The American College of surgeons, minimum standards for hospitals, and the provision of high-quality laboratory services

Abstract

Context: The first major project of the American College of Surgeons (Chicago, Illinois), founded in 1913, was implementing Minimum Standards for Hospitals. The 1918 standard (1) established medical staff organizations in hospitals; (2) restricted membership to licensed practitioners in good standing; (3) mandated that the medical staff work with hospital administration to develop and adopt regulations and policies governing their professional work; (4) required standardized, accessible medical records; and (5) required availability of diagnostic and therapeutic facilities. One hundred years ago, these were radical expectations. Objectives: To describe the origin, "marketing", and voluntary adoption of the 1918 standards, and to describe how the evolution of those standards profoundly affected laboratory medicine after 1926. Design: Available primary and secondary historical sources were reviewed. Results: The college had no legal mandate, so it used a highly consultative approach, funded by its membership and the Carnegie Foundation (New York, New York), to establish the Minimum Standards, followed by a non-threatening mechanism to determine which hospitals met them. Simultaneously, the college educated the public to fuel their expectations. Compliance by more than 100-bed hospitals in the United States and Canada, although entirely voluntary, rose from negligible when first implemented in 1918 to more than 90% in only a few years. From 1922 to 1926, the American Society for Clinical Pathology (Chicago, Illinois) worked creatively with the college to establish Minimum Standards for "adequate" laboratory services. Conclusions: The birth and implementation of this program exemplifies how a consultative approach with full engagement of grassroots stakeholders facilitated a voluntary, rapid, sweeping North America-wide change-management process. This program eventually evolved into the Joint Commission (Oakbrook Terrace, Illinois).