Since early in this century, the medical profession has provided firm leadership in promoting high-quality patient care in the nation's hospitals. During the past two decades, this effort has steadily spread to involve a wide spectrum of organized health care settings. In this issue of the Journal, Roberts and colleagues1 describe the historical evolution of the Joint Commission on Accreditation of Hospitals and its role in effecting this professional mandate.
While the achievements of the Joint Commission are note-worthy, there is little basis for self-satisfaction in the current health care climate. In today's altered environment for patient care, resource limitation, changing and sometimes perverse reimbursement incentives, the professional liability crisis, and increased competition for patients have led to the elevation of quality of care to the status of a major public policy issue in this country. Public and professional concerns about the potential adverse impacts of these forces on