Accreditation 360: What Are the National Performance Goals?

When the Joint Commission launches Accreditation 360 on January 1, 2026, two new chapters will shape how hospitals are evaluated:

• PE — Physical Environment, and
• NPG — National Performance Goals.

Much of the early attention has gone to the Physical Environment chapter, which consolidates the old Environment of Care (EC) and Life Safety (LS) standards. But the National Performance Goals (NPG) deserve just as much focus. They represent the Joint Commission's new framework for how hospitals demonstrate safety, culture, and performance excellence beyond the bricks-and-mortar environment under Accreditation 360.

A Shift in Focus with Accreditation 360

According to Jim Grana, Field Director at the Joint Commission, the NPG chapter gathers requirements that are essential to high-reliability performance but not specifically required by CMS Conditions of Participation or building codes.

"You can think of the National Performance Goals as the Joint Commission's own set of quality and safety objectives," says Grana. "They're not about the physical structure — they're about the systems, culture, and safeguards that support patient and staff safety."

In other words, PE covers compliance, while NPG covers culture.

What the National Performance Goals Include

The NPGs draw together several existing topics from previous chapters, such as patient safety, emergency preparedness, and workforce readiness. Many of these were previously embedded in the Environment of Care, Leadership, or National Patient Safety Goals chapters. Under Accreditation 360, they are unified into a single, outcomes-oriented framework that includes:

• Culture of Safety & Organizational Leadership – Focus on accountability, communication, and safety culture maturity.
• Emergency Management Alignment – Integration with community response plans and leadership engagement.
• Health Equity & Access – Continuing the Joint Commission's effort to reduce disparities in care delivery.
• Infection Prevention & Control – Maintaining policies and surveillance mechanisms that prevent transmission risk.
• Workplace Safety & Violence Prevention – Expectations for hazard assessments, mitigation plans, and reporting culture.
• Competency & Training – Validation that staff meet the organization's own competency requirements.
• Imaging Safety and Radiation Protection – Safeguards in diagnostic and therapeutic imaging environments.
• Suicide Risk Reduction and Behavioral Health Safety – Assessment and mitigation of environmental and clinical risks for at-risk patients.

"We didn't add new requirements," Grana explains. "We repositioned existing expectations so that hospitals can see how these systems work together to support safety and performance."

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Why the National Performance Goals Matter

The National Performance Goals reflect the Joint Commission's philosophy that safety and performance can't be separated. Compliance with codes and standards keeps the building safe; a culture of competence and accountability keeps patients safe.

For facilities and operations teams, this means Accreditation 360 will evaluate not just what systems exist, but how those systems are supported through leadership engagement, staff training, and monitoring.

Hospitals that succeed under NPG will demonstrate:

• Strong, documented competency programs for facilities and support staff.
• Cross-department collaboration between facilities, safety, and clinical leaders.
• Evidence that leadership is actively reviewing and acting on safety data.

Accreditation 360 Requirements: How to Prepare for National Performance Goals

1. Review the NPG Webinars – The Joint Commission's free online sessions explain how EC and LS standards were reclassified into NPG and PE.
2. Map Your Current Programs – Identify existing policies or metrics that now fall under NPG.
3. Engage Leadership – Success depends on executive participation and accountability tracking.
4. Integrate Competency and Training – Ensure job descriptions and competency files reflect hospital expectations with supporting documentation.

The Bottom Line on Joint Commission Accreditation 360 National Performance Goals

The National Performance Goals don't replace the old National Patient Safety Goals — they expand them. They signal that healthcare quality is as much about organizational performance as it is about regulatory compliance.

As Jim Grana summarizes: "The process isn't changing — the structure is. The National Performance Goals simply bring everything that drives safety and culture into one place."

In short, Accreditation 360's NPGs encourage hospitals to think beyond codes and checklists — toward measurable leadership, accountability, and resilience.

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