In the winter of 2008, I took a short drive out to Oakbrook Terrace in suburban Chicago to interview Mark Chassin, M.D., who barely had a week under his belt as the new head of the Joint Commission. It was a wide-ranging discussion. We talked about standards development, the Joint Commission's stature within the field and with lawmakers, and much more. What stood out most, however, was how passionately Chassin spoke about evolving the Joint Commission from an accreditation agency to a major player in quality and safety. He said he wanted to create programs that worked "outside, alongside, compatible with accreditation" to drive performance improvement.

In spring 2010, H&HN Contributing Editor Howard Larkin revisited Chassin and the Joint Commission to see how things were going. In a cover story, Larkin wrote about how the Joint Commission was changing its own culture to become a high-reliability organization, one that is focused on continuous improvement both internally and externally. "Chassin says hospitals and other providers must adopt process improvement programs similar to the Joint Commission's. That will help make care more effective, more efficient and less vulnerable to failure. To sustain that 'quality culture,' executives and trustees will have to step up and accountability systems will need to be established," Larkin wrote.

You can see in our coverage and elsewhere that Chassin's vision for the Joint Commission is steadily taking shape. It is evident in the commission's Center for Transforming Healthcare, which is partnering with hospitals to find targeted solutions for some of the most vexing problems in health care, including hand hygiene, hand-off communications, surgical site infections, and, most recently, wrong-site surgery.

And it was evident yesterday during a press call when Chassin unveiled the Joint Commission's Annual Report on Quality and Safety. For the first time, the commission spotlighted hospitals that are "top performers" in 22 measures across five categories — heart attack, heart failure, pneumonia, surgical care and children's asthma. The report names 405 hospitals — 14 percent of Joint Commission accredited hospitals — that hit a 95 percent performance threshold on these so-called accountability measures.

During the press call, Chassin highlighted some of last year's biggest achievements: hospitals scored 96.6 percent composite performance on 12.3 million opportunities, compared with 81.8 percent on 957,000 opportunities in 2002. In other words, hospitals followed evidence-based protocols 96.6 percent of the time on those 12 million "opportunities." Compliance with measures for heart attack care rose to 98.4 percent, up from 86.9 percent in 2002.

"The new Joint Commission report clearly shows that hospitals are achieving success in providing the right care to patients at the right time," Rich Umbdenstock, president and CEO of the American Hospital Association said. "All hospitals are making significant strides toward providing the best evidence-based care for patients. While improving care is a never-ending journey and there is more hospitals can do, today's report is good news for patients and families."

One of the things that gained immediate attention in the Joint Commission report was the hospitals listed, or rather, those that weren't. Big names such as the Mayo Clinic, Cleveland Clinic, Johns Hopkins, Geisinger are noticeably absent. "Small and rural hospitals are over-represented compared to their percentage of total hospitals. Academic medical centers are under-represented," Chassin said. When asked repeatedly by reporters how hospitals that are considered standard bearers in so many clinical areas can be left off a list of top performers, Chassin responded simply that they haven't achieved 95 percent on their accountability measures.

Chassin said the list should serve as recognition that small and rural hospitals can do an excellent job on the quality and safety front. Just as important though, he wants it to be a "wake-up call" to larger hospitals "to put more resources to these types of programs."

And that's sort of the larger point. It goes back to that initial interview I had with Chassin and his goal to push, prod and pull hospitals along toward performance improvement. To that end, starting Jan. 1, accreditation will hinge on hospitals scoring at least 85 percent on the accountability measures. Chassin said that 121 hospitals out of nearly 3,800 currently would not meet the standard.

"Our theme is to galvanize improvement and improve performance," Chassin said.