Monitoring and evaluation: the Joint Commission's 9-step model

In essence, the nine step model is a macro-description of the content of the program's structure and provides a brief description of the process. What it does not provide is a methodology for conducting the data-gathering and evaluation process (#6 and #7). Here is where the creativity of the QA coordinator is put to test. This methodology has not been formally prescribed by the Joint Commission, as QA is a rather new science which entails defining the concept in addition to determining consistent methodologies. We are thus left to explore other established disciplines, such as research and evaluation methodologies of education, for example, for the procedures and instrumentation to be employed in the data-gathering and analysis process. The application of the nine-step model is a helpful means of conceptualizing how each department's program should appear, including what to monitor, how to conduct the activity, who is to participate, and the frequency of activities. Hospitals are bastions of procedure manuals for everything from surgical draping to foley cath insertion. The establishment of a procedure manual for QA that is consistent with this model, however, is a necessary and effective means of taking a facility one step closer to compliance with established requirements.