Healthcare quality systems have evolved from narrow inspection and compliance mechanisms into broader, multi-level architectures that combine standards, measurement, organizational learning, patient safety, equity and patient-reported outcomes. Yet the field remains fragmented, with substantial variation in how quality is defined, measured and operationalized across countries and healthcare settings. This narrative review synthesizes major international quality systems and frameworks used in healthcare delivery, examines principal methods for evaluating and improving quality, and critically discusses organizational and policy conditions associated with successful implementation. A purposive review of the seminal conceptual literature and authoritative documents from major international organizations was undertaken to identify cross-cutting themes relevant to hospitals, ambulatory care and health systems. The review shows that influential approaches-including the World Health Organization's quality and patient safety frameworks, Joint Commission International accreditation, NCQA/HEDIS, the EFQM model, ISO-based management systems, AHRQ quality indicators and OECD performance initiatives such as PaRIS-should be viewed as complementary rather than competing models. Their effectiveness depends less on formal adoption alone than on leadership commitment, workforce engagement, data infrastructure, patient involvement and alignment with financing and regulation. Evidence is strongest for gains in standardization, safety processes, teamwork and selected efficiency outcomes; direct causal effects on patient outcomes remain less consistent, particularly when quality systems become compliance-driven or are insufficiently adapted to local context. Future healthcare quality systems should integrate equity, digital interoperability, AI-enabled learning capabilities, patient-reported measures and continuous improvement while reducing measurement burden and indicator proliferation.

The current study aimed to examine whether Joint Commission International (JCI) accreditation is associated with higher patient satisfaction. A cross-sectional, questionnaire-based comparative study was conducted between April and July 2025 in outpatient departments of one JCI-accredited hospital (University Medical Center) and two nationally accredited public polyclinics in Astana, Kazakhstan. The questionnaire was designed to assess satisfaction across four domains: communication, staff responsiveness, hospital environment, and perceived quality of care. The patients attending the JCI-accredited hospital demonstrated significantly higher satisfaction across all domains compared to those of nationally accredited hospitals (p < 0.01). The largest difference was observed in staff responsiveness. In the multivariable regression analysis, the accreditation status emerged as the strongest independent predictor of overall patient satisfaction score (β = 0.42; 95% CI: 0.31-0.53; p < 0.001), even after adjusting for age, gender, education, employment status, and prior hospital visits. Education level and previous hospital experience were modest yet statistically significant predictors, whereas age, gender, and employment status were not significant in the adjusted analyses. JCI accreditation was associated with higher patient satisfaction scores in outpatient care settings, indicating a positive relationship between accreditation status and patient-centered outcomes.

In the Italian National Health Service (Servizio Sanitario Nazionale, SSN), healthcare quality governance operates through a dual-track system: mandatory institutional accreditation regulated at the regional level under Legislative Decree 502/1992, and voluntary third-party certifications such as International Organization for Standardization (ISO) 9001:2015 and Joint Commission International (JCI). The enactment of Law 24/2017 ("Gelli-Bianco") mandated clinical risk management (CRM), while ISO 7101:2023 introduces a paradigm shift toward people-centered quality management. This scoping review maps the adoption and integration of these quality frameworks in Italian healthcare. The review was conducted following the updated JBI methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. The protocol was prospectively registered on the Open Science Framework (OSF). A systematic search was performed in PubMed/MEDLINE and Scopus from January 2016 to December 2024, complemented by a targeted grey literature search. The Population, Concept, Context (PCC) framework guided the research question. Data were extracted into a predefined charting table and synthesized narratively. Twenty-six sources were included. The Italian accreditation system shows persistent regional heterogeneity, with no peer-reviewed studies evaluating accreditation effectiveness during the review period. Law 24/2017 remains incompletely implemented, with 72% of clinical risk managers (CRMs) lacking regular interaction with regional centers. ISO 9001:2015 is the most widely studied voluntary standard, with 73.3% of respondents reporting continuous improvement. JCI accreditation remains concentrated in approximately 28 highly specialized centers. The first empirical study on ISO 7101:2023 demonstrated significant improvements in patient health literacy (66.35 to 76.29, p<0.001). The Agenzia Nazionale per i Servizi Sanitari Regionali (AGENAS) Programma Nazionale Esiti (PNE) documents a persistent North-South quality divide. The Italian healthcare quality landscape is evolving from a compliance-driven model toward an integrated, multi-framework ecosystem. ISO 7101:2023 represents a strategic inflection point as a potential unifying paradigm. Future research should prioritize the empirical evaluation of ISO 7101 adoption in Italian settings and the investigation of the Southern quality governance gap.

Refining and defining the elements of staffing performance.

Orthopaedic nurses play a pivotal role in the collection of social determinants of health (SDOH) data. Therefore, it is crucial to determine orthopaedic nurses' preparedness to address the new SDOH mandates put forward by the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission (TJC). This study examines nurse awareness and understanding of the new CMS and TJC SDOH requirements for orthopaedic practices. A total of 100 nurses from the National Association of Orthopedic Nurses were electronically surveyed regarding their preparedness for the new CMS and TJC SDOH requirements. Knowledge assessment revealed that 63% of nurses could correctly identify the SDOH domains of the new CMS requirements and 47% of nurses could correctly identify one of the major TJC SDOH mandates. Nurses play a crucial role in screening for SDOH but may need more education regarding the CMS and TJC SDOH mandates.

Since orthopaedic nurses often guide patients through pre- and postoperative periods, they play an integral role in fulfilling the new screening requirements released by the Centers for Medicare & Medicaid Services and the Joint Commission. This study aims to highlight measures taken by orthopaedic healthcare organizations to fulfill the 2024 Social Determinants of Health (SDOH) screening requirements. Survey questions were developed and distributed in collaboration with the National Association for Orthopaedic Nurses to assess organizational responses to the requirements. On average, participants rated their institutions' preparedness to screen for SDOH as 3.21, with 30% of respondents ranking their preparedness as a 1 or 2 (5 being "very prepared" and 1 being "not prepared at all"). Organizations should consider developing a written action plan to screen for and address SDOH. They should also consider integrating workflows into the electronic medical record to facilitate easier screening and increase communication between hospital administration and nursing staff surrounding these new requirements.

Global healthcare has become exceedingly complex-clinically, financially, administratively, and even politically. While the international patient safety movement has yielded significant benefits worldwide, there remains a concerning prevalence of unsafe and substandard care. In this article, leaders of The Joint Commission and Joint Commission International (JCI), the world's largest accreditor and performance-improvement enterprise, highlight key areas of focus-from capacity strengthening to healthcare equity and sustainability-and share insights on achieving zero patient harm.

Climate change is a pressing global challenge that requires urgent action. The Paris Agreement and the 2030 Agenda of United Nations (UN) set clear global targets for emission reduction and sustainability to limit warming to 1.5 °C. Partnerships between standardization organizations are crucial in accelerating climate action. The Geneva Sustainability Centre (GSC) is at the forefront of healthcare sustainability, launching the Sustainability Accelerator Tool (SAT) in 2023 to help hospitals assess their environmental impact. In partnership with GSC, Joint Commission International (JCI) has integrated sustainability into its accreditation standards and will introduce the JCI-GSC Healthcare Sustainability Certification in 2025, built on the SAT. To accelerate the achievement of the Sustainable Development Goals (SDGs), ISO and the UN formed a strategic partnership in 2023 to create the first global SDG standard. ISO has published the IWA 42:2022 Net Zero Guidelines and is developing its first global Standard on Net Zero, set for release in 2025. Additionally, ISO introduced the Climate Change Amendments, embedding climate considerations into over 30 existing management system standards, including ISO 9001. With these amendments now shaping all newly developed or revised standards, future updates to ISO 15189 will likely incorporate sustainability requirements, especially as ISO 9001 is an essential part of ISO 15189. Reducing operational emissions from healthcare and medical laboratories alone will not achieve net zero. A sector-wide approach is essential, tackling supply chain emissions from energy, pharmaceuticals, and medical devices. Combating climate change requires a coordinated, cross-sector effort, making international collaboration indispensable. This review highlights key global frameworks, standards, guidelines, and initiatives that have evolved through collaboration to help healthcare organizations, including medical laboratories, to advance sustainability and climate resilience.

The Joint Commission (TJC) released new health care equity (HCE) standards for hospitals with the goal of helping organizations monitor and improve equity of care. This study assessed the state of the field immediately following the release of the new standards to gain a baseline understanding of the field's progress toward HCE.