Does the "C" in JCAHO stand for change?

A retrospective of joint Commission changes from its early days to the present is provided in this column. How the Joint Commission on the Accreditation of Health care Organizations evolved from the American College of Surgeons initiative to standardize hospital systems and equipment is discussed. Structural standards developed into important functions that crossed departments within an organization. Discussion of the current initiatives and future challenges to improve care to the public is included.