Like people, institutions like to be cited for their accomplishments with praise and medals. When it comes to hospitals, which daily deal with life-and death situations and are subject to medical malpractice lawsuits, getting accreditation from an objective authority is highly sought after.
A growing number of Israeli medical centers now boast on their stationery and in their lobbies the round, gold symbol of the Joint Commission International (JCI).
Established in 1998 as a division of Joint Commission Resources, Inc. a private, not-for-profit affiliate of The Joint Commission that has accredited more than 21,000 healthcare institutions in the US, JCI focuses on raising the quality of patient care and enhancing patient safety in some 60 other countries, including Israel. Over 1,000 healthcare institutions around the world have been accredited outside the US. While this recognition is not mandatory, the JCI gold medallion is considered a seal of approval by medical travelers from the US and other countries, and is recognized as a mark of high quality and patient safety in those organizations that attain JCI accreditation.
There are many hundreds of criteria for a high quality of hospital medicine – from having skilled anesthesiologists in surgical theaters and functioning MRIs to how carefully doctors and nurses wash their hands in the bathrooms, the rate of infections in neonatal intensive care units and the preparation and storage of food served to patients and in the cafeteria.
JCI hires salaried surveyors – doctors, nurses, pharmacists, engineers and other professionals – who are employed or have worked in the past within healthcare services but who may devote all or part of their time for the accreditation survey process. The surveyors travel to healthcare organizations around the globe to evaluate their operational practices and facilities against established JCI standards and elements of performance. Different levels of standards are applied to hospitals according their size, location, departments, academic affiliation and status – from community hospitals to tertiary academic medical centers. JCI-hired consultants, such as Judith Moomjian, teach the standards and survey process to hospitals and ministries and assist them in their preparation for accreditation survey readiness and in developing programs to improve quality of care and patient safety.
FOR ISRAELI hospitals, Moomjian is “Ms. JCI.” The organization’s principal consultant has been here so many times in the last 17 years that friends joke she has come on aliya.
She has more than 35 years of experience in nursing, quality management, healthcare administration and as a leader in hospital accreditation and certification preparations. She is well familiar with most Israeli hospitals, even those in east Jerusalem and some geriatric and psychiatric institutions, and knows as much about healthcare here as some senior Health Ministry officials (even though she doesn’t speak Hebrew).
She has extensive experience as a former Joint Commission surveyor; in critical care, dialysis and transplant programs; in hospital administration and quality performance and improvement, with educational and operational expertise in human resources, competency, performance improvement, patient safety, medication management, infection prevention and control.
“I have been to Saudi Arabia as well as to Qatar and Egypt,” she told The Jerusalem Post
in an interview. Also, I have worked extensively in Europe, the Mideast, multiple Asian countries, South and Central America and more. I’ve been working in Israel with hospitals, health funds and the Health Ministry for more than a decade – since Israel began to show interest in JCI accreditation.”
Born in Houston, Texas, she was taken by her parents back to Manhattan as a baby, Moomjian told The Jerusalem Post in an interview. Her father was the private pilot of American businessman, investor, film director, philanthropist and eventual recluse Howard Hughes, and her mother was a secretary.
Moomjian earned her bachelor’s degree in health sciences at Empire State College, nursing degree at Mt. Sinai Medical Center School of Nursing, and a master’s degree in public administration at C.W. Post College of Long Island University. She began her career as a nurse, but then switched to healthcare administration in the surgical and urology departments at Long Island Jewish Medical Center and was coordinator of the renal dialysis program at Stony Brook University Hospital and Booth Memorial Medical Centers. Among her honors, she is a fellow of the American College of Healthcare Executives and a member of the Pi Alpha Alpha Honor Society for Healthcare Administration. She is certified as a professional in healthcare quality by the National Association of Healthcare Quality.
At a conference of healthcare assessors, people encouraged her to become a surveyor and introduced her to staffers at the Joint Commission, which existed under different names over the years but developed an official impact in 1965, when the US federal government decided that a hospital that met Joint Commission accreditation met the Medicare and later Medicaid conditions of participation.
“At the Joint Commission, you do not need to be an expert in everything medical to be a surveyor or Joint Commission consultant. Our job is not there to tell hospitals how to run their clinical services but rather how to apply the Joint Commission standards and to perform clinical processes according to evidence- based guidelines and data,” she explained. While there are other healthcare accreditation organizations in the US and internationally, said Moomjian, “our standards are the most comprehensive and are highly respected.”
She noted that every US state has its own department of health to ensure that institutions meet basic state and federal medical standards. But some states, as in New York and California, are much more stringent. “Joint Commission certification is not mandated by the government, but many health maintenance organizations require it before they accept the organizations into insurance plans.”
Moomjian was first brought to Israel by the largest health fund, Clalit Health Services (then Kupat Holim Clalit) about a dozen years ago. Clalit was very eager for its 14 general, geriatric, psychiatric and rehabilitation hospitals to be accredited by JCI. Soroka University Medical Center in Beersheba, the Rabin Medical Center- Beilinson Campus in Petah Tikva, Meir Medical Center in Kfar Saba and Emek Medical Center in Afula were the first in Israel to get the gold seal.
“I kept flying back and forth to teach the hospital personnel about meeting standards, becoming self sufficient, running training programs and teaching them how to survey themselves,” she recalled. “Hospitals outside the US regard accreditation as a way to ensure a high quality of care and improve performance. I can’t say if it has reduced medical malpractice suits, but institutions that we accredit are run better, and Israel’s Health Ministry, which wants all of its hospitals to be accredited as well, is watching the process. The ministry’s designated coordinator for accreditation is not an expert on our standards, but she coordinates the JCI accreditation process in Israel and assists the hospitals in achieving accreditation and reaccreditation.
Accreditation is a three-year cycle. Once hospitals pass their accreditation survey, they must be resurveyed every three years and pass each accreditation survey in order to retain their accreditation.
Private hospitals do not have to have emergency departments, so the standards they must meet are less demanding. The survey process and standards are adapted to each organization, based upon the services and programs they provide.
“When we do our surveys, we speak to staff and patients and assess patient satisfaction. We examine numerous departments, look at patient privacy, medication storage and many other factors. There should be plenty of culturally appropriate signage and pictograms, as indicated, for diverse populations.
Then we trace medical records of individual patients, observe patient care and decide if accreditation standards requirements are met.”
Although the Health Ministry expressed shock and anger when the media uncovered and recorded on video cases of abuse of psychiatric and geriatric patients in institutions in the past few years, Moomjian said that she and her team have not discovered cruel or violent treatment in such hospitals here.
“In various institutions in other countries around the world, however, we have seen the use of restraints and seclusion for some patients. We have seen overmedicated patients, four-limb restraints and uncomfortable metal beds in wards. These are included in our reports.”
JCI teams give a lot of attention to nosocomial infections that patients get due to being hospitalized.
“We have a whole chapter in our manual on prevention and control of hospital infections. I know that whole families often come to hospital wards to visit patients; this can cause problems. There are worldwide challenges regarding nosocomial (healthcare-acquired) infections, such as in neonatal intensive care units, but you have had success in eradicating some of them. There are, however, challenges to have an adequate number and availability of infection-control specialists in the country,” she said.
THE MAJORITY of Clalit- and stateowned general hospitals here have JCI accreditation today or are in the final stages of being accredited. Clalit’s Beit Loewenstein Rehabilitation Center in Ra’anana has also received the JCI gold seal. Jerusalem’s Shaare Zedek Medical Center, which spent several million shekels to upgrade itself, has just received its first accreditation.
The Hadassah Medical Organization has not yet gone through the process of JCI accreditation for its two Jerusalem hospitals.
The private Assuta Medical Center in Tel Aviv has been accredited twice, as hospitals have to be surveyed every three years to continue to show the gold emblem. Assuta Ashdod, the public hospital built for the government that will be fully opened in November, is busy getting organized, said Moomjian, but it plans to pursue accreditation in the near future.
“When they are completely open, we will begin to work with them in preparation. I’ve visited a number of private Israeli hospitals that have begun the process as well. Nazareth’s French Hospital has just received accreditation, and I was at St. Joseph Hospital in east Jerusalem to help them to prepare for their first survey.”
Accreditation of Israeli medical centers should take, from start to finish, no more than a year to 18 months if they are solidly committed to the process. I advise them to establish a timeline and teach them how to work with project management. After consultation initial surveys, we leave detailed reports and advise them to work on improvements. Then we have a consulting team come back for a mock survey so we can inform them how far they have progressed and additional work that might be needed.”
Moomjian noted that in the US, Joint Commission surveyors now come unannounced so that medical institutions cannot make special preparation to look better and be on their best behavior. But abroad, as arrangements for translators and hotels for the surveyor teams have to be made, there can be no surprise visits.
“We have a firewall between consulting and accreditation services to assure that there is no perception of bias,” she continued. “I am one of the JCI consultants, so I am not involved in actual granting of accreditation. My job is for teaching, organizing and conducting mock surveys and the like. We do not share information with those who conduct the accreditation surveys. If we did, the hospitals would be afraid to reveal their challenges and problems. Every hospital has difficulties. There is never 100%.”
Israeli hospitals, especially in the periphery, have serious shortages of doctors, and the shortage of nurses exists all around the country. So the institutions have to manage with what they have.
“There used to be Israeli patients in the hallways, especially in the winter and in internal medicine departments, but this is improving.
Once hospitals get accreditation here, they can go even higher and get clinical-care-program certification for their specialized and high-functioning clinical care programs. This is a highly specialized focus and very prestigious, she said.
IF SHE were sick, internationally, where would Moomjian want to be? “In a JCI accredited hospital.”
As for Israel, because of its universal national health insurance, accessibility, superior teaching in university medical schools and high levels of community health services in the health funds, the JCI principal consultant thinks that the healthcare system here, despite its problems, provides excellent care and services.
“But Israeli hospitals have to stay committed to upgrading themselves, despite financial and manpower problems. Don’t focus on the survey and certification processes. Worry about patients. Our gold seal is just a stamp of recognition for high-quality care and patient safety,” she concluded.