JCAHO reorganizes patient education standards, merged with provision of care

Some educators feel that integrating the standards obscures their role

It is difficult to predict what impact the revised patient education standards will have once they are implemented by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations (JCAHO). On Jan. 1, 2004, the majority of the standards officially will be included in a new chapter titled "Provision of Care" along with the assessment, care, and continuum of care standards.

"It is a little early to tell how the changes will impact us over the long run. I think it really helped in the past when they developed the education chapter because it helped us become a major focus," says Louise Villejo, MPH, CHES, director of patient education at M.D. Anderson Cancer Center in Houston. The downside to the changes is that patient education could become lost among the other standards, she adds.

To make sure that this does not happen, patient education managers may have to work harder to ensure that education is an integral part of patient care. They may need to keep bringing the standards to the attention of leadership and clinical staff, working with them hand in hand to make sure they are met, says Villejo.

A separate chapter has given patient education a lot of visibility, says Annette Mercurio, MPH, CHES, manager of patient, family, and community education at City of Hope National Medical Center in Duarte, CA.

"When I heard that there was no longer going to be a separate chapter, I was a little concerned about whether the emphasis or prominence of patient education was going to decrease or not," she says.

Currently, in the introduction to the patient education chapter, there is a diagram showing the systematic approach to education that provides a good overview of the process. Mercurio says she will miss that tool because it shows the big picture. Sometimes people forget that it is more than handing out materials, she reports.

However, the integration of assessment, care, education, and the continuum of care does make sense, says Mercurio. For the patient, it brings together all these processes so that health care providers don’t think of them separately. Ultimately, it could strengthen patient education, she says.

Goal of the Joint Commission

The changes made were in no way an effort to diminish the importance of patient education, says Nancy Kupka, BNSc, MPH, RN, associate project director in the Division of Standards and Survey Methodology at the Joint Commission. "One of the hallmarks of quality care is educating and empowering the patient," she reports.

Although patient education is no longer a stand-alone chapter within the 2004 accreditation standards, the requirements have not really changed; they are just formatted and presented differently, says Kupka. The standards were reworded and condensed, but no requirement for patient education was removed, she says. Overall, only a few standards that were outdated or obscure were eliminated.

"We really tried to retain all the existing requirements. We wanted to streamline the way in which they were presented," says Kupka.

The new format includes:

  • a brief statement of the standard;
  • a rationale for the standard, when appropriate, and background or additional information about the standard;
  • elements of performance that provide specific information about the precise basis for scoring compliance with the standard;
  • a self-scoring mechanism to help organizations determine compliance;
  • elimination of compliance tips, also called examples of implementation. These tips instead will be found on JCAHO’s web site allowing for more frequent updates that will help organizations meet standards requirements.

A pre-publication version of the new standards also can be viewed on the Joint Commission web site, www.jcaho.org. There also is something called a "crosswalk" on the site, which is designed to help health care professionals see how the language of the standards has been changed by comparing the former standard with the new version.

In viewing the crosswalk, Cezanne Garcia, MPH, CHES, manager of patient & family education services at the University of Washington Medical Center in Seattle, found much of the new wording incomplete. Many of the specific details have been removed, which leaves the standards open to various interpretations, she says.

The standards are more generalized now because it is impossible to create a list of requirements that fit every health care institution, explains Kupka. Education needs to be appropriate to the scope of services offered, the patient population, and the individual patient. For example, educational materials and teaching protocols for diabetes would be different in an outpatient diabetes center from a general medicine unit in the hospital, she adds.

Anyone who has trouble implementing the standards can contact the standards interpretation department at the Joint Commission either by telephone or e-mail. "We will work with the organization to see if they are meeting the standard," says Kupka. Once people begin implementing the newly organized standards they are welcome to offer comments on areas in which they see problems occurring as well, she says.

The good news is that there still is a primary focus on educating patients and families, says Kathy Ordelt, RN, patient and family education coordinator at Children’s Healthcare of Atlanta. "[Former U.S. Surgeon General] C. Everett Koop said it best when he said, There is no prescription more valuable than knowledge.’ This is even more important given our present health care environment," she says.

Kupka says that while some would argue that patient education is diminished by not having a separate chapter, others would say that because it is integral to caring for patients it shouldn’t be in a separate chapter.

She is in the second group, as is Dorothy Ruzicki, PhD, RN, director of the Department of Educational Services at Sacred Heart Medical Center in Spokane, WA. "I’ve always believed that patient education is part of total patient care and by pulling it out it becomes more the responsibility of a single person. It should be integrated into nursing care not seen as a separate activity apart from all the care a patient gets," she says.

(Editor’s note: As health care institutions begin to prepare for Joint Commission surveys in 2004, Patient Education Management will print a follow-up article to discuss how they are structuring their committees and how patient education becomes part of the equation.)


For further discussion of the changes in patient education standards and their implementation, contact:

  • Cezanne Garcia, MPH, CHES, Manager, Patient & Family Education Services, University of Washington Medical Center, 1959 N.E. Pacific St., Box 356052, Seattle, WA 98195-6052. Telephone: (206) 598-8424. E-mail: ccgarcia@u.washington.edu.
  • Nancy Kupka, BNSc, MPH, RN, Associate Project Director, Division of Standards and Survey Methodology, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL, 60101. Telephone: (630) 792-5000.
  • Annette Mercurio, MPH, CHES, Manager, Patient, Family and Community Education, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010-0269. Telephone: (626) 301-8926. E-mail: amercurio@coh.org.
  • Kathy Ordelt, RN, Patient and Family Education Coordinator, Children’s Healthcare of Atlanta. Telephone: (404) 785-7839. E-mail: Kathy.ordelt@choa.org.
  • Dorothy Ruzicki, PhD, RN, Director, Department of Educational Services, Sacred Heart Medical Center, W. 101 Eighth Ave., Spokane, WA 99220-4045. Telephone: (509) 474-3390. E-mail: ruzickd@shmc.org.
  • Louise Villejo, MPH, CHES, Director Patient Education, M.D. Anderson Cancer Center, 1515 Holcombe-Box 21, Houston, TX 77030. Telephone: (713) 792-7128. E-mail: lvillejo@notes.mdacc.tmc.edu.