards have been 'cross-walked' to the Medicare Conditions of Participation (CoPs) for each type of facility. This cross-walk approach means anyone reading the HFAP standards manual can clearly see how each standard ties directly to a Medicare Conditions" (Working with HFAP, 2012, HFAP).

From a nurse leader's perspective, HFAP's accreditation process of "application, survey, deficiency report, plan of corrections," and "accreditation action" is conducted in a very straightforward and user-friendly manner (Working with HFAP, 2012, HFAP). The aim of the assessment process is to immediately correct any deficiencies. All surveyors are current medical professionals, with practical field experience as well as additional training from HFAP. Most HFAP units are composed of a physician, a registered nurse and hospital administrator, so any advice can be specifically phrased to address unique nursing needs. Assessors are required to critique fellow auditors as well as the facility, to ensure the competence of the assessors.