“Essentials”

Joint Commission International’s

Essentials of Health Care Quality and
Patient Safety

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by Joint Commission International (JCI)
The State of Global Health Care
 Each year 1 million people
die from complications
following major surgery
 Nearly 1 in 10 patients is harmed as a result
of a medical error
 Estimated that 50% of complications and

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deaths could be avoided if certain basic
standards of care were followed

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 Adverse Events in Healthcare
– The problem of adverse events in health care is
serious
– 10% of hospital patients suffer an adverse event each
year (UK, New Zealand, Canada and Europe)
– 16.6% of hospital patients suffer an adverse event
(Australian study)
– 98,000 hospital deaths every year through error (USA)
– 1.4 million hospital patients worldwide acquire HAI (at any

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given time)
– UK: 100,000 cases of HAI lead to 5,000 deaths a year
– USA: 1 out of every 135 hospital patients acquires HAI

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 Economic Impact of
Patient Safety Problems

– The economic impact is important:

– UK: costs as high as US $6 billion a year
– USA: about US $29 billion a year
– The problem of adverse events in
health care is even more serious in

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developing countries.
– Less data is available

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 JCI Mission
 Improve the safety
and quality of care
in the international
community
–through the provision of education,

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publications, consultation, evaluation,
and accreditation services

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How We Meet Our Mission
 Accreditation of health care
organizations worldwide
 Assisting Ministries of Health
and governmental agencies to
strengthen the role of quality
oversight at the country level

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 “Essentials”

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 Organizational Base

– Joint Commission International (JCI) is the

international arm of The Joint Commission
(USA).
– Both organizations are independent, non-profit,
non-governmental agencies

– Since 1994, JCI staff have worked in 80

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countries to provide education, consultation,
and/or accreditation services

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 Essentials

– Quality and safety improvement framework

designed to help organizations focus on the
risk areas that have the greatest impact on
patient safety

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– JCI can better serve organizations at every
stage in their journey to higher quality care

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 Essentials

Essentials can help to:

 Determine levels of risk to patient safety in a health
care organization
 Develop strategies to mitigate risks

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 Better allocate resources to improve quality and
safety

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Essentials System Design
Essentials was designed for use by:
–Governmental organizations (Ministries
of Health, regional or municipal health
authorities)
–Multinational organizations, such as
international insurance providers

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–Hospital systems
–Intergovernmental organizations

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How Essentials Is Applied
Essentials will help an organization to:
–Identify the risks that have the greatest
impact on safety
–Design an approach for addressing these
risks
–Implement changes

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–Periodically reassess the impact of these
changes

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Why JCI Developed Essentials

– Provide objective information that will

guide strategic and financing decisions
– Provide the tools to gather and analyze
the level of risk
– Enable health care purchasers and

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insurance companies to direct patients
to lower risk healthcare settings

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Why JCI Developed Essentials
– Many healthcare organizations
frequently lack the fundamentals to
begin the quality journey
– Essentials helps provide direction and a
framework for implementing other JCI
quality improvement and patient safety

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tools

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JCI Methodology / Framework
– Builds upon scientific research, best
practices and Joint Commission
experience in developing evidence
based standards for evaluating level of
risk in its organizations
– JCI uses a similar approach in

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development of other solutions based
programs and services

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How Essentials & Accreditation Differ
– Essentials is different from JCI accreditation,
which recognizes hospitals meeting the
highest standards for care
– Essentials is a resource for developing
organizations working on more fundamental
elements of quality and safety

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– No formal recognition – such as
accreditation or certification -- given to
hospitals using the Essentials framework

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 Overview of
International Essentials for
Quality and Patient Safety

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Essentials Address Five Risk Areas
– Developed from extensive international
healthcare literature and experience
– Ten Criteria for each Risk Area provide
clear and achievable risk
reduction strategies
– Progressive “Levels of Effort” are

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identified for each Criterion

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Overview of Five Risk Areas
Five widely recognized domains of risk
1. Leadership Process and Accountability
2. Competent and Capable Workforce
3. Safe Environment for Staff and Patients
4. Clinical Care of Patients

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5. Improvement of Quality and Safety

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Risk Area #1: Leadership
Process and Accountability

– Responsibilities and accountabilities

identified
– Leadership for quality and safety
– Collaboration and cooperation at all levels
– Quality requirements in contracts
– Quality, patient safety, and risk

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management are integrated

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Risk Area #2:
Competent and Capable Workforce
– Personnel files and job descriptions
– Review of credentials of physicians
– Review of credentials of nurses
– Review of credentials of other health
professionals

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– Staff are oriented to their jobs

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Risk Area #3: Safe Environment of
Staff and Patients
– Regular inspection of buildings
– Control of hazardous materials
– Fire safety program
– Biomedical equipment safety
– Stable water and electricity sources

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Risk Area #4: Clinical Care of Patients

– Correct patient identification

– Prior to medication or blood administration,
procedures, surgery
– Informed consent
– Before surgery, anesthesia, use of blood
products, and other high risk procedures

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– Medical and nursing assessments for all
patients
– Standardized and timely

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Clinical Care of Patients continued

– Laboratory services are available and

reliable
– Diagnostic imaging services available,
safe, and reliable
– Planned and provided care is written

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– Guidance on uniform documentation and
care planning
– Monitoring data are used to improve care

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Clinical Care of Patients continued
– Anesthesia and sedation are used
appropriately
– Policies and procedures
– Data on complications and incidents used to
improve
– Surgical services appropriate to patient needs
– Medication use is safely managed
– Complex set of processes; selection, storage,

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prescribing, dispensing, administration, and
monitoring
– Patient are educated to participate in their
care

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Risk Area #5:
Improvement of Quality and Safety
– There is an adverse event reporting
system
– Adverse events are analyzed
– High risk processes and high risk
patients are monitored

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– Examples: emergency care, resuscitation
– Patient examples: immune-suppressed or ,
comatose patients

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Implementing the Essentials

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How Can JCI Help?
– JCI will assist organizations through
education programs, and if needed, expert
assistance and advice
– JCI will help organizations collect their data
and compare it with other similar
organizations

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– JCI will use an on-line collection and
database tool

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 For more information:
The Joint Commission Resources Web Site
www.jcrinc.com

The Joint Commission International

www.jointcommissioninternational.org

Joint Commission International Center for Patient Safety

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www.jcipatientsafety.org

cramponi@jcrinc.com

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