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June 30, 2008

Is the Joint Commission Really Necessary?

Paperwork72x721 The declared mission of this private organization is "To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations." It is often believed (erroneously) that The Joint Commission is an American or even a worldwide public authority, which is not the case. This perception occurs because of the company's deeming power - "Under 42 U.S.C. §§ 1395bb(a),(b), a hospital that meets Joint Commission accreditation is deemed to meet the Medicare Conditions of Participation" (which is a requirement for Medicare reimbursement).

The Joint Commission is therefore virtually a monopoly, enjoying unique statutory protection in the USA and collecting $113 million in annual revenue, mainly from the fees it charges US hospitals for evaluating their compliance with federal regulations. From what I am hearing the Joint Commission has been making the rounds among NYC Hospitals -- the most recent survey taking place at Bellevue Hospital. Nursing administrators have been reviewing with all of us “what to say and not say to a surveyor.” It seems to me that the Joint Commission is more of a punitive agency than anything else. Right or wrong?

In my more than 20 years of nursing practice, I have never met or seen the Joint Commission within the medical facility reviewing charts or interviewing staff. I must be working the wrong shift (nights)! Not a single question has ever been asked of me by a surveyor. As for the surveyors, the Joint Commission utilizes full-time salaried individuals, people who generally used to work within healthcare services, but who now work 100% of their time for the accrediting Commission.

What are your thoughts about the mission of the Joint Commission? Are they doing what they are supposed to be doing?

Source : The Joint Commission 

June 30, 2008 in Beka | Permalink


I had to drive with a Joint Commission surveyor to half of our clinical sites, we had twelve. One of the sites was in Norfolk, Nebraksa. A surgeon was with us, and had to get back to Omaha for a late surgery, the surveyor was aware of this but had us stop at the Johnny Carson museum in Norfolk so he could check it out. The same surveyor told us that we could check our waived survey results (urine for pregnancy)against one of our pregnant nurse's urine. Very funny right? NOT!!
Over the years the institutions that I have worked for have spent huge dollars paying salaries for people to just keep up on all the arbitrary rules that Joint makes up. Health reform should start here.

Posted by: P | Mar 12, 2010 10:00:51 AM

TJC is just a purchased product that the hospital uses for marketing purposes. Magnet status is the same. the hospital where i work actually hired a person from out side of the organization to write the script, book, what ever it is that is presented to AACN for Magnet status and of course just like Joint commission surveys we were given a script on how to answere surveyers. I have worked at hospitals that are not JC or Magnet that give great care are up to date with Evidence based Care and pay attention to HAC reduction abd they are saving monwy by not purchasing thes products and following their product wasing techiques.

Posted by: t | Jan 16, 2010 7:02:45 PM

Has anybody here ever gone over their financial statements? Yes, most of their revenue comes from charging hospitals for accredation, but that's where most of their expenses go, too. The real boogeyman is their investments. They actually lost about $27 million in the market in 2008, but in 2007, when the market wasn't so bad, they made 5 times as much money investing as they did accrediting ($5 million versus less-than-$1 million profit for doing hospital stuff). Over half the value of JCAHO is in investments, and over half their investments are in the stock market. I wonder how many of those stocks are in medical supplies and pharmaceuticals?
You guys are nurses, I'm not. (I do know many people who work in hospitals and hate JCAHO.) The next time your hospital has to buy unnecessary medical supplies or flush a whole bottle of meds down the toilet for a stupid reason, write your representative, and attach this:


It's not casual reading, but it's got the data. Page 13 shows how much money JCAHO had in the stock market in 2007 and 2008. Unfortunately, it doesn't have JCAHO's portfolio, because that information is private. A nice federal investigation could fix that.

Posted by: C | Oct 25, 2009 10:24:51 PM

Okay, everyone's points here are valid and as the Director of Quality Improvement at a small hospital, I am livid! TJC arrived at 12AM, no &$%*, 12AM !! It lasted all night and the whole next day!!! Then, they had the brass balls to charge our two MD, small specialty hospital $16000 for the overnight survey! On top of that, we have been surveyed 4 times in 3 years!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! They even had the audacity to combine two of the surveys and make us conditional. Our F/U survey was 2/09 and we had another full survey 6/09!!!!!! CMS and TJC screwed up numerous times and we had to pay the price each time with multiple full surveys. So, we had to pay the 16K or they would take away our accreditation status WTF???

My question is, where can WE complain about TJC and their thieving ways? How can we recoup OUR $?

Posted by: Tara | Sep 3, 2009 11:47:27 AM

TJC is going through some changes that will affect the unqualified staff they employ. You are right, it is time that TJC is surveyed.

Posted by: employee | Jun 5, 2009 2:56:13 PM

This is a JACHO joke.

They will never enforce anti bullying in the workplace. One bullies embellishes and the others lie for them.

This is a patient safety issues; I was bullied right out of the hospital with a director that wouldnt believe it was going on. Funny how we have accepted this standard and instead of helping each other, we put up with intimidation, screaming, nasty tones etc. ah but wait.. 'it didn't happen'.

Posted by: mik | Mar 12, 2009 12:18:11 AM

Ok, this should get readers rilled up a bit.

Joint Commission orders code of conduct for bad behavior
The Joint Commission says health care facilities, labs and other related organizations by next year must establish a code of conduct that defines and sets out a process for handling unacceptable behavior by health care workers, such as rude language, temper tantrums and bullying. The Commission said such behavior can impact patient care by causing breakdowns in provider communication and teamwork. Chicago Tribune (free registration) (7/10) , MSNBC (7/9)

Source : ANA SmartBriefs.



Posted by: beka | Jul 29, 2008 1:06:53 PM

JCAHO, not just no, #@#@ no. Usless in Home Health. Trying to make each patient's home into an ICU. The cost keeps rising, the survey's get longer, the paper we waste getting ready and then the stupid wasteful studies and policies we get after they leave would drive a sane person crazy. Lets dump them and then we would have time to actually care for our patients instead of writing about the little care they are actually getting.

Posted by: jane | Jul 24, 2008 1:57:27 PM



Posted by: SHIRL | Jul 24, 2008 1:16:56 PM

I was stunned when I learned that the JC was a private not even a government agency. How many shifts have I stole away to the quiet of a lone stall in the staff locker room (frequently my only respite during a 12 hours shift )only to be met with many a "quiz-flyer-JC do's and do nots", posted directly across from me-leaving me no choice but to read-and this caused irritation and I couldnt help but remove and dispose of the source before heading back to the floor with an attitude and thoughts running through my head;why are nurses idiots?Am I alone? And if this is a MAGNET facility why does it suck so badly? I could write a book, it is just comforting to read that I am not alone. There's too much "Best Practice" this and "JC" that.

Posted by: ellak | Jul 24, 2008 6:03:45 AM

Not only no, but $$#@ NO. They are a self perpetuating organization with no controls. They create new rules so they have to come back and keep charging the hospitals money. They must have a strong lobbyist and be in bed with the medicare folks.

Posted by: Debi | Jul 23, 2008 5:58:07 PM

As a nurse of 25 years I learned very quickly that I had no respect what so ever for JCAHO. IF they were so concerned about patient safety, they would look at staffing issues and they never do. They are more worried about whether the linen is covered or how many locks are on the door before you can get to your IV poles. And if they add one more piece of paperwork that has to be done in triplicate I may just retire! To me it's like the fox watching the henhouse.

Posted by: Samsaunt | Jul 22, 2008 10:42:00 PM

In a word NO.
They are inconsistent. Most of their focus points are absurd. Instead of a hospital utilizing disiplinary action to correct the few making mistakes, the JCAHO mandates are reducing personal accountability and driving UP health care costs AND not improving safety.
The dog and pony show comes to our hospital, during the summer months (we are in a resort; what a perfect excuse for a tax write off vacation for the family Hm-m-m-m)
I have never felt enlightened after they have been here, they have NEVER changed my practice. Scientific rational, evidence based practice and journal articles, have changed my practice.
It seems JCAHO is easily bribed with dinners or are easily distracted and steered away from glaring clinical issues by management.
JCAHO certification has done NOTHING to guarantee a regional standardization of care...or to guarantee that the public gets its' money worth.
Pay your money, get your site visit and blessing to operate---sounds like nothing more than Social Loan Sharking..

Posted by: edie | Jul 22, 2008 7:35:45 PM

In a word, No. Over the last 30 years of TJC inspections, there has been poor consistency in their reviews and suggestions. Each team comes with their individual ideas of what meets the Joints requirements and what doesn't. You then spend the next three months doing paperwork to improve what they found in need, and then the new standards come up for the next year. You can never catch up. Seems they are always looking for something to catch everyone on. Medication Reconciliation they have more questions abou this than answers.
Too much time on paper work and not taking care of patients.

Posted by: Patrice | Jul 22, 2008 6:35:27 PM

TJC relies on self reporting for sentinal events. In the past the hospital was allowed to pick the medical records for the closed medical record review. TJC adds very little to patient safety or quality improvement. Their surveyors are ill informed and not in touch with current health care trends. Insurance plans are the ones that promote TJC if that's not telling, I don't know what is!

Posted by: Rick | Jul 22, 2008 3:31:20 PM

I think that TJC had it's purpose, but now that we are into the P4P game and CMS is monitoring us closely on the Core Measures and patient safety goals, TJC is just another agency that is making money off hospitals who don't have enough to begin with... Not only that, but TJC always has to be a WEE bit off the mark so that you have TWO or more sets of goals to meet. CMS AND TJC. Ridiculous.

Posted by: jode311 | Jul 22, 2008 1:29:59 PM

Just last week we were told that we now had to make sure our water-soluble lubricant and the triple antibiotic ointment had to reside behind locked doors.

Joint Commission, you see.

"Nuff said.

Posted by: Kim | Jul 22, 2008 1:26:10 AM

JCAHO sets itself up as the arbiter of truth, safety and patient care when it is little more than a bureaucratic backwash of useless political agenda and stultifying nonsense. The wake left after a JCAHO "visit" generates more policies and time wasting paperwork than almost anything I have ever seen. The "issues" change with every three year Monday-through-Friday nine-to-five survey and yet nothing is ever truly accomplished. The system is self perpetuating, because it has tied itself to Medicare reimbursement thus making itself the worlds longest staying unwelcome guest. All hospitals should need are inspections by the local Health Departments. Then maybe the hospitals can put all that wasted money into hiring some staff.

Posted by: paula walla | Jul 15, 2008 7:26:38 PM

I think the medical profession should get together and "stop the insanity" that JCAHO has become. The amount of paperwork that needs to be completed just to meet the standards has become absurd!!

Posted by: Alice | Jul 14, 2008 4:50:41 PM

The joint commission makes money off the facilities they survey. Hospitals are closing everyday r/t financial problems. If joint commission did their job effectively, there would not be a hospital standing. They need to visit the hospital on weekends & nights, when most facilities are short staffed. They need to speak with the staff/worker bees, not mgt.

Posted by: angela ford | Jul 14, 2008 12:13:06 PM

Having worked at a variety of hospitals, I have come to the decision that the TJC does not standardize its evaluation process. In one hospital, patient names on a board are acceptable. Go to another hospital "down the road" and the hospital is penalized for violating the privacy of the patient.

While I totally agree that the patient's safety is the goal I think that the process for determining whether that safety is being insured is cumbersome and costly.

I think the government should strip off the layers of JCAHO and see where they are spending their dollars. Are there enormous corporate salaries?

It is time JCAHO is evaluated by the medical community to see if they are meetiing the standards that they profess to uphold.

Posted by: Olivia | Jul 14, 2008 7:00:49 AM

I think that the Joint Commission, similar to most government agencies (quasi-governmental as it is) has become a burden rather than a help and promulgates standards that are easy for it to check (PAPERWORK)rather than addressing the real needs of patient care and safety in doing so--nurse competencies, education and support are now limited by the burdens of proving JCAHO compliance.

Posted by: Rae | Jul 14, 2008 4:36:32 AM

I have had a few years of exposure to the Joint Surveyors. I have found that they can either be very helpful in pointing areas that could be improved or come in with a preconcieved opinion and no matter what data you have to refute their findings, it will not be looked at. Our recent audit had surveyors that were very rude and unprofessional to many of our staff. This type of behavior leaves a very bad impression for the whole company.

Posted by: Lori | Jul 8, 2008 11:42:11 AM

I think that the biggest problem is the cost imposed on folks who want to attend their seminars and learning events. Cost is obscene.

Posted by: Sherry | Jul 8, 2008 10:00:32 AM

I just heard from an manager ( 45 years as a hospital based RN ) that in the old days the Joint Commission was in a sense " non-punitve in nature " and that hospitals shared survey findings with one another as a problem solving mechanism ? True ??


Posted by: beka | Jul 6, 2008 4:48:57 PM

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