There’s a lot of buzz in the healthcare community about the right path to choose for accreditation and deemed status with CMS. For many years, The Joint Commission (TJC) has been the number one choice, providing accreditation for the majority of hospitals in the U.S. (more than 4,000). But Det Norske Veritas (DNV), a newcomer in 2008, is gaining significant ground representing 350+ hospitals and growing.
Between the 1980s and early 2000s, The Joint Commission’s standards seemed to be continually evolving. Expectations of The Joint Commission and how to prepare for the survey were constantly moving targets. Plus, teams of surveyors with varying skills and personalities have left many wishing for something better.
DNV is the first organization to come along and offer a noticeably different approach to deemed status. They offer accreditation built on 2 components:
- A set of hospital standards, National Integrated Accreditation for Healthcare Organizations (NIAHO)
- Additional requirement to achieve ISO 9001 certification, or at least ISO 9001 compliance within the first 3 years
The NIAHO standards are basically the Medicare Conditions of Participation (CoPs). The ISO 9001 standards are a broader framework and set of principles for operating an effective organization, much like the Baldrige framework for performance excellence. Within the ISO 9001 standards is a major focus on 3 things:
- Alignment with strategy
- Clear and effective quality management system
- Consistent process execution
Which way should you go?
For me, the answer lies in figuring out what it takes for your organization to implement and sustain processes that provide high-quality and safe patient care.
The Joint Commission
The Joint Commission has done a great job of putting the CoPs in context for hospital leaders through a larger set of standards that define how high-quality/safe patient care should be delivered. The standards have evolved over time through the work of healthcare leaders and subject matter experts, along with input from accredited organizations, as they have tested new standards.
There are leadership standards that focus on aligning the organization around a set of improvement priorities, a quality management system and consistent process execution. But these tend to take a back seat to the clinical standards by both the accredited hospitals and The Joint Commission survey teams.
DNV
DNV takes a different stance. You must comply with the Medicare CoPs. DNV doesn’t supplement the CoPs with any additional patient care standards or patient safety goals. So how care is provided is left up to the individual hospital. The framework for deciding which processes to focus on, how to design/improve them and how to manage their performance lies within the ISO 9001 requirements that the organization must learn and be in compliance with by their third year of accreditation under DNV.
The upside for many is that DNV doesn’t prescribe (for example) that you mark the surgical site and do a time-out before every surgical procedure. Your leadership team decides if that’s something important for your organization to do. If it is, you define how it will be done and ensure that it’s done consistently.
The downside is that DNV doesn’t provide the depth of resources that you see on The Joint Commission’s website for designing and implementing important patient care and safety processes, like the Universal Protocol for preventing wrong site surgeries. You’ll need to look to other resources for that guidance. On top of that, your leadership team, including physician leaders, has to understand and know how to execute the ISO 9001 framework and standards – no small (or inexpensive) task.
My advice
In my nearly 30 years of experience working with hospital leaders to help them comply with Joint Commission standards and the CoPs, I think the secret to success in meeting any regulatory agency’s expectations starts with having strong hospital and medical staff leaders. These leaders should be able to integrate compliance with the basics of safe, quality care into the strategic priorities of the organization rather than relegating that activity to a single department or a few individuals.
Equally important is a structure and process for holding individuals (hospital and medical staff) accountable for implementing the basics of safe, quality care. There also has to be a solid performance improvement function within the organization to support the design of new processes and improvement of existing processes that routinely fail.
Perhaps a new approach to deemed status/accreditation is just what you need. Achieving compliance with ISO 9001 will cause you to examine your structure and processes for leading and improving your healthcare organization.
On the other hand, for those who are Joint Commission accredited and feeling challenged to meet those expectations, you might want to simply take a deeper look at the Leadership and Performance Improvement standards in the accreditation manual.
I think I’d try that first!