HHCN Franchise Forum: The Financial Benefits of Investing in Quality and Safety

This article is sponsored by The Joint Commission. This article is based on a Home Health Care News virtual discussion hosted by Ashley Zagotta, with input from Vicki Cantwell, Director of Market Research and Stakeholder Engagement at Joint Commission and Bethany Marek, Associate Director of Market Research at Joint Commission. The discussion took place virtually on December 8, 2022, during the HHCN Franchise Forum. The article below has been edited for length and clarity.

Ashley Zagotta: Thank you Vicki and Bethany for being here with us today. Vicki has been with the enterprise since 2006, and Bethany joined us in July, but she brings almost 15 years of market research and analytics experience to the team. My name is Ashley Zagotta and I’m the marketing manager for Home Care at The Joint Commission, and I’ll be your moderator for today’s discussion.

The Joint Commission is the health care industry’s premier performance improvement organization. We offer a robust portfolio of accreditation and certification programs for the entire continuum of home care. Accreditation is a quality-focused market distinction that’s achieved by demonstrating your organization’s performance against a set of industry standards.


That’s done through an onsite (or offsite, in some cases) survey that’s conducted every three years. Our Gold Seal of Approval® is the most widely recognized quality and safety distinction in health care among providers, referral sources, and payors.

That’s helped us become the market leader for home care accreditation.

Every certification, every service, and educational program that we offer is designed to help you strengthen your quality, grow your bottom line, enhance your outcomes, and advance your reputation so that you can stand head and shoulders above your competition.


As the health care space relies more and more heavily on data, there’s a growing demand for proof points that show the tangible impact that we as the Joint Commission have on the function, profitability, and reputation for our customers.

More succinctly, we needed to know how does the Joint Commission make a demonstrable difference in our customer’s quality, safety, and efficiency? We decided to engage an external independent marketing research firm to help us come up with both qualitative and quantitative answers to that question.

Vicki Cantwell: Now we’re going to talk about the how. What we did is we worked with an outside organization, the ROI Institute. The ROI Institute has actually worked with more than 6,000 organizations in more than 70 countries. We were very lucky to team up with them and be able to work with them for this project.

How did we determine the impact and effectiveness of the Joint Commission, and specifically the ROI for Joint Commission Home Care accreditation?

We worked with ROI Institute to create a list of costs and benefits that was then brought to focus groups to see if our customers agreed on what we thought the cost and benefits were for the accreditation as well.

We also wanted to see if they were able to get some type of monetary data associated with these costs and benefits. We wanted to know if it was easy for them to be able to get it because we didn’t want to have a huge lift on the organization.

Benefits Factored:

  • Patient Revenue
  • Reimbursement Rate
  • Reduction in Staff Turnover
  • Liability & Workers’ Compensation Insurance Costs
  • Risk Reduction & Lawsuit Mitigation
  • Operational Efficiencies
  • Improvement Efforts
  • Competencies of Staff
  • Competencies of Supervisors
  • Other/Miscellaneous

After the focus groups, ROI Institute sent out an in-depth online survey to a random sample of our accredited home care organizations. In total, we had 196 Joint Commission home care accredited organizations participate in this study.

We included a wide range of organizations, anything from small community organizations to large nationwide health care providers. The size of the organization was also random. Some organizations had as little as 8 staff, or as many as 175 staff. Overall, the average staff count is 31.

We included organizations that had less than one year of accreditation, to more than 30 years of accreditation with the Joint Commission for their home care programs. All organizations did have to have either a home health or a hospice service. Some of them did have more than those services, but they at least had to have one of those two services.

In order for the ROI Institute to calculate the return on investment or the ROI we included an exhaustive list of cost and benefits, and we’ll talk about the costs first here.

Costs Factored:

  • Accreditation and Survey Fees
  • Compensation/Benefits Packages for Accreditation Personnel
  • Facilities Modifications
  • Accreditation Materials and Supplies
  • External Accreditation-Related Consulting, Training, and Education
  • Internal Employee Travel Costs
  • Purchase, Maintenance, and Support of IT Equipment/Software
  • Other/Miscellaneous

We included costs for all accreditation survey fees, as well as costs for accreditation materials and supply. This includes materials or supplies that organizations invest in as part of accreditation, such as publication tools, marketing materials, or anything else that they could think of.

We asked organizations to include any costs for dedicated accreditation staff or an accreditation team. When we asked for this, we asked them to include staff salaries and the benefits for the time that they were involved in that accreditation process. We also included costs such as survey material prep. Sometimes when we go on site we have to have things that are printed out, so we wanted them to include that. We also included costs for mock surveys as well as the additional salary and benefits of staff that may not be on that dedicated team but were involved in the accreditation process.

In addition to the dedicated staff or dedicated team cost, we actually also included cost for external consultants. We realized that some of our organizations do use external consultants. We asked for the cost of what the consultant was, as well as the travel expenses or meals or whatever would be included in that accreditation process.

We included cost for facilities modification as well, such as building maintenance and equipment, and the cost for purchase and maintenance of support for IT equipment and software that is used in the accreditation process.

Lastly, to be sure we hadn’t exhausted the list of what costs we would include, we asked for any additional costs that organizations felt was part of their accreditation process. Some of the additional things that we saw were the education and training for accreditation readiness, such as conferences, webinars, workshops, books, or whatever additional costs that we may not have thought of.

We also asked organizations to give us a monetary value of benefits of accreditation. We asked them to estimate the average annual increase in patient revenue, increase in reimbursement rate, and any reduction in liability insurance, as well as workers’ compensation insurance costs. We asked for cost savings through risk reduction and lawsuit mitigation, as well as operational efficiencies, such as standardizing processes and addressing risks to patients and staff.

Additionally, we asked for improvements or cost benefits for improvement efforts, which could include streamlining operational processes, improving emergency management, infection control and prevention processes, or anything in this realm. Another area that we did ask them for was if there was a reduction in staff turnover, and possibly having a monetary evaluation with that.

Now we do realize that this question was asked during COVID, so we did ask them specifically to think about pre-COVID. When you think about accreditation, how was your staff turnover? Was there a reduction in staff turnover that you could associate with the accreditation process?

Lastly, we asked about the monetary benefits or competency of staff and supervisors. We asked for an estimate of how much their staff’s competencies improved with the accreditation process and standards that were put into place because of accreditation.

Once we had all these costs and benefits, we closed the survey and ROI Institute used all this information to calculate an ROI for the Joint Commission Home Care Accreditation Organization.

We are excited to say that our ROI was 453%. This means for every dollar the Joint Commission Home Care accreditation customers spent, they received that dollar back, as well as an additional $4.53. In addition to that one we also looked at what the average annual benefits per organization were.

We saw an increase in revenue for each organization, with more than $60,000 as an average annual benefit. Improvement efforts had more than $14,000 for an average annual benefit. Risk reduction and mitigation of lawsuits came in at more than $28,000. One of the largest average annual benefits per organization was the cost savings for the reduction in staff turnover, with more than $140,000.

Finally, that largest average annual benefit was improved competencies for the staff. You can see that’s over $947,000. I’ll hand it over next to Bethany who’s going to talk about intangible benefits as well.

Bethany Marek: Vicki just walked through some of the tangible financial benefits, but we realized that’s not the full picture of the impact of accreditation. There were some additional intangible benefits that we asked respondents to weigh in on as well. Since these were intangible non-financial benefits, instead of being asked to give a dollar amount, respondents rated them on a scale of 1 to 5 in terms of the significance of the influence of accreditation on these intangible benefits. We calculated the percentage of respondents who said that it was either a moderate influence a 3, a 4, or a 5 being a very significant influence of Joint Commission Accreditation on these positive intangible benefits.

The most positively influenced intangible benefit as a result of Joint Commission Accreditation is compliance with regulations, followed by quality of patient care and improved patient safety, as well as improved patient outcomes. Additional benefits were improved culture of the organization, organizational sustainability, brand image reputation, and patient caregiver satisfaction.

The percentages were quite high for the percentage of respondents who voted at least a moderate influence to a very significant influence of the accreditation on these factors.

Again, you can see awfully close to 100% for at least moderate to very significant influence of Joint Commission Accreditation on the scales related to creating impactful policies or procedures, standardizing processes, and implementing leading practices regarding quality and safety. Very positive, very impressive results there that we are very pleased to see.

This excerpt has been edited for length and clarity. To watch the full discussion on video, please visit:

The Joint Commission offers unbiased assessment of quality achievement in patient care and safety. To learn more visit: https://www.jointcommission.org/.

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