Accreditation can be defined as a process whereby a professional association or nongovernmental agency grants recognition based on a demonstrated ability to meet predetermined criteria or established standards. It can also be defined as a process of formal recognition of a school or institution attesting to performance in education or training. Both types of accreditation pertain to the anesthesia technician. The majority of health care organizations must seek accreditation in order to demonstrate a level of quality satisfactory to governmental regulatory agencies and to health care insurers. The perioperative arena in which anesthesia technicians work is a key area that is scrutinized when hospitals undergo the accreditation process. In addition, many anesthesia technicians may wish to attend an educational program that may be subject to accreditation. This chapter addresses the accreditation programs most pertinent to the anesthesia technician.

When consumers seek health care at a hospital, how do they know that the hospital provides quality health care services? When insurers, including the government, pay for health care services to a hospital, how do they know that their customers are receiving quality health care? As the cost of health care increased in the 1950s and both states and the federal government began spending more money on health care, these questions became increasingly important to answer and drove the formation of organizations to assess the quality of health care delivery in hospitals. Although there are many other organizations that accredit or certify facilities or health care providers, the Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations) is the most well-known health care accreditation organization and any discussion of accreditation must begin with it.

The Joint Commission is a US-based nonprofit organization founded in 1951. It began offering accreditation to hospitals in 1953. At that time, hospitals voluntarily applied for accreditation, which was granted if they met a set of standards published by the Joint Commission. The federal government soon recognized the importance of assessing hospital performance and compliance with federal regulations. In 1965, the US government began accepting Joint Commission accreditation as meeting one of the Medicare Conditions of Participation. This directly linked the ability of a hospital to obtain federal funding for Medicare and Medicaid to accreditation. Today, 46 states and the Centers for Medicare & Medicaid Services (CMS) rely on the Joint Commission’s accreditation of hospitals in lieu of conducting their own inspection. In addition, many private health insurers require Joint Commission accreditation or preferentially work with fully accredited hospitals.

Although the initial focus of the Joint Commission was the accreditation of hospitals, the Joint Commission has grown to accredit several different types of health care organizations including ambulatory health care providers, freestanding surgery centers, behavioral health care organizations, critical access hospitals, home care organizations, medical equipment service companies, laboratory services, and long-term care facilities. The Joint Commission also offers accreditation to international health care organizations. The mission of the Joint Commission is not only to accredit health care organizations (to
measure them against standards) but also to use the process to inspire those organizations to provide ever safer and more cost-effective care.

What does it take to be accredited? The Joint Commission is governed by a board composed of physicians, nurses, administrators, employers, health insurers, ethicists, quality experts, and consumer advocates. The board receives input from national physician and hospital associations as it develops the “standards” that will be used in the accreditation process. The standards cover key functional areas within hospitals, including medication safety, patient treatment, infection control, patient rights and advocacy, etc. Hospitals must report on a selection of 57 different quality measures. For example, hospitals must report on the percentage of patients with an acute myocardial infarction (heart attack) who are discharged with a betablocker or the percentage of surgical patients for whom antibiotics are indicated, who receive the appropriate antibiotic within 1 hour of surgical incision. In 2010, the Joint Commission began placing a higher emphasis on those performance measures that produce the greatest impact on patient outcomes. It published a position paper calling for performance measures to be backed by strong scientific evidence demonstrating an impact on outcomes that the process being measured is closely connected to the outcome, that the measure accurately assesses the evidence-based process, and that the measure does not introduce unintended adverse effects. Organizations seeking accreditation must report on compliance rates with published performance measures to the Joint Commission and to CMS. Both the Joint Commission and the CMS report much of this data to the public. In addition to an assessment of compliance with performance measures, an organization seeking accreditation must undergo a site review.

The process by which the Joint Commission performs an assessment and site review is called a “survey.” The survey is an inspection by a Joint Commission team to assess the organization’s compliance with the current standards set forth by the Joint Commission and