The National Healthcare Quality report released by the Agency for Healthcare Research and Quality (AHRQ) found that healthcare quality in America is suboptimal and that the receipt of needed healthcare varies widely (Kneipper, 2009). A report published by the Institute of Medicine, To Err is Human, diagnosed the quality problem in health care caused by people struggling to perform within a system riddled with opportunities for mistakes (Buchbinder and Shanks, 2007). While it is recognized that even the most strenuous accreditation programs will never eliminate all the issues in the facilities and services being accredited; it is important that steps are taken to significantly improve quality and reduce risk. Pursuing accreditation demonstrates a commitment to improving quality in health care. Numerous accrediting bodies exist in the U.S. with each having their own particular area of focus. This paper will examine three that are responsible for monitoring quality in health care organizations.
Joint Commission, founded in 1951, is a health care accreditation agency known for its high-quality patient care standards. It develops standards for quality and safety and evaluates performance within healthcare organizations based on these standards. In addition, it strives to enhance the effect that performance measures have on improving health outcomes for patients.
The duties of the Joint Commission are numerous. The Joint Commission assesses organizational compliance through unannounced surveys that include direct observations, data analysis and staff interviews. It accredits and certifies over 18,000 health care organizations and programs in the US. It has identified hundreds of performance standards that represent the highest in quality health care. It publishes quarterly reports that track performance on quality of care measures. It issues annual reports as part of its ongoing efforts to emphasize the health importance of accountability and continuous improvement.
The Joint Commission monitors quality by continually reviewing the best practices that optimize patient care. It works with various subject matter experts to identify quality measures. Hundreds of performance standards guide health care providers in administering care and improving performance. Hospitals are expected to adhere to standardized processes for quality measurement, reporting and improvement. The Joint Commission requires annual periodic performance reviews. A health organization must conduct a self-assessment ascertaining its compliance with the Joint Commission’s standards and submit a report to them. Joint Commission uses this information as part of its Periodic Performance Review.
Joint Commission’s efforts promote quality of care. Its annual reports identify the top compliance issues each year which include quality standards that were the most difficult for hospitals to meet. Joint Commission’s collaborative efforts with clinicians, health care providers, hospital associations, performance measurement experts, and health care consumers identify quality measures that reflect the best evidence-based treatments for specific medical conditions. Through this collaboration, a set of standard national measures are created that allow comparisons across health organizations. To help hospitals make a significant impact on patient outcomes through performance measurement, the Joint Commission introduced an approach placing greater emphasis on an organization’s accountability measures (measures of evidence-based care that yields the greatest the most favorable impact on patient outcomes) and less on non-accountability measures (suitable for secondary use). In 2009 it formed the Center for Transforming Healthcare that works on developing collaborative programs with leading health care systems to identify causes of breakdowns in patient care. The Joint Commission collaborates with other organizations, including the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum (NQF), to align quality measures with other measurement efforts to ease data collection efforts and ensure that the data is gathered and calculated consistently across all organizations.
Another organization responsible for monitoring quality is the Commission on Accreditation of Rehabilitation Facilities (CARF) which has accredited programs in five continents. Founded in 1966, CARF accredits in the areas of behavioral health, aging services, child and youth services, employment and community services, and medical rehabilitation. Through a consultative accreditation process, CARF’s attention focuses on enhancing the lives of the people with disabilities. Their consumer-focused standards help organizations measure and improve the quality of the programs and services that achieve optimal outcomes.
CARF assists providers and organizations in improving the quality of its services and demonstrating value. It accredits providers for many specific programs and services that support rehabilitative health, with many providers seeking CARF accreditation in multiple areas. It publishes standards manuals that correspond to the fields served that relate to health and safety, risk management, and corporate compliance. These nationally and internationally recognized service standards are developed with input of key stakeholders such as professionals, organizations, surveyors, purchasers, and those served. They are reviewed and revised annually at a national and international level to ensure they exhibit standards for quality that are current, relevant, and practical.
For monitoring quality, a quality improvement plan that matches the needs of the program or services is a critical part of the accreditation process. Rather than an inspective approach, a survey team employs a consultative methodology to conduct an on-site survey to evaluate its services. Once the report information has been reviewed the organization and survey team partner to develop a quality improvement plan to improve the operations and service delivery. An accredited provider participates in reviewing its practices on an annual basis. The organization’s leadership sends a signed commitment to CARF affirming that it continues to their standards to guide their organization.
To promote the quality of care, every year CARF creates standards that help programs monitor their services, quality, recovery and business. Surveyors are peers in the field with experience in the programs and services that are accredited. They are matched to organizations they survey based on the organization’s characteristics and program types. CARF accreditation assures the public that the provider/organization is committed to improving the quality of services with a focus on service outcomes as well as customer satisfaction.
A third organization responsible for monitoring quality in medical imaging and radiation oncology is the American College of Radiology (ACR). The ACR is the most recognized medical imaging and radiation oncology accrediting body that began accreditation in 1987. It continually promotes recognition for issues of quality and safety in radiologic procedures. ACR accreditation consists of a self-assessment and an independent external expert audit that assesses personnel qualifications, policies and procedures, equipment specifications, quality assurance activities, patient safety, and the quality of patient care.
The ACR is involved in numerous undertakings. It has established over 150 practice guidelines and technical standards to improve how imaging, radiation therapy, and interventional services are delivered. Currently, eight accreditation programs have been established by the ACR and there are plans to add more. Over 160 sets of evidence-based guidelines have also been set up to assist referring physicians in making the most appropriate imaging or treatment decision.
The ACR uses several methods to monitor for quality. Accreditation requires active participation in a physician-peer review program. Radiology exams must be systematically reviewed and evaluated for the appropriateness of the exam as well as for the accuracy of interpretation as part of the overall quality improvement program at that facility. Complications and adverse events must be monitored, analyzed and reported as required. They must also be regularly reviewed to identify opportunities for improving patient care. Imaging facilities must have documented policies and procedures for monitoring and evaluating the effective management, safety, and operation of equipment.
ACR accreditation promotes quality of care in several ways. It focuses on factors unique to imaging that includes image quality, dose monitoring, phantom testing, equipment evaluation, calibration and maintenance, and personnel qualifications. The Appropriateness Criteria enhance quality-of-care decisions; contribute to the most effective use of radiology; help providers address issues of overutilization of radiological care, and in the near future, will provide information on appropriate radiation dose.
In conclusion, people seek medical attention to improve their health. The economic pressures of spiraling healthcare costs and suboptimal health outcomes are intensifying the search for new approaches to health management. Accreditation helps to ensure that patients will receive adequate and appropriate health care according to nationally accepted standards and it demonstrates commitment to improving quality in health care.