The Joint Commission Requires ‘Safety Goal’ of DEI’s ‘Healthcare Equity’ for Organizations Seeking Accreditation

The Joint Commission (TJC) is familiar to healthcare professionals as the entity that has them scrambling to prepare in the days and weeks prior to an accreditation survey of their facilities. The patient safety realm is a large part of TJC’s mission to ensure healthcare organizations “excel in providing safe and effective care of the highest quality and value” for the public. But there’s a new National Patient Safety Goal (NPSG) that claims identifying patients by race and ethnicity – rather than as individuals – will make “safety” a priority.

Based on an element of the Leadership chapter of TJC’s accreditation standards (LD.04.03.08) “which addresses healthcare disparities as a quality and safety priority,” NPSG 16 took effect July 1, says the TJC’s website (archived link). Although the accreditation requirements aren’t changing, TJC adds, “the change is being made to increase the focus on improving healthcare equity versus reducing healthcare disparities.” This is outside the usual tone of the NPSGs over the past twenty years, which traditionally focus on true patient safety issues such as improving staff communication and using medications safely. NPSG.16.01.01 states:

Improving healthcare equity is a quality and patient safety priority. For example, healthcare disparities in the patient population are identified and a written plan describes ways to improve healthcare equity.

To achieve this NPSG (which is being extended into 2024), hospitals and other healthcare facilities seeking TJC accreditation, including ambulatory and behavioral healthcare organizations, are required to:

• Identify an individual to lead activities to improve healthcare equity.
• Assess patients’ health-related social needs.
• Analyze quality and safety data to identify disparities.
• Develop an action plan to improve healthcare equity.
• Act when the organization does not meet the goals in its action plan.
• Inform key stakeholders about progress to improve healthcare equity.

“Organizations need established leaders and standardized structures and processes in place to detect and address healthcare disparities,” TJC says in one of its R³ Report (Requirement, Rationale, Reference) documents, emphasizing again that a focus on a patient’s racial and ethnic identity is on par with essential safety concerns.

“These efforts should be fully integrated with existing quality improvement activities within the organization like other priority issues such as infection prevention and control, antibiotic stewardship, and workplace violence,” TJC states.

TJC’s requirement, however, of the identification of a “leader” of an organization’s “healthcare equity” activities, along with “standardized structures and processes” in order to “detect and address healthcare disparities” sets up another bureaucracy focused on political identity groups, rather than individualized patient care.

The commission appears to try to refute this criticism with the claim it will be focusing on “health-related social needs (HRSNs)” of patients, rather than the population-centered “social determinants of health (SDOH).”

HRSNs, TJC argues, are a “proximate cause of poor health outcomes for individual patients.”

“Understanding individual patients’ HRSNs can be critical for designing practical, patient-centered care plans,” the commission continues its argument, using the examples of “a care plan for tight control of diabetes may be unsafe for someone with food insecurity, and outpatient radiation therapy may be impractical for someone who lacks reliable transportation to treatment.”

All healthcare organizations, however, have social work services already in place to assist patients with special needs to obtain necessary medical treatments. Setting up and funding a new bureaucracy based on DEI ideology and activism seems more politically expedient than required for “safe and effective care of the highest quality and value.” Such mandates impose even more burdens on healthcare providers to address patient socioeconomic issues, rather than focus on delivering quality medical care.

Hospitals and other healthcare organizations seeking Joint Commission accreditation are invited to use the “Health Care Equity Accreditation Resource Center” in order to meet the new standards. But even with such a robust collection of resources, it is difficult to determine exactly how TJC defines health care equity. “And although health care equity is often viewed through a social justice lens,” TJC says, “we understand it to be first and foremost a quality-of-care problem.”  Before “sustainable improvement” in health outcomes for minorities can be attained, institutions must start by “understanding the root causes and implementing targeted standards of care,” TJC claims.

Do No Harm Chairman Stanley Goldfarb, M.D. recently pointed out how the evidence to support racial inequity as the root cause of health disparities simply isn’t out there.

“The research establishment studying racial disparities in healthcare has a big problem,” Goldfarb stated in a piece in May at City Journal. Researchers have made “a concerted effort to ignore any literature” that contradicts their belief that differences in health outcomes are due to race-based factors.

The former associate dean of the University of Pennsylvania Perelman School of Medicine asserted that “the largest study of racial concordance, which included 56,000 patients, failed to show a benefit.” Yet other publications in the literature that provide “useful information about actual healthcare outcomes” have been largely ignored.

With NPSG 16, TJC is disregarding the difference between eliminating health disparities and producing health equity. Efforts aimed at removing health disparities include implementation of programs and processes with the goal of improving the delivery of healthcare for everyone. However, measures to create health equity are focused only on patient groups that meet certain racial identity criteria, while doing nothing to innovate healthcare delivery for groups of patients who do not fall into those categories. Regardless of the latest labels used to describe it, the promotion of “health equity” is a discriminatory practice.

The Joint Commission once used the best available scientific evidence to set its standards for improving patient safety and quality of care. Considering its level of influence over the delivery of services across the continuum of patient care in more than 22,000 organizations, TJC must return to being guided by facts, not ideology, as a means to achieve patient safety goals.