Accreditation is one of the most important responsibilities of hospitals and ambulatory surgery centers (ASCs), helping ensure the highest levels of healthcare quality and patient safety. There are three main independent accrediting bodies: The Joint Commission, the Accreditation Association for Ambulatory Health Care (AAAHC) and QUAD A (formerly known as the AAAASF).
Similarities & Differences
These accrediting bodies are similar but also different in several key respects, says perioperative consultant Patti Owens, MHA, BSN, RN, CMLSO, CNOR, FAORN.
“Deciding which one to work with depends on the type of facility (hospital or ASC), type of services offered, goals of the organization and whether CMS deemed status is desired,” Owens explains.
According to Owens, QUAD A is often chosen for office-based or procedural practices needing strong surgeon credentialing and safety transparency while The Joint Commission is preferred for organizations requiring broad national recognition. “AAAHC is commonly selected by ambulatory-only providers seeking a quality-improvement focused, peer-driven model,” she says.
All three organizations conduct onsite surveys performed by trained healthcare professionals. They all award accreditation on a multiyear cycle (typically three years) with expectations for ongoing compliance and offer Medicare-deemed status, which allows eligible organizations to meet CMS requirements without separate federal surveys.
“In addition, all three use published standards and evidence-based practices in covering patient safety, quality of care, governance, credentialing, infection control and risk management,” says Owens.
While they are similar in some ways, there are important differences that should be considered when choosing an accrediting body, says Elethia Dean, RN, BSN, MBA, Ph.D., the CEO of consulting firm ASC Compliance.
“For example, The Joint Commission also focuses on environment of care and national patient safety goals while AAAHC includes a chapter on administration, which is different from leadership/governance, and QUAD A includes standards that focus on prevention of drug diversion,” says Dean.
Owens says The Joint Commission survey is the most rigorous and formal, with highly structured tracers tied to National Patient Safety Goals. “AAAHC is known as educational and collegial with a peer-based, educational survey style,” she says. “And QUAD A is clinically strict but operationally narrower in focus.”
Here are some of the main things you should know about each major accrediting organization, along with tips to help you prepare for accreditation surveys.
The Joint Commission
The largest and most widely recognized healthcare accrediting body in the U.S., The Joint Commission accredits more than 23,000 healthcare organizations, including hospitals and ASCs. “The Joint Commission sets national benchmarks for quality, patient safety and performance improvement,” says Owens.
Beverly Kirchner, MSN, RN, CNOR, CNAMB, vice president, compliance with SurgeryDirect, says The Joint Commission accreditation is considered the “gold standard” by many in the industry. “I view them as a marketing opportunity for ASCs,” she says. “I can tell my patients and doctors that our center follows the same regulations and standards of care as hospitals and hospital-owned ASCs.”
Here are a few unique characteristics of Joint Commission accreditation surveys:
- Usually unannounced and highly structured, with outcomes-driven standards.
- Focus on patient-centered culture of safety.
- Feature strong integration with CMS Conditions of Participation (CoP).
- Recognized by most states for licensure and Medicare/Medicaid eligibility.
- Recognized by third-party payers and investors.
Lindsey Fujimoto-Mullica, CST, administrator with SurgeryDirect, was part of the facility’s Joint Commission accreditation process last year.
“One of the most important lessons I learned is that Joint Commission accreditation is not about ‘passing a survey’ – it’s about building a culture of patient safety and continuous improvement,” she says. “The process reinforced the importance of standardized workflows, clear accountability and consistent, ongoing staff education.”
Fujimoto-Mullica was pleasantly surprised at how collaborative and educational The Joint Commission surveyors were during the process.
“Rather than acting as inspectors, they functioned more like partners in quality improvement,” she says. “This approach helped ease anxiety and turned the survey into a meaningful learning experience for everyone.”
Kirchner finds The Joint Commission’s application process “easy and user-friendly. They expect detailed documentation of policies, processes and documentation of care. The surveyors love to share their knowledge, including how they have seen regulations met in other facilities. I find them easy to work with and more consistent in their survey process.”
Even though they are seen by some as more difficult, Kirchner believes The Joint Commission is fair and consistent with the survey process. “They educate the whole team as they survey and their website is also very educational, which help ASCs stay survey-ready,” she says.
Dean says that success during a Joint Commission survey can be achieved by maintaining an ASC that mimics the setup of hospitals. “Over the past year, The Joint Commission has decreased their standards by 50 percent,” she says. “The impact of these changes is still yet to be determined.”
Owens lists several new Joint Commission developments to watch out for this year. These include Accreditation 360 for hospitals and critical access hospitals, National Patient Safety Goals and National Performance Goals, survey reporting and benchmarking improvements (SAFER), and Survey Process Guides, which will replace Survey Activity Guides.
Accreditation Association for Ambulatory Health Care
The AAAHC focuses exclusively on accreditation for ASCs. “The AAAHC is widely known for promoting continuous quality improvement (QAIP) rather than one-time compliance,” says Owens. “They focus on the 1095 Strong, Quality Every Day model during the entire accreditation cycle with a strong emphasis on patient rights, governance, credentialing and quality improvement.”
“AAAHC accreditation is most widely used by independent and physician-owned centers,” says Kirchner, who has completed 13 AAAHC accreditation surveys in the past two years. “The organization is aligned with CMS ASC Conditions for Coverage and surveyors tend to have extensive ASC experience.”
When preparing for an AAAHC survey, Kirchner focus on credentialing and privileging, QAIP integration into the center’s care practice, infection prevention, governance and patient rights. “Infection prevention is a big focus because without great infection prevention practices, the center’s care is not safely provided,” she says.
AAAHC surveyors like to meet with the medical director and board members to make sure they understand their responsibilities for all operational practice. “I find the surveyors to be collaborative throughout the survey process,” says Kirchner. “They share their knowledge freely with all center team members.”
“While AAAHC surveyors are fair, they tend to bring more of their opinion to the survey than Joint Commission surveyors,” adds Kirchner.
“What I like most about AAAHC is that they offer a supportive survey approach and do not come in heavy handed,” says Jamie Ridout, CNOR, NEA-BC, CASC, system vice president, perioperative nursing practice at Geisinger Health System. “The sense I’ve always gotten is that the surveyors want you to be successful, offering consultative instruction and things to consider for future surveys.”
AAAHC seems to be more commonly used by larger, free-standing, multi-specialty ASCs, says Ridout. “While their requirements can seem vague at times, I’ve always felt it’s not impossible to keep my ASC continually ready for survey compliance.”
According to Dean, the AAAHC prides itself on being “not prescriptive. In this methodology, facilities can interpret standards and implement compliance measures. What I am seeing is that sometimes surveyors interpret the standards differently from the facility and the facility receives deficiencies based on the surveyor’s interpretation.”
Owens lists several new AAAHC developments to watch out for this year. These include v44 Standards becoming fully effective, making 2026 the first full survey year under v44, an expanded focus on data collection and outcomes, greater alignment of standards with state scope of practice rules, and integration of survey outcomes with Quality Roadmap reports.
QUAD A
QUAD A is a physician-founded accreditation organization created in 1980 with a strong focus on patient safety, procedural quality and provider qualifications, particularly in outpatient and office-based procedural settings. “Initially, they were primarily focused on office-based plastic surgery centers,” says Kirchner. “QUAD A is considered to be very physician friendly.”
Dean prefers QUAD A as an accrediting organization. “Their standards are clear, objective and have very few gray areas for interpretation. The standards are free on the QUAD A website (quada.org) which represents a cost saving for all facilities. In 2025, QUAD A also included an interpretative guidelines section in the standards manuals to close any gaps that may exist in the standards.”
Dean stresses that QUAD A requires 100 percent compliance with all of its standards for QUAD A facilities. “This is something that can be achieved with clear, concise and objective standards. Without this information, it’s a guessing game and often facilities guess incorrectly; hence deficiencies are cited.”
Owens lists several new AAAHC developments to watch for this year. These include revised standards for 2026 that supersede all past interpretive guidance and newsletters, updated anesthesia classification and monitoring requirements, and a stronger emphasis on leadership awareness of updated requirements.
Margaret Vargas, BSN, RN, nursing accreditation officer with Refreshed Aesthetic Surgery in Aliso Viejo, Calif., participated in her first QUAD A survey last year. “I would say the most important things I learned are the importance of being organized and staying up to date,” she says. “This proved crucial as the surveyor reviewed everything from patient charts and policies to sterilization and narcotic logs.”
The surveyor was also present in the OR during patient timeouts and checked the crash cart, including medication lists, supplies and expiration dates. “Regular monitoring of medications, supplies and their expiration dates, along with maintaining a thorough log, assured that everything was up to date and resulted in a successful survey,” says Vargas.
Vargas was surprised at how friendly and thorough the surveyor was in discussing her role in the survey process. “This allowed our team to perform with confidence while maintaining patient safety and quality of care as the primary goal,” she says. “She told us that while having standards, policies and protocols in place is important, every member following them is what makes the biggest difference in a positive survey outcome.”
Expert Advice
Vargas’ main advice for centers that are preparing for a QUAD A survey? “Conduct regular meetings in which everyone is encouraged to provide feedback on whether current policies, standards and protocols are being met. I would also advise having logs and records regularly audited to make sure they’re up to date because our surveyor was very thorough in reviewing these.”
“While the survey experience may seem stressful and intimidating, our surveyor made it easy and informative,” Vargas adds. “Our team feels confident and prepared for our next survey!”
Regardless of which accreditation body you choose, Kirchner recommends learning its regulations inside-out. “Don’t argue during the survey because you have options to address anything you thought was not fair or not accurate afterward,” she says. “Be prepared to write an appeal letter that quotes the organization’s regulations, how you addressed them and why you addressed them this way.”
“My advice is simple: Be prepared,” says Ridout. “Familiarize yourself with the standards and provide the evidence to support your compliance with them. I believe my center has been successful in our surveys because we treat compliance as part of our daily operations so when the survey comes, it’s business as usual.”
Owens recommends that hospitals and ASCs make sure staff is well-educated on the specific accreditation body’s standards and understands their role in the survey process. “Take advantage of seminars, workshops and educational tools associated with your accreditation organization,” she says. “Take a deep breath and use this survey as a learning opportunity.”
Dean says ASCs that achieve success in accreditation surveys usually have a mock survey completed by an individual or consultant with expertise in the chosen accrediting body.
“Each facility must search throughout the industry to find the individual who knows the most about the standards and regulations they will be measured by,” Dean says. “Then choose someone who can objectively measure your compliance and provide a report with recommendations.”
“My advice is to prepare every day, not just in the months leading up to the survey,” says Fujimoto-Mullica. “While the process is rigorous, it ultimately strengthens operations, improves outcomes and reinforces trust with the patients and communities we serve. I view accreditation not as an obligation, but as an opportunity to continuously elevate the care we provide.”
