Safety and Quality Standards ~ Driving Patient Expectations


Cost and quality don’t always mesh, but these two factors are the most common reasons that people travel abroad for health care.  Americans, for example, travel to India, Thailand, Singapore, Costa Rica, and other countries for joint replacement, cosmetic surgery, dental treatments, or heart surgery to take advantage of costs that can be drastically lower than in the United States. Some Americans also seek care outside their home country in order to access what are considered alternative treatments that are not yet approved in the United States.


One 2008 report found that more than 750,000 Americans sought treatment outside the United States in 2007 and projected that number to grow to 6 million by 2010. People in other parts of the world are also leaving their countries for medical care, sometimes coming to the United States.

The same report estimated that more than 400,000 non-U.S. residents will seek care in the United States. Deloitte Center for Health Solutions: Medical Tourism: Consumers in Search of Value: 2008 Survey of Health Care Consumers. http://www.deloitte.com/dtt/cda/doc/content/us_chs_MedicalTourismStudy(1).pdf (accessed Jun. 24, 2009).)

For those coming into the United States for treatment, the deciding factor is not always cost but instead the reputation for high quality care with advanced technology and highly-specialized medical facilities and physicians, as well as the potential for quicker access to services that might not be as readily available in a patient’s country of origin.

Safety and Quality Standards

The challenges of seeking care in another country are significant and require careful consideration. Although some medical tourism firms tout relaxing destinations and amenities, high quality care and patient safety must always be the top priorities.

It is important to remember that despite medical breakthroughs and an ever-expanding knowledge base, providing safe, high quality care is a challenge for each and every health care organization around the world. Health care facilities still struggle to create the systems that achieve effective care, produce the desired results, and reduce the risk of unwanted outcomes.

Because standards of care may vary widely from one health care facility to another and from one country to another, it is important to look for assurances that a health care organization has publicly committed to safe, quality patient care. One of the best known symbols of this commitment is accreditation, a voluntary process that provides a universal standard of credibility.

In the United States, The Joint Commission has been recognized as a driving force in evaluating and promoting safe, high quality care for more than 50 years and is the leader in health care accreditation. An independent, not-for-profit organization, The Joint Commission was founded in 1951 by major medical societies in the United States to standardize the way patient care is measured.

Today, The Joint Commission accredits nearly16,000 hospitals, ambulatory surgery centers, outpatient clinics, home care agencies, laboratories, behavioral health facilities, and nursing homes. A Joint Commission-accredited health care facility must constantly strive to improve its performance and reduce risk.

The Joint Commission’s nationally developed accreditation standards cover all of the major clinical, management, and administrative functions that contribute to safe, quality care. This includes infection prevention and control, medication management, provision of care, and human resources. Accreditation helps an organization build a framework for improving patient safety and quality, based on evidence and best practices.

Joint Commission International

A host of care issues confronts patients who travel abroad to undergo treatment and then return to their home countries. Joint Commission International (JCI), established in 1997 as The Joint Commission’s international arm, applies standards specifically developed for international application.

JCI standards are developed with the input of experts from around the globe to assess and accredit health care organizations in more than 30 countries. JCI was created to meet the growing global demands for a standardized method of evaluating patient care and a demonstrated commitment to continuous quality improvement.

JCI works in more than 80 countries to continuously improve safety and quality in the international community, working at both the health system macro level as well as with individual health care organizations. JCI accreditation addresses many of the same clinical topics found in The Joint Commission’s standards for hospitals in the United States. JCI’s patient-centered standards are developed and reviewed by experts in various health fields across Asia Pacific, Europe, the Middle East, and Latin America.

In addition, JCI is accredited by the International Society for Quality in Health Care (ISQua) and, with The Joint Commission, is the world’s first World Health Organization (WHO) Collaborating Centre for Patient Safety Solutions dedicated to developing and disseminating patient safety solutions.

JCI offers accreditation for hospitals, ambulatory care facilities, clinical laboratories, care continuum services, medical transport organizations; and certification in disease- or condition- specific care for a variety of health care programs, including primary stroke, maternal and well child care, chronic kidney disease, HIV/AIDS, oncology care, cardiac disease, and diabetes care.

While JCI standards are the same across all countries, JCI accreditation is designed to accommodate specific legal, religious and cultural factors within a country. As with Joint Commission accreditation in the United States, facilities accredited by JCI must constantly strive for and demonstrate improvement in patient care performance and reduced risk.

JCI has accredited nearly 260 organizations in countries such as Austria, Bangladesh, Barbados, Bermuda, Brazil, Chile, China, Costa Rica, Cyprus, Czech Republic, Denmark, Egypt, Ethiopia, Germany, India, Indonesia, Ireland, Israel, Italy, Jordan, Kingdom of Saudi Arabia, Korea, Lebanon, Malaysia, Mexico, Pakistan, Philippines, Portugal, Qatar, Singapore, Spain, Switzerland, Taiwan, Thailand, Turkey, and United Arab Emirates.

Both The Joint Commission and JCI look at important aspects of health care such as how patients are assessed, the care of the patients, anesthesia, surgical care, medication safety, patient education and patient rights. The Joint Commission and JCI also focus on how organizations prevent and control infections and create an overall safe environment for patient care.

Staff qualifications and education are also a part of the accreditation process. For example, a key question that Joint Commission and JCI standards examine is: How is the organization ensuring that physicians have the training and skills to do the procedures that they are performing?

Understanding Accreditation

Accreditation should not be the only decision making factor in selecting a health care organization.  Patients must take the time to make sure that their medical needs can be met by an organization. Patients should communicate directly with the hospital and with the physician or dentist that will be responsible for their care.

Joint Commission and JCI accreditation address the most important factors and concerns that patients should consider when seeking care outside their home country. Some key considerations for patients and expectations for accredited facilities are:

  • Patients should inquire as to whether the hospital is accredited by a recognized accrediting body, such as The Joint Commission or JCI. Accreditation by The Joint Commission and JCI means the organization voluntarily sought accreditation and met recognized health and safety standards. The Joint Commission and Joint Commission International conduct on-site surveys to review the hospital’s medical and nursing care, physical condition, life safety program, special care units, pharmaceutical services, infection control procedures and a number of other areas affecting patient care.
  • Does the hospital or clinic have a written description of its services and fees? What resources does the hospital provide to help you find financial assistance if you need it?
  • Is the hospital clean? Visit the hospital and look around. Ask to see the waiting rooms and patient rooms.
  • Do the services and specialties provided by the health care facility meet the patient’s specific medical needs? Medical history and current medical condition should be important factors in the type of hospital patients choose.
  • What is the hospital’s success record in carrying out the specific medical procedure patients need? What is the training of the doctor who will perform the procedure? Ask how often the particular procedure is done.
  • Does the hospital explain the patient’s rights and responsibilities? An accredited hospital must be able to provide a copy of the patient rights and responsibilities information.
  • Who is responsible for maintaining the personal care plan? How are the caregivers kept informed about specific care needs? Can the patient and family be kept up-to-date on the medical care?
  • Will a discharge plan be developed for the patient before leaving the hospital? Patients should find out what services are available and the primary care doctor’s involvement to ensure continuity of care.
  • Does the hospital provide the patient with the necessary training for continued care in the home after discharge? Ask what training is provided in changing bandages, taking medications or using medical equipment or devices.
  • Does the hospital provide translation services with easy-to-understand written instructions?

While theses issues are a small sampling of the accreditation expectations, they represent some of the key policies and procedures that must be in place for proper patient care. Accreditation is rigorous, but the benefits for the patient, the organization and the community are the ultimate payoff.

For More Information

To find out if a health care organization in the United States is accredited by The Joint Commission, visit Quality Check® at www.qualitycheck.org.  Quality Check is a search engine to find any Joint Commission-accredited health care organizations. Joint Commission-accredited organizations are identified by the Gold Seal of Approval on Quality Check.  

Quality Check provides Quality Reports that include information on the organization’s overall performance level and how it compares to other organizations nationwide and statewide in specific performance areas. Visit www.jointcommission.org for more on The Joint Commission.

Karen Timmons is President and CEO of Joint Commission International To find out if a hospital outside the United States is JCI-accredited, visit www.jointcommissioninternational.org. The JCI Web site features a list of the accredited organizations and in most cases there is an immediate link to the organization’s Web site.


Karen H. Timmons is the president and chief executive officer of Joint Commission Resources, Inc. (JCR) and Joint Commission International (JCI).  JCR and its international division, JCI, are not-for-profit organizations working to improve health care quality and patient safety in over 80 countries around the world. JCI is leading health care improvement worldwide through its work with The Joint Commission as a Collaborating Center for Patient Safety Solutions, development of international standards for quality and safety, development of international patient safety goals, and by offering domestic and international consulting, international accreditation, education, publications, Continuous Survey Readiness, and e-Learning.

Under her leadership, JCI is developing an international collaborative network to improve patient safety.  Ms. Timmons is the primary liaison with the World Health Organization (WHO), which in 2005, designated The Joint Commission and JCI as the first Collaborating Centre for Patient Safety dedicated to the development of patient safety solutions.  She chairs the International Steering Committee of the WHO Collaborating Centre for Patient Safety Solutions, and leads the JCI Regional Advisory Groups in the Asia Pacific, Europe and the Middle East.  Ms. Timmons also spearheaded the establishment of the Joint Commission International Center for Patient Safety, and is a past board member and Treasurer for the International Society of Quality Assurance (ISQua).  

Ms. Timmons has served as chair of the World Health Organization’s HIV Quality of Care Working Group on HIV-AIDS and was appointed to serve on the Scientific Council of ANAES, the French National Agency for Accreditation and Evaluation in Health. She is also past chair of ISQua’s Agenda for Leadership in Programs for Healthcare Accreditation (ALPHA) Council.  The ALPHA Council was the first worldwide body to bring together national and other major health care accreditation organizations to develop a global approach to aligning health care standards and accreditation processes.  In addition to her international involvement, Ms. Timmons is a former member of the National Advisory Board for the Neag School of Education at the University of Connecticut in Storrs, Connecticut and she served on the Parents’ Board of Directors for DePauw University in Greencastle, Indiana.

Ms. Timmons earned a master of management degree from the J.L. Kellogg Graduate School of Management at Northwestern University, Evanston, Ill., and a Master of Arts degree from Fairfield University, Connecticut. She obtained a Bachelor of Science degree from the University of Connecticut.

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