Quality of Healthcare

History

During the first quarter of the 20th century, a confluence of events served as a strong impetus to the institutionalized, systematic evaluation of hospital quality. Abraham Flexner's report on medical education in the United States and Canada, published in 1912, called attention to the serious deficiencies in the training of American physicians. Ernest A. Codman successfully persuaded his fellow surgeons that the development of hospital standards, along with complete, accurate records of care and outcomes and the development of clinical databases for the study of end results, was necessary for the improvement of medical care.

In 1917, the new American College of Surgeons (ACS), created in 1913, established its Hospital Standardization Program, fundamentally embodying Codman's proposal. The ACS formulated a one-page “Minimum Standard” on the basis of which its volunteer member-surveyors began surveying hospitals that wished to obtain ACS accreditation, the badge of excellence. Early hospital surveys revealed that medical records were for the most part utterly inadequate as documentation. The entire medical community was alerted to the need for the formulation of standards for medical and surgical care and to the need for a system of medical records that would thoroughly and accurately document patient care.

Foundation Organizations and Programs

For 35 years the ACS conducted its Hospital Standardization Program, using as surveyors its own members who volunteered their services. Over the years, it became obvious that the logistical and financial burdens of a single-organization volunteer program had become too great for the ACS to support on its own. In 1952, the ACS was joined by the American College of Physicians (ACP), American Hospital Association (AHA), American Medical Association (AMA), and Canadian Medical Association (CMA) in forming the Joint Commission on Accreditation of Hospitals (JCAH). A few years later, the CMA withdrew to become a founding member of the new Canadian Council on Hospital Accreditation (CCHA).

With the passage of the federal Medicare program in 1965, the U.S. Congress conferred “deemed status” on JCAH-accredited hospitals in the nation, granting accredited hospitals automatic eligibility for Medicare reimbursement. In view of this delegation of federal authority, as it was perceived by many critics, it became imperative to develop objective standards for the evaluation of hospital performance. The JCAH responded by completely overhauling its research and standards development programs from 1967 to 1970 and publishing updated, more objective standards with which compliance could be measured.

In 1988, in recognition of its expansion to include mental health, long-term care, home-care, and ambulatory-care providers, the JCAH changed its name to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Since then, it has expanded its reach to include non-hospital-based clinical laboratories and office surgery practices. As a result, it has recently changed its name to simply the Joint Commission.

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