Publisher: Joint Commission Resources, ISBN: 978-1-59940-285-7, Publication date: 2009, Pages: 204 plus CD, Price: $155; AAMI Members: $130, Order:, or (877) 249-8226

The current edition of Environment of Care Essentials for Health Care helps sort out the many changes that The Joint Commission has made for 2009. The most obvious change is that the standards for some (but not all) accreditation programs have been renumbered (again). The Joint Commission has asserted that the renumbered standards do not include additional requirements for accreditation. However, there are significant changes in wording that do affect the way we manage our programs. So it's worthwhile to keep track of what has changed and where it has moved. The “crosswalks” on the included CD that compare the 2008 and 2009 standards are particularly helpful in this regard.

It's also important to note that for some (but, again, not all) accreditation programs, the emergency management standards have been removed from the Environment of Care chapter and placed (after substantial reorganization) into a new Emergency Management chapter. Some of the life safety standards, primarily those related to the Life Safety Code, NFPA 101, also have been removed and placed (after substantial expansion) into a new Life Safety chapter. The Joint Commission now refers to these three chapters collectively as the Physical Environment chapters. Fortunately, despite its backward-compatible title, Environment of Care Essentials covers them all.

The third major Environment of Care-related change for 2009 is about the scoring process for the standards, associated Elements of Performance, and the organization as a whole. As part of its Standards Improvement Initiative, The Joint Commission has substantially revised (and complicated) its scoring system. It's worth our time to understand how the new scoring works so we can prioritize our efforts in medical technology management because, for example, the relative importance levels of some Elements of Performance have changed. The good news is that Environment of Care Essentials does a good job of explaining the new scoring system.

Assessment: A real strength of Environment of Care Essentials, and a major factor in my decision to buy the publication every year, is that it addresses not only The Joint Commission's hospital accreditation program but also its other facility-based programs, including ambulatory health-care accreditation, critical access hospital accreditation, behavioral health accreditation, laboratory accreditation, and others. This is particularly valuable for those of us working in organizations that participate in multiple accreditation programs offered by The Joint Commission. Environment of Care Essentials covers these accreditation programs in a single publication at a reasonable price.

Beyond the standards, which are very clearly laid out in tabular form, Environment of Care Essentials provides a wealth of related information. The accreditation survey process is described in detail, with attention to the sometimes mysterious “tracer” methodology that can bring up Environment of Care-related issues. There is an extensive glossary and a good index. The CD includes self-assessment documents (“fillable” PDF forms) that help us discover our “opportunities for improvement” (i.e., stuff we need to fix before the surveyor arrives).

An important limitation of the publication is that it does not address standards outside the Environment of Care (Physical Environment) standards. The Human Resources, Infection Control, Leadership, Information Management, and other chapters contain requirements that are relevant to our work in medical technology management. We need to look elsewhere for that information.

Another shortcoming is that, because it is published annually, Environment of Care Essentials cannot provide information on ongoing changes by The Joint Commission.

In my Environment of Care consulting work, I still find departments following outdated (or entirely apocryphal) Joint Commission standards—doing things that don't need to be done and not doing things that are currently required. They're playing a game without knowing the rules (because the rules keep changing, sometimes with good reason). If you are a medical technology manager, get this publication. It really is essential.