30 Minute Interview

'JCI Would Increase Focus on India & South Asia'

For more than 50 years, The Joint Commission has been working to improve the quality and safety of healthcare services. Today, as one of the largest accrediting body of healthcare organisations in the United States, The Joint Commission surveys nearly 20,000 healthcare programmes through a voluntary accreditation process. With quality being the buzzword in Indian healthcare industry now, and nine JCI accredited organisations in India, Joint Commission International (JCI) is surely gaining a strong foothold in this part of the subcontinent. Nancy Singh catches up with Dr Paul Chang, Managing Director, Asia-Pacific, JCI, on the organisation's business plans. Excerpts:

Dr Paul Chang Managing Director, Asia-Pacific, JCI

What is the average rate of applications that JCI receives per year from the world?

JCI will complete more than 110 surveys this year. It has an accreditation renewal rate of approximately 91 per cent.

Which ones are in the pipeline in India?

Seven organisations are in the pipeline. I'm afraid I can't reveal their names.

If you compare the cost of JCI with other accreditation bodies, JCI seems costlier. So what are steps taken to reduce the cost?

The professional fees charged by JCI are constant around the world because the services are the same, no matter where they are provided. The fees are proportional to the size and complexity of the accreditation survey required the travel cost of the surveyors. Whereas this can be considerable, JCI has now trained many surveyors around the world and continues to do so in order to mitigate these travel costs.

If there is a survey in Asia, we may include Thailand and nearby areas together to reduce the overall travel cost. We also try to make our surveys efficient depending on the need of that organisation's demand. Hence, if an organisation is going in for a re-accreditation, we do not tend to repeat the parameters which have already been met. This also helps in reducing the cost. Having said all this, comparing JCI with other accreditation services is not necessarily meaningful, because the purpose of accreditation is not the receipt of a diploma on the wall. It is the kind of transformation that an organisation undergoes during the entire accreditation process, not only at the time of survey. Every institution has to decide the value of that transformation for itself. We believe that JCI accreditation provides value by improving processes within healthcare systems.

Please brief me about the tracer methodology that has been adapted by the JCI.

The tracer methodology was developed by our parent organisation, The Joint Commission. Tracer methodology is an evaluation method in which surveyors select a patient, and use that individual's record as a roadmap to move through an organisation to assess and evaluate the organisation's compliance with selected standards and the organisation's systems of providing care and services. Surveyors retrace the specific care processes that an individual experienced by observing and talking to staff in areas that the individual received care. As surveyors follow the course of a patient's treatment, they assess the healthcare organisation's compliance with JCI's standards. Tracing the care of several patients easily reveals the way the systems of care function, or where they need improvement; and provides the needed evidence to score the standards.

Tell us more about your strategic partnership with Astron.

Having a local partner in India keeps the JCI brand visible among the 10,000 plus hospitals and healthcare organisations in India and Astron has a proven record of successful educational activities.

How are the Asia-Pacific standards indigenised as per the local needs?

We are an international body and hence the standards are definitely the same. But yes, since all our standards are in English, we do have a translator for non-English speaking countries like China, Indonesia etc. Also, certain countries have law pertaining to their culture. So, we do tend to include them in our standards. For example, if a country has a stringent law pertaining to narcotics, we obviously prioritise and include them. Secondly, to meet the local needs, we have even strategically partnered with local bodies like ASTRON, in India so that all the traveling costs and time is reduced significantly. In the future, we are thinking of such strategic partnerships in other countries.

Tell me how does JCI benefit from ISQua accreditation?

ISQua, a non-profit, independent organisation with members in more than 70 countries, is known as the accreditor of accrediting bodies. Accreditation by ISQua provides assurance that the standards, training and processes used by JCI to survey the performance of healthcare organisations meet the highest international benchmarks for accreditation entities.

When it comes to Indian healthcare, what do you think are its strengths and weaknesses in terms of quality standards?

The greatest strength of healthcare in India is the existence of excellent institutions of higher learning, which produce very capable professionals. The challenge is that with 33 states and other territories which regulate healthcare within their boundaries, there is a need to strengthen the regulatory activities that govern quality of care, in order to limit the disparities in the quality of care provided in hospitals.

How do you ensure that quality standards are maintained after receiving accreditation? Isn't three year a significantly longer time to review the standards?

Quality improvement doesn't end with the award of accreditation. Organisations are required to submit progress reports on areas of partial compliance and related to the International Patient Safety Goals, and in the near future they will submit a self assessment analysis against all the standards at the mid point in their accreditation cycle. In addition, JCI will visit an organisation when necessary to investigate complaints or other information, or to evaluate the organisation when it makes a major change such as moving to a new facility or new ownership.

JCI would be undergoing revision the third time. So, over the years in what manner have the guidelines been modified?

The 'Joint Commission International Accreditation Standards for Hospitals, Third Edition' was published in 2007 and became effective from January 2008. Revisions are needed to keep the standards at their optimal achievable level as the science and technology of patient care changes, new strategies to improve quality and patient safety are introduced. For example, the International Patient Safety Goals, and new ethical and social issues arise, such as staff health and safety, harvesting and transplantation of organs and tissues, and communicable disease outbreaks. Previously, JCI introduced standards for the evaluation and treatment of pain, and for care of the dying patient.

Please elaborate on your future plans with regards to Asia-Pacific, especially India.

JCI's future plans include increasing the focus on India and the entire South Asian subcontinent. We believe that there is great demand for meeting international standards of performance, by the growing stratum of Indian society that places emphasis on the quality of all services it receives, including healthcare. Whereas this group will pay attention to the 'award' of accreditation now, eventually - and not in the distant future - it will actually demand the kind of organisational transformation that only a seasoned leader in international accreditation, such as JCI, can assist a hospital in accomplishing.

nancy.singh@expressindia.com