The Joint Commission launched its nationwide Cooperative Accreditation Initiative in 1995 to reduce the cost and duplication of survey and inspection activity experienced by hospitals and other health care organizations. Under this initiative, The Joint Commission strives to better coordinate activities among the various public and private sector organizations that provide quality oversight to health care organizations. The Cooperative Initiative permits The Joint Commission to substantially rely on the process, findings and decisions of other oversight or accrediting organizations in circumstances where The Joint Commission would otherwise conduct potentially duplicative surveys of organizations seeking dual accreditation.
In March 2002, The Joint Commission enhanced the Cooperative Initiative by providing an additional category of agreement with other accrediting bodies. The new Cooperative Initiative now provides different requirements for cooperative accrediting agencies, depending on the level of duplication with The Joint Commission’s standards and survey process for the mutually accredited organization. For example, agencies that accredit health care organizations or components for which The Joint Commission has separate standards and accreditation programs are eligible for Comparative agreements since their accreditation requirements are comparable to The Joint Commission’s. Entities that focus more on the technical or clinical aspects of departments or services of health care organizations (for example, radiology services and rehabilitation units) are eligible for Complementary agreements since their accreditation requirements complement The Joint Commission’s by covering additional or more detailed aspects of care delivery.
To be considered for a Cooperative agreement with The Joint Commission —either Comparative or Complementary—an interested accrediting organization must meet the following basic threshold eligibility criteria:
- Be a non-profit, non-governmental organization.
- Be recognized by state or federal agencies.
- Have an on-site survey cycle of three years or less.
- Agree to maintain an approach to public disclosure of organization findings comparable to The Joint Commission’s approach.
- Have a customer base that is common with The Joint Commission’s.
Comparative agreements
To be eligible for a Comparative agreement with The Joint Commission, an accrediting body must demonstrate comparability with the basic threshold criteria mentioned above, as well as overall comparability with Joint Commission standards, survey process, methods of ensuring surveyor competence, and accreditation policies. These policies include the conduct of unannounced surveys, the identification of National Patient Safety Goals, self-assessment, the reporting of performance measurement results, the identification and analysis of sentinel events, and the use of public input and complaints about accredited organizations in the survey process. Additionally, The Joint Commission maintains a strong commitment to public disclosure of accreditation status and expects comparable approaches to be maintained by cooperative partners. Finally, accrediting bodies participating in this Cooperative Accreditation Initiative option must agree to reimburse The Joint Commission for personnel and travel-related costs associated with administering the program.
A health care organization component that is accredited by a comparative cooperative partner will be exempt from The Joint Commission’s tailored survey policy. However, the recognition will not apply when a component falls under the auspices of a Joint Commission accreditation program for which The Joint Commission has federal deemed status, and the cooperative accrediting body does not have deemed status for the same program. The Joint Commission’s comparative partners have passed an extensive review of their standards and standards development process; survey process; selection, training and monitoring of surveyors; and accreditation decision process. The following organizations have Comparative agreements with The Joint Commission:
- College of American Pathologists (CAP) -- Laboratory
- COLA -- Laboratory
Complementary agreements
Accrediting organizations that establish Complementary agreements with The Joint Commission must also demonstrate comparability with the basic threshold criteria mentioned above; however, they will not be required to maintain comparability with The Joint Commission’s standards and survey process applicable to the unit, department or service of an organization subject to review. In most cases, the standards and survey process of these partners are more focused on the technical and clinical aspects of the department or service within a health care organization and are not applicable to the entire organization. During survey activities, such as patient and systems tracers, The Joint Commission could visit the unit or service, even if the unit or service is accredited by a cooperative partner. All applicable Joint Commission standards could be assessed for compliance during such visits.
For consumers, complementary recognition provides the benefit of knowing that a health care organization has voluntarily met the standards of multiple accrediting bodies, including those with a specific focus on one department or service. The Joint Commission provides the public with information about complementary partners on the Quality Check® segment of our website, including a direct link to the cooperative partner’s website, providing consumers with quick access to additional information on the performance of the mutually accredited organization. In a reciprocal fashion, the complementary cooperative partner agrees to display The Joint Commission status of its accredited organizations. The following organizations have Complementary agreements with The Joint Commission:
- American Society for Histocompatibility and Immunogenetics (ASHI) -- Tissue/Immunology
- American College of Surgeons-Bariatric Surgery Accreditation Program --Bariatric Surgery
- American College of Surgeons-Commission on Cancer (ACoS-COC) -- Cancer Programs
- American College of Radiology (ACR)-- Radiation Oncology
For more information, contact Mark Crafton, executive director, State and External Relations, in the Division of Business Development, Government & External Relations, at (630) 792-5260 or visit www.jointcommission.org.
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