Scenario
You are the Quality Director of a local health system. Your organization has decided to seek accreditation through the Joint Commission. Your first task has been penned by the CEO to prepare for the accreditation process by conducting a literature review on the impact of accreditation on quality of care. The review of literature should include the historical underpinnings of quality initiatives since the publishing of the blockbuster report by the Institute of Medicine – To Err is Human - and an evaluation of the developments in quality initiatives over the past two decades. Upon completing the review of literature, you are asked to compile a report highlighting the history of quality improvement and the significance of quality initiatives on the future of care delivery. Your report should support the organization’s goal of earning accreditation through the Joint Commission.
Instructions
Complete a report that encompasses the history of Quality Healthcare, which focuses on the ways in which quality improvement has changed over time and how past initiatives shape current and future quality initiatives. At a minimum, your report should include:
An assessment of the accreditation process and its role in improving quality of care.
A review of the quality initiatives that have been developed in recent years and the impact of the initiatives on the quality of care delivered.
Support for accreditation based on the review of literature on quality from the historical perspective to future implications.
A discussion on the fundamental changes that have been implemented since the IOM’s report and potential for continuous quality improvement.
Recommendations for your organization to prepare for the accreditation process based on your review of literature and your assessment of the overall process.
Full Answer Section
The review reveals that accreditation is not merely a credential; it is a structured, evidence-based process that provides a framework for continuous quality improvement. The standards set by TJC are a direct response to the systemic failures highlighted by the Institute of Medicine (IOM) in 1999, shifting the focus from individual blame to systemic safety. This report argues that TJC accreditation is essential for our organization, not only to validate our commitment to quality but also to enhance our market position, secure payer relationships, and, most importantly, improve patient outcomes.
Fundamental changes, such as the rise of electronic health records, value-based care models, and a culture of patient-centeredness, have all shaped the current quality landscape. TJC standards are designed to ensure we are not only compliant with these changes but are leading the way in their implementation. Based on this assessment, this report concludes with five key recommendations to guide our organization in a successful and strategically sound preparation for the accreditation process.
1. The Historical Context of Quality Improvement and the Impact of To Err is Human
Prior to the late 20th century, quality in healthcare was often measured anecdotally and was primarily viewed as a function of an individual provider's skill and competence. This paradigm was fundamentally shattered in 1999 with the publication of the Institute of Medicine (IOM) report,
To Err is Human: Building a Safer Health System. This blockbuster report revealed that as many as 98,000 Americans were dying each year from preventable medical errors, underscoring that the problem was not a result of "bad" doctors or nurses but of flawed systems and processes.
The IOM report was a watershed moment that instigated a profound paradigm shift. It moved the conversation on quality from one of individual blame to one of systemic responsibility. This led to fundamental changes, including:
- The Rise of Patient Safety: Patient safety became a distinct discipline and a central focus of healthcare delivery. The report’s findings led to the development of patient safety goals, checklists, and standardized protocols designed to prevent common errors.
- A Culture of Safety over a Culture of Blame: The report argued for a shift away from a punitive environment where staff feared reporting errors. The new philosophy emphasized a just culture where errors were treated as learning opportunities to improve the system.
- Increased Public Transparency: The IOM's findings spurred greater public demand for accountability and transparency in healthcare. This led to the development of public reporting initiatives, such as CMS's Hospital Compare, which allows patients to access quality and safety data.
These changes laid the groundwork for the structured quality improvement initiatives that would dominate the next two decades, with a clear focus on system-level reform to ensure better patient outcomes.