TRANSFORMING. patient safety and quality of care Viewbook

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1 TRANSFORMING patient safety and quality of care 2014 Viewbook

2 3 Joint Commission International Leading practices shared with the WORLD TRANSFORMING The Earth is home to more than 7 billion people and its population increases by 200,000 people a day. That growth translates into millions of patient care encounters each day, spanning births and chronic disease care to lifesaving surgeries and organ transplants. As patient needs expand, health care is poised on the cusp of change. New technology. Breakthrough drugs. Disease prevention strategies. A knowledge-based workforce. All of these contribute to a transformed arena where progress is made yet risks multiply. 7Billion+ Millions Patient Care Encounters 24 hrs In the face of accelerated change, achieving and maintaining the highest quality and safety standards remains a top priority. Let Joint Commission International guide your patient care strategies.

3 4 5 PEAK Unlocking potential PERFORMANCE Joint Commission International (JCI) serves as a recognized beacon for quality and safety standards around the world. We work with hospitals, health systems, government ministries, public health agencies, academic institutions, and businesses to ensure success at every stage of a provider s quality improvement journey. From neighborhood clinics to national health systems, our experts bring leading practices to the delivery of local care. The result? Better outcomes, stronger management, and reduced costs. JCI At JCI, we live our mission every day: to continuously improve the safety and quality of care in the global community through innovative education, advisory services, and international accreditation and certification. Hospitals Health Systems Government Ministries Agencies Academia Businesses As JCI celebrates its 20-year anniversary in 2014, we renew our promise to serve as strong allies in achieving peak performance and serving patients safely. Paula Wilson President and CEO Joint Commission International and Joint Commission Resources

4 6 7 GOLD STANDARD Accreditation from the world s leader JCI accreditation is considered the gold standard in the global health care community. JCI-accredited organizations receive Gold Seal of Approval recognition as a visible sign of their commitment to quality and patient safety. TM While all health care settings benefit from accreditation, there has been more activity among ambulatory care and primary care providers as these segments face increasing demand. As patients move fluidly from setting to setting, there is even more focus on preserving quality and safety during care transitions. The 5th edition of JCI s Accreditation Standards for Hospitals, published in September 2013, is the latest significant advancement in defining best practices: global benchmarks with local relevance. The revised standards (effective April 2014) place more emphasis on the critical role of leadership in driving clinical improvement. An innovative component of the 5th edition standards requires organizations to establish priority improvement areas and measure their efficiency and costs against achieving results. Under the 5th edition, organizations track their return on investment as they make systemic, standards-driven improvements. JCI is more than a standard-setter. We work with client organizations to help them establish their improvement goals and then provide the tools and education they need to achieve those goals. Our work is not about inspection, but inspiration. Paul vanostenberg, DDS, MS Senior Advisor Global Growth and Innovation Joint Commission International Hospital Home Care Academic Medical Center Primary Care Ambulatory Care Clinical Laboratory Long Term Care Medical Transport < Accreditation for every setting Accreditation SURVEYOR TRAINING PROGRAMME JCI standards meet highest international benchmark No other health care accreditor has as many sets of standards approved and endorsed by the International Society for Quality in Health Care (ISQua) as JCI. ISQua s International Accreditation Program accredits the accreditors and provides worldwide recognition for meeting approved international standards.

5 8 9 VOICES What health care organizations say about achieving their accreditation goals JCI accreditation has been the best platform to standardize and improve the quality of care processes within our organization. It has helped us achieve our goal in creating a safe culture for both internal and external customers. Dr Abdulla Al Khayat Chief Executive Officer Latifa Hospital United Arab Emirates JCI accreditation has motivated and assisted our organization in striving to deliver a service of patient-centered safety and quality excellence, placing Bon Secours at the forefront of modern health care and providing a secure footing into the future in the ever challenging delivery of quality private health care in Ireland. Kieran McNamara Fire, Health & Safety Officer Bon Secours Hospital Cork Ireland For us, selecting JCI as our accrediting body was an obvious choice. JCI remains the undisputed gold standard in international accreditation. The standards are frequently updated and are attuned to an international audience, which is very essential to us. Being the first hospital in Japan to be JCI accredited was a powerful message to all stakeholders of a commitment to continuous quality improvement and safety based on global standards. It positively altered our corporate culture. We have gone from good, to measurably better, to best. John Wocher Executive Vice President Kameda Medical Center Japan Since its first accreditation in 2007, Severance Hospital has made not only structural improvements, but also quality improvements in medical services that led to improved customer satisfaction. Changes in medicine and technology have accelerated. The structural improvements necessary for JCI reaccreditation have enabled Severance to adapt to those changes promptly. Namsik Chung, MD, PhD, FAHA, FASE General Director, Severance Hospital Professor of Cardiology, Yonsei University College of Medicine South Korea JCI provides IMH [Institute of Mental Health] with the framework for clinical and organizational excellence, which enables us to monitor and anticipate the improvements that are needed to continuously provide quality and safe clinical care. Hong Choon Chua Chief Executive Officer Institute of Mental Health Singapore Rana M. Al Mandil, MD, MHA Director, Quality & Strategic Planning Administration King Fahad Specialist Hospital-Dammam Saudi Arabia

6 10 11 PACESETTER New dimensions to accreditation As health care evolves, so too does accreditation. That s why 2013 began with a new and unique accreditation designed exclusively for academic medical centers. Addressing the specialized mission and scope of larger institutions, the revised standards and process have been well received by academic medical leaders around the world. The standards present a framework for including medical education and human subject research in the quality and patient safety activities of academic medical centers. Academic medical centers in Argentina, Belgium, China, Colombia, Ireland, Israel, the Netherlands, Portugal, Singapore, South Korea, Taiwan, and other countries have earned this new accreditation, with dozens more on the pathway to completion. Another market-responsive adaptation is JCI s new network accreditation. Now similar organizations within a single system or corporate entity can achieve accreditation efficiently through a single network application. In 2012 Ambulatory Health Services, part of Abu Dhabi Health Services Company (SEHA), became the first organization to achieve network accreditation across 20 health care centers, five disease prevention and screening centers, and three mobile clinics. The accreditation process required 18 months of preparation and concluded with several weeks of surveyor visits and interviews. E. Saif Bader Al Qubaisa, MD Chairman Abu Dhabi Health Services Company United Arab Emirates Quantifying the value of JCI accreditation To measure the impact and monetary value of implementing JCI standards, two groups of acute care hospitals in Jordan were evaluated over a three-year period: three accredited hospitals versus two similar, nonaccredited hospitals. JCI accreditation demonstrated statistically significant improvements in quality, such as reduced readmissions, fewer returns to the ICU within 24 hours, and more complete medical records (a substantial difference of 30.1%). Accredited hospitals reported much lower staff turnover (a 16.0% difference) and US$87,600 annual savings per hospital. Excerpted from ISQua presentation, October 2010, prepared by Donald S. Shepard, PhD, and Yara A. Halasa, MD, DDS, Schneider Institutes for Health Policy, Brandeis University, and Paul vanostenberg, DDS, MS, Joint Commission International We are very proud of this accomplishment and would like to congratulate our employees at Ambulatory Health Services whose hard work and dedication to excellence have helped achieve this honor. One of our goals is to have all of SEHA s facilities earn this distinguished seal of accomplishment.

7 12 13 CERTIFICATION < 15 areas eligible for certification> Special recognition for clinical programs Heart failure Acute myocardial infarction Primary stroke Chronic kidney disease The Clinical Care Program Certification has been in high demand since its introduction in Some 50 programs have been certified to date and new disease areas are under review for future certification designation. Palliative care HIV/AIDS management Pain management Joint replacement Health systems and hospitals throughout the world are seeking new ways to strengthen their advanced specialty areas. JCI certification represents the highest level of achievement in providing evidence-based care in major Chronic obstructive pulmonary disease Diabetes End-stage renal disease Traumatic brain injury disease management areas, a distinction that attracts patients to these high-performing organizations. Paul Chang, MD, MBA, MPH, CPHQ, FACHE Vice President Accreditation, Standards, and Measurement Joint Commission International Cancer Asthma Transplantation

8 14 15 INSIGHTS JCI Advisory Services in action Delivering best practice solutions for urgent challenges Health care leaders reach out to JCI experts for evidence-based advisory services in a variety of areas. During 2012 JCI consultants completed 118 assignments in 40 countries, ranging from improving medication safety, using tracers and mock surveys to enhance performance, and conducting targeted gap analyses of high-risk areas. Accreditation and Certification Preparation > Introductory Consultation Organizational Assessment JCI teams are trained in Robust Process Improvement TM techniques that integrate change management tools and a blended Six Sigma approach. They understand how to work with hospital leaders and staff to make lasting changes. JCI teams have also partnered with ministries of health to develop national accreditation programs, self-assessment systems, and training and education. Ongoing Assistance Simulated Survey with Tracers Safe Health Design TM Our consulting assignments are as varied as our clients and host countries. JCI experts have collaborated with local health care leaders to measurably improve care, elevate the patient experience, and build safer and more patientcentric hospitals. The unifying element in these assignments is always a commitment to excellence among our partners. Marwa J. Zohdy, PhD Vice President Global Consulting Services Joint Commission International and Joint Commission Resources Infection Prevention and Control Policy Development and Management Multidrugresistant Organism Prevention Quality Improvement and Management Medication Management Diploma Programs < Quality and Safety Improvement

9 16 17 LIVING OUR MISSION Raising the bar through global collaboration UZBEKISTAN Strengthening accreditation expertise FOCUS: The Uzbekistan Medical Association and Ministry of Health wanted to develop accreditation standards for maternity hospitals. OUTCOME: JCI faculty created and delivered a five-day education program that aided understanding in accreditation, standards, decision making, reporting, and the survey process. The course drew helpful distinctions between standards and requirements and provided an actionable outline for pursuing accreditation. Funded by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Germany. In support of its not-for-profit mission, JCI chooses to participate in select mission-driven projects that enhance patient care and professional education. JCI experts work to help countries advance their national health care accreditation and certification goals. It is challenging and rewarding work that JCI provides as part of its enduring commitment to international collaboration. Here are several examples of JCI s recent mission-inspired work: JORDAN Creating a national hospital accreditation program and achieving ISQua-approved accreditation FOCUS: Jordanian hospitals wanted to develop and implement accreditation standards, with a particular goal of securing International Society for Quality in Health Care (ISQua) approval for their standards. We re proud to support initiatives that elevate health care to a new level of quality and consistency. JCI consultants bring a substantial and diverse set of skills in patient safety, accreditation standards, quality improvement, staff compliance, and organizational change. Sherry Kaufield, MA, FACHE Executive Director International Services Joint Commission International RWANDA Collaborating on national quality and safety standards FOCUS: Rwanda wanted to build a national hospital accreditation system that was tailored to the health care delivery customs and challenges of the country. OUTCOME: The JCI consulting team subcontracted with Management Sciences for Health to deliver a comprehensive review and development of Rwandan hospital standards and the surveyor process, as well as surveyor and field training. Five hospitals served as pilot organizations to test the Rwandan standards and survey process in action. Funded by U.S. Agency for International Development (USAID). OUTCOME: JCI experts subcontracted with University Research Corporation to provide technical assistance on standards development, governance and organization of the Jordanian accrediting body, and surveyor training. The Jordanian standards achieved ISQua accreditation and the JCI team worked with 15 pilot hospitals in the successful and sustainable implementation of those standards. Funded by U.S. Agency for International Development (USAID). GEORGIA Creating a maternal/child health certification FOCUS: Georgia was interested in creating a maternal/child care certification program for its hospitals. OUTCOME: The JCI consulting team subcontracted with John Snow International to provide a thorough standards review guided by an experienced obstetrician/gynecologist, a pediatrician, and a pediatric nurse. Participants visited JCI s headquarters for an in-depth review of certification essentials, followed by in-country training of surveyors and hospital participants. The certification program is now available to Georgian hospitals. Funded by U.S. Agency for International Development (USAID).

10 18 19 QUALITY CURRICULUM Innovative education for today s quality professionals < 8 comprehensive education modules> Principles of Quality Management Data Analysis Leadership and Planning Health Care Improvement Information Management Patient Safety and Risk Management Launched in 2012, this unique program is designed to advance quality improvement programs and staff development to the next level. Government ministries, hospitals, health systems, and universities are working with JCI to bring evidence-based education to hospital staff to help them establish and refine their quality programs. Data Collection Evaluation and Accreditation The integrated curriculum is presented in eight modules during an academic year and is taught by JCI experts with decades of experience in performance improvement and patient safety. Students learn leading-edge quality models, data analytics, and how to successfully bring quality initiatives to their care teams. In 2012 the Ministry of Defense in Saudi Arabia graduated JCI s inaugural class of 62 students, who earned diplomas from Prince Sultan Military College in Dhahran. Ministry leaders chose the JCI program to strengthen quality performance and leadership throughout the ministry s 22 hospitals. We are very happy with the program. The experienced faculty s approach was nonthreatening and they focused on practical solutions beyond pure theory. We chose young, highly motivated individuals to participate because we want to prepare them for quality leadership roles throughout our hospitals. Dr Noura AlNowaiser Director, Department of Continuous Quality Improvement and Patient Safety Medical Services General Directorate Ministry of Defense Saudi Arabia

11 20 21 RESPONSE More access, friendly service JCI listens carefully to what health care leaders need. Our consultants approach every engagement on a personal level, offering customized advice and becoming fully engaged in local challenges. We are your mission-focused ally. Unlike commercial interests, our not-for-profit status prompts us to direct resources and revenues toward supporting performance improvement goals rather than distributing profits. In response to customer feedback, the JCI Accreditation team launched E-App in 2013 to accept online accreditation applications. This tool saves health care organizations time and improves the accuracy of transmitted information. Another innovation JCI Direct Connect provides a secure client portal to store and download quality and safety tools, helping organizations to link to JCI resources around the clock. JCI communicates with our community digitally through customer-focused websites, outreach, and social media. Live tweets from accreditation updates, idea-sharing on Facebook, online surveys, and YouTube video stories are just some of the ways we connect with health care professionals whenever and wherever they are. During a consultation, I help my clients by not only identifying the gaps in performance, but also using my expertise to provide direction and recommendations to improve performance. My RPI TM (Robust Process Improvement TM ) training allows me to work with hospitals to adopt effective and sustainable solutions to their challenges. Jeannell Mansur, RPh, PharmD, FASHP, FSMSO Practice Leader, Medication Safety Conversing with the JCI community >

12 22 23 AT A GLANCE GUIDANCE JCI by the numbers (data as of 7 January 2014) JCI founded Accredited organizations 57 Countries home to accredited organizations UAE Country with the most accredited organizations Countries with the most accredited academic medical centers China South Korea ( ) Helping patients on 5continents 11countries JCI consultants representing based in these disciplines Countries with the most CCPC designations Brazil Thailand 11 Languages for JCI s Accreditation Standards for Hospitals, 5th Edition Africa Europe Asia South North America America 34% Physicians 36% Nurses 23% MBAs 19% PhDs 1999 Brazil Home of JCI s very first accredited hospital 2013 Board of Directors (as of November 2013) John Babiarz Consultant, Kenneth Bloem Executive Chairman, MedData/MedDirect Inc, John W. Bluford, MBA, FACHE President and CEO, Truman Medical Centers, Mark R. Chassin, MD, FACP, MPP, MPH President and CEO, The Joint Commission, Clarion E. Johnson, MD (Vice Chair) Craig W. Jones, FACHE President, Oklahoma Hospital Association, Dr Sneh Khemka, MBChB, MRCOphth England J. Thornton Kirby, FACHE President and CEO, South Carolina Hospital Association, Nabil M. Kronfol, MD, DrPH President, Lebanese HealthCare Management Association, Lebanon Suet Wun Lim, MD Director, Parkway Holdings Ltd & Executive Vice President, Parkway Group Healthcare Pte Ltd, Singapore LaMar S. McGinnis Jr, MD, FACS (Chair) Senior Medical Advisor and Liaison, American Cancer Society, Tamra Minnier, RN, MSN, FACHE Chief Quality Officer, University of Pittsburgh Medical Center, John Arne Øvretveit, BSc(hons), MPhil, PhD, CPsychol, CSci, MHSM Director of Research & Professor of Health Innovation, Improvement, and Evaluation, The Karolinska Institute, Sweden Rebecca J. Patchin, MD Christopher J. Queram President and CEO, Wisconsin Collaborative for Healthcare Quality, J.B. Silvers, PhD Professor, Weatherhead School of Management, Case Western Reserve University, Paula Wilson President and CEO, Joint Commission International and Joint Commission Resources, 2013 Standards Advisory Panel Dana Alexander, RN, MBA, MSN, FHIMSS, FAAN Heleno Costa Jr, RN Brazil Brigit Devolder, MS Belgium Samer Ellahham, MD, FACP, FACC, FAHA, FCCP, ASHCSH United Arab Emirates Hossam E.M. Ghoneim, MB, BCh, MSc, MD, FRCOG, HMD Saudi Arabia Paul B. Hofmann, DrPH, FACHE Annette Jolly, MBA Ireland Stanley J. Kent, MS, RPh, FASHP Tamra Minnier, RN, MSN, FACHE (Chair) Kim Montague, AIA, EDAC, LEED, BD+C, NCARB Angela Norton, MA, PGCE, RHV, RM, RN United Kingdom Chung-Liang Shih, MD, PhD Taiwan Paula Vallejo, PhD Spain Jorge Augusto Vasco Varanda Portugal Yau Onn Voo, MBBS, MMed(PH), FAMS Singapore

13 24 25 REGIONAL PERSPECTIVES 2013 Regional Advisory Councils Asia-Pacific Regional Advisory Council Anuwat Supachutikul, MD CEO, Institute of Hospital Quality Improvement & Accreditation, Thailand Gillian Bohm Principal Advisor, Quality Improvement, Health Quality & Safety Commission, New Zealand Ricardo Ch. Costes, MD President, Philippine Council on Accreditation of Healthcare Organizations, Philippines Sutoto Mkes, MD President, Indonesian Hospital Association, Indonesia Nico A. Lumenta, MD Director of Information & Cooperation, KARS, Indonesian Committee of Hospital Accreditation, Indonesia Toshiki Mano, PhD Professor, Medical Risk Management Center, Tama University, Japan Suwanna Ruangkanchanasetr, MD President, Thai International Health Care Standard Training Center, Thailand Jacob Thomas, MD Chairman, Ramsey Sime Darby Healthcare, Malaysia Tsuneo Sakai, MD President, Japan Hospital Association, Japan Kim Kwang-Tae, MD, PhD President, International Hospital Federation Executive Committee, South Korea Yau Onn Voo, MBBS, MMed(PH), FAMS Director, Standards and Quality Improvement Division, Ministry of Health, Singapore Chiu Wen-Ta, MD, PhD Minister of Health, Ministry of Health, Taiwan Suet Wun Lim, MD Director, Parkway Holdings Ltd & Executive Vice President, Parkway Group Healthcare Pte Ltd, Singapore Europe Regional Advisory Council Basia Kutryba European Society for Quality in Healthcare, Poland Michael Soop, MD, PhD Medical Director, Socialstyrelsen, Sweden Charles D. Shaw, PhD, MBBS, FFPH, FHSM United Kingdom Prof Niek S. Klazinga Health Care Quality Indicator Project, OECD Health Division, France Dr Ronni Gamzu, MD, PhD, MBA, LLB Director General, Ministry of Health, Israel John Arne Øvretveit, BSc(hons), MPhil, PhD, CPsychol, CSci, MHSM Director of Research & Professor of Health Innovation, Improvement, and Evaluation, The Karolinska Institute, Sweden Jesper Gad Christensen Director, Danish Institute for Quality and Accreditation in Healthcare, Denmark Andreas Ellmaier Head of Unit, Bavarian State Ministry of the Environment, Germany Dieter Mildenberger ECCLESIA Mildenberger Hospital, Germany Dr Bernadette Carr Medical Director, Ireland VHI, Ireland Dr Tim Wilson, FRCGP, FRCP, MFPH Partner, Health Industries, Price Waterhouse Coopers, United Kingdom Hasan Kus President, Anadolu Grubu, Turkey Eric de Roodenbeke Professor, International Hospital Federation, France Dr Paula Vallejo Director, Accreditation, Fundación para la Acreditación y Desarrollo Asistencial, Spain Ehud Davidson, MD Deputy Director General, Head of Division, Clalit Health Services, Israel Yalcin Nak Deputy General Manager, Acibadem Health Care Group, Turkey Luciano Ravera CEO, Istituto di Ricovero e Cura, Italy Nicky Jermyn Group CEO, St Vincent s Hospital, Ireland Boris Frehner Swiss Reinsurance Company Ltd, Switzerland Middle East and North Africa Regional Advisory Council Dr Fawzi Abdulla Amin Consultant, Office of the CEO, King Hamad University Hospital, Bahrain Dr Hanan Al-Kuwari CEO, Hamad Medical Corporation, Qatar Dr Ahmed Bin Salim Al Mandhari Director General, Sultan Qaboos University Hospital, Oman Dr Manar M. Al Moneef Managing Director, Imagination Breakthrough, Middle East and Pakistan, General Electric EL Seif, GE Healthcare, Saudi Arabia Dr Ali Nasha`at Ali Sha`ar Public Health Consultant, Palestine Dr Nagwa El Hosseiny Ministry of Health Quality Consultant & Head of Quality Management Committee, Dar Al Fouad Hospital, Egypt Dr Safa El Qsoos Quality Director, Ministry of Health & Regional Consultant, World Health Organization, Eastern Mediterranean Regional Office, Jordan Dr Jaafar Heikel Professor of Medicine, University of Casablanca, Morocco Prof Tawfik A.M. Khoja Family Physician Consultant, Director General, Executive Board, Health Ministers Council for Cooperation Council States, Diplomatic Quarters, Saudi Arabia Dr Mondher Letaief World Health Organization, Eastern Mediterranean Regional Office, Egypt Dr Anupam Sibal Group Medical Director, Apollo Hospitals Group, India Dr Bushra Al Ayed Assistant Professor, Applied Science Private University & Vice Chairman, Jordan Society for Quality, Jordan Dr Yakoub N.M. Neyaz Director General, Ministry of Health, General Director of Quality Assurance, Saudi Arabia Dr Abdulla Ibrahim Al Khayat CEO, Latifa Hospital, United Arab Emirates

14 Working with global and regional experts to provide superior services 26 As a global citizen, JCI fosters alliances with a variety of respected organizations ALLIANCES that share our mission to improve patient care. Working with global and regional experts to provide superior services JCI collaborated with the World Health Organization (WHO) to develop standards and resources for providing safe male circumcision services As a to global decrease the citizen, transmission JCI of HIV. fosters JCI and The alliances Joint with services a variety in Spain using of JCI respected standards. organizations Commission also served as a former WHO Collaborating Centre for that Patient share Safety to our further mission advance patient to safety improve through system patient care. design, product safety, services, and environment of care. Accreditation alliances The Fundación para la Acreditación y Desarrollo Asistencial (FADA) has worked with JCI since 1996 to jointly provide accreditation Accreditation The Consórcio Brasileiro alliances de Acreditação (CBA) has worked with JCI since 2000 to champion quality improvement excellence in Brazil. The experts at JCI are at your service to share leading practices in transforming CONNECT quality and patient safety. Contact your regional JCI office or visit jointcommissioninternational.org as your gateway to proven, practical resources. The experts at JCI are at your service to share leading practices in transforming quality and patient safety. Contact your regional JCI office or visit jointcommissioninternational.org as your gateway to proven, practical resources. JCI partners collaborated with with the Council the World for Health Organization Service Accreditation (WHO) of to Southern develop standards Africa and and PharmAccess resources for Foundation providing safe of the male Netherlands circumcision in services the SafeCare to decrease Foundation, the transmission designed of to HIV. assist JCI providers and The from Joint developing Commission countries also served in their as a former quality WHO improvement Collaborating initiatives Centre and for Patient the delivery Safety of to safer further patient advance care. patient Health safety care facilities through earn system certificates design, product of improvement safety, services, through and environment a step-wise process of care. that is realistic for resource-restricted settings. Consulting The Fundación alliance para la Acreditación y Desarrollo Asistencial (FADA) has worked with JCI since 1996 to jointly provide accreditation services in Spain using JCI standards. Progrea S.r.l., a leading Italian consulting firm, and JCI collaborate to enrich the availability of quality tools and resources in the European health care arena. The Consórcio Brasileiro de Acreditação (CBA) has worked with JCI since 2000 to champion quality improvement excellence in Brazil. JCI partners with the Council for Health Service Accreditation of Southern Africa and PharmAccess Foundation of the Netherlands in the SafeCare Foundation, designed to assist providers from developing countries in their quality improvement initiatives and the delivery of safer patient care. Health care facilities earn certificates of improvement through a step-wise process that is realistic for resource-restricted settings. Consulting alliance Progrea S.r.l., a leading Italian consulting firm, and JCI collaborate to enrich the availability of quality tools and resources in the European health care arena.

15 MOMENTUM Celebrating 20 years of collaborating with health care organizations to achieve the best patient care in the world Headquarters 1515 West 22nd Street Suite 1300W Oak Brook, Illinois USA Voice Fax Joint Commission International Consulting Voice Joint Commission International Accreditation Voice Middle East Office P.O. Box Bldg 27, Suite B503 Dubai Healthcare City Dubai United Arab Emirates Voice Fax Asia-Pacific Office 37th Floor Singapore Land Tower 50 Raffles Place Singapore Voice Fax jointcommissioninternational.org Other Regions Follow us Joint Commission International (JCI) is a division of Joint Commission Resources, Inc., a wholly controlled not-for-profit affiliate of The Joint Commission. JCI provides leadership in international health care accreditation and quality improvement. The International Quality Approval Gold Seal, RPI, and Robust Process Improvement are trademarks of The Joint Commission, registered in the and other countries. JCIAON0114