A History of This Subject

The following is The Joint Commission response.

from: Glossa, Dawn DGlossa@jointcommission.org
to: Alan Pakaln <alanpakaln@gmail.com>
cc: “Glossa, Dawn” <DGlossa@jointcommission.org>
date: Feb 9, 2018, 3:19 PM
subject: RE: External E-Mail: Re: Joint Maintenance Article
mailed-by: jointcommission.org
signed-by: jointcommission.onmicrosoft.com

Dear Alan-

Thank you for clarifying your intentions.  I have spoken with everyone you reached out to and I am responding on behalf of those staff.

We want to thank you for your efforts expended in your letter from January 24, 2018.  It appears that you have thoroughly researched the topic of equipment maintenance rates.

However, the Center for Medicare and Medicaid Services (CMS) has approved our maintenance rate of 100%. The Healthcare Organization has the responsibility to prove to the Joint Commission surveyor that they are meeting that 100% requirement.


Dawn Glossa, MPA
Director Corporate Communications
Certified Change Agent
The Joint Commission
One Renaissance Blvd.
Oakbrook Terrace, IL 60181
Telephone:  1-630-792-5630


This is an early (2004) response from The Joint to my proposal for calculating maintenance compliance.
Fifteen years and counting.

From: <JFishbeck@jcaho.org>
To: “Concerned Connections” <info@concernedconnections.org>
Cc: <BBerek@jcaho.org>; <rawise@jcaho.org>; <jloeb@jcaho.org>
Sent: Thursday, January 08, 2004 7:47 PM

Subject: Submission – Medical Equipment Management

Though your rational was most eloquently presented, it was felt that since the healthcare organizations we accredit vary widely in size, complexity, operations, and risk, our standards rarely are able to prescribe one particular method of compliance of the type presented in your letter. In addition it was felt that prescribing one method of compliance could limit development of other ideas.

Each setting we accredit may have different operational variables and are expected to customize their medical equipment management programs to optimize their effectiveness. The definitions for “compliance” provided your letter appear to be relevant to your setting; as always our on-site process would confirm if they are indeed effective.

Finally, it was felt the concepts and definitions you presented may be useful as examples to others, and perhaps you should explore providing input to groups that develop guidance and management strategy documents for similar settings (i.e. large hospitals, in this case). Some suggestions would be ASHE ‘s “Maintenance Management for Medical Equipment”, the AAMI publication “EQ-56” or the AAMI publication “Joint Commission Standards for Clinical Engineering Departments” by Bob Stieffel. These would be appropriate venues for this type of information.

John Fishbeck
Associate Director
Division of Standards and Survey Methods

Organizations I have contacted regarding this issue:

24×7 Magazine
Agency for Healthcare Research and Quality (AHRQ)
Akron Children’s Hospital
AMA Medical Student Section
American Medical Foundation Patient Safety
American Society for Health Care Risk Management (ASHRM)
Anesthesia Patient Safety Foundation
Answers Media Network
Ascension Healthcare Patient Safety
Association for the Advancement of Medical Instrumentation (AAMI)
Association of Health Care Journalists
Atlanta VAMC
Aunt Minnie. Com
Barnes-Jewish Hospital
Bassett Medical Center
Baylor College of Medicine
Becker’s Hospital Review
Boston Children’s Hospital
Boston Globe
Brigham and Women’s Hospital
Brooklyn Hospital Center
California Arthritis Partnership Program
California Hospital Association
Cancer Treatment Centers of America
Catholic Health Services of Long Island
Center for Evidence and Practice Improvement
Center for Patient Safety
Center for Quality Improvement and Patient Safety (CQuIPS)
Centers for Medicare and Medicaid Services
Centralized Hospital Intake Program
Chicago Sun-Times
Chicago Tribune
Child Health Patient Safety Organization
Children’s Hospital Colorado
Children’s Hospital of Pittsburgh of UPMC
Cleveland Clinic
Cleveland Clinic, Medicine Institute
Cleveland Clinic, Quality & Patient Safety Institute
Colorado Department of Healthcare Policy
Community Health Center, Inc./ReachMD
Consumers Union
Consumers Union Safe Patient Project Network
DARTNet Institute
Data Across Sectors for Health
Delaware Division of Public Health
Department of Health and Mental Hygiene
Duke University Health System
Duke University Hospital
Emergency Consultants PSO, LLC
Encompass Health Patient Safety Organization
Florida Academic Healthcare Patient Safety
Garden State Patient Safety Center
George Washington Medical Faculty Associates
Health Catalyst, Inc
Health Watch USAsm
Healthcare Council of Western Pennsylvania
Healthcare Systems Engineering Institute
HealthcareScene.com & HITMC.com
HealthTech Magazine
Hospital for Special Surgery
Hospital Quality Institute
HPM Department
Illinois Department of Public Health
Illinois Health and Hospital Association
Institute for Healthcare Improvement
Institute for Innovation in Health
Institute for Patient Safety
Institute for Safe Medication Practices
Institute for Safe Medication Practices
Institute for Safe Medication Practices (ISMP)
Intermountain Healthcare
Internet Health Management
Investigative Reporters and Editors
Jefferson Hospital
Johns Hopkins All Children’s Hospital
Johns Hopkins Bloomberg School of Public Health
Johns Hopkins Hospital
Joint Commission Journal
Kaiser Permanente Research
Kaiser Permanente School of Medicine
LA County Department of Health
LA Times
Los Angeles Biomedical Research Institute
Maimonides Medical Center
Massachusetts Department of Public Health
Massachusetts General Hospital
Mathematica Policy Research
Mayo Clinic
Mayo Clinic Health System
Medical School and College of Engineering the University of Michigan
MedStar Health
MedStar Health
MHA Health Foundation
MHA Keystone Center
Michigan Department of Community Health
Michigan Health Information Network Shared Services
Mid-Atlantic Patient Safety
Modern Healthcare
Montefiore Hudson Valley
Montefiore Hudson Valley
Mothers Against Medical Error
Mount Sinai
Nassau University Medical Center
National Committee for Quality Assurance
National Institutes of Health
Nebraska Hospital Association
New England Quality Care Alliance
New Jersey Department of Health
New York Times
New York University
New York-Presbyterian
Northwell Health
Northwestern Medical Group
Northwestern University
Nursing Alliance for Quality Care
NY Post
NY State Dept Health
NY Times
NYU Langone
NYU Lutheran Medical Center
Ohio Department of Health
Ohio Patient Safety Institute
Ohio State University Wexner Medical Center
Oregon Public Health Department
Partners HealthCare
Patient Safety Action Network
Patient Safety Movement Foundation
Penn State Health
Pennsylvania Department of Health
Pennsylvania Patient Safety Authority
Permanente Medical Group
Philadelphia Enquirer
Press Ganey
Project HOPE
Public Health Reaching Across Sectors
Quality Center Patient Safety
Quality Circle for Healthcare
Robert Wood Johnson Foundation
Robert Wood Johnson University Hospital
Rush University College of Nursing
San Diego Health Connect
Seattle Times
SF Chronicle
Society of Corporate Compliance and Ethics
St. Francis Hospital
Stanford Health Care
Stanford University
Stanford University Department of Medicine
Stanford University School of Medicine
Strategic Radiology Patient Safety
Surgical Outcomes & Quality Improvement Center
Tennessee Center for Patient Safety
Texas Hospital Association
The Baltimore Sun
The Detroit Free Press
The James M. Anderson Center for Health Systems Excellence
The Joint Commission
The Leapfrog Group
The National Quality Forum
Today’s Practice Magazine
University Hospital
University of Chicago Medicine
University of Iowa
University of Michigan Health System
University of Michigan Hospitals
University of Pennsylvania
University of Pittsburgh Medical Center
UPMC Presbyterian Shadyside, Pittsburgh
USA Today
Vanderbilt University Medical Center
Veterans Administration
Virginia Hospital and Healthcare Association
Wall Street Journal
Wall Street Raw Radio
Washington Advocates for Patient Safety
Washington Post
Washington State Department of Health
Weill Cornell Medical College
WellStar Health System
Westchester Medical Center
Xtelligent Media