The Joint Commission. . . SAFER™ Than Ever! | Joint Commission
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The Joint Commission. . . SAFER™ Than Ever!

May 17, 2017 | 2316 Views

By P.J. Sanders
Business Development Specialist
Ambulatory Care Services
The Joint Commission

The Joint Commission’s new process for helping health care organizations identify risk and improve their patient care processes – the Survey Analysis for Evaluating RiskTM (SAFERTM) Matrix – has been fully integrated with the Ambulatory Care Program’s accreditation program since the beginning of 2017.  An integral part of The Joint Commission’s multiphase Project REFRESH initiative, SAFER’s streamlined, innovative approach, applies to all Joint Commission accreditation and certification programs.

The SAFER Matrix (view SAFER Matrix Extranet Tool Video Demo below) replaces our former scoring methodology and allows our surveyors to place each Requirement for Improvement (RFI) within a matrix according to the issue’s likelihood to cause harm to patients, staff, or visitors, and according to the scope of the cited deficiency. It also allows for improved real-time, on-site evaluations of potential deficiencies.

Beyond SAFER
So, now that we have experience working with the new SAFER Matrix, let’s take a look at other REFRESH innovations underway. As you may recall, Project REFRESH is The Joint Commission’s multiphase process improvement project simplifying and modernizing various aspects of our pre-survey, on-site survey, and post-survey activities, intended to provide more transparency to the accreditation process. By any means, REFRESH is a successful undertaking, as indicated by the following:

  • Redesigned Evidence of Standards Compliance (ESC) form to help organizations better describe the critical aspects of their corrective actions and promote successful submission of ESCs.
  • Reduction in number of Elements of Performance (EP) Project eliminated 85 Ambulatory Care EPs and 50 Office-Based Surgery EPs, as explained in our last blog.
  • Phase IV of the EP Review Project will continue to consolidate or eliminate standards requirements across all accreditation programs.

Your Input Makes A Difference!
Through feedback gathered from you, our valued accredited ambulatory care customers, as well as insights from our Ambulatory Customer Advisory Councils, recent on-site surveys, and targeted market research, we’ve made significant positive changes to the on-site survey process which will continue to bear fruit in the months and years ahead.

Find in-depth information regarding the SAFER Matrix enhancements on the new SAFER informational portal or please submit your questions to




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