What Accreditation 360 Is — and What It’s Not

The Joint Commission's new Accreditation 360 program goes into effect January 1, 2026 for hospitals and critical access hospitals. Accreditation 360 is generating a lot of buzz — and some confusion.

So, let's separate the facts from the fears.

What Accreditation 360 Is Not

1. A brand-new survey process

The survey agenda, tools, tracers, and on-site flow remain the same. You'll still see the same Document Review Tool, Building Tour, Kitchen Tracer, Emergency Management review, and SAFER matrix for findings. As Field Director Jim Grana put it, "The standards are changing; the survey process is not."

2. A change to the Conditions of Participation (CoPs)

CMS Conditions of Participation aren't changing. Accreditation 360 simply aligns Joint Commission standards more closely with CMS expectations — reducing overlap and redundancy.

3. A relaxation of requirements

Yes, the number of standards and Elements of Performance (EPs) is dropping — but the expectations for compliance remain identical. This isn't about "fewer rules" — it's about eliminating duplication and streamlining how compliance is written and scored.

4. A new risk for more findings

Some facility leaders worry that fewer, broader standards mean more "high-risk" findings. That's not the case. Surveyors will still use the SAFER matrix — evaluating each finding by risk (likelihood of harm) and manner & degree (how widespread it is). No new weighting or scoring changes are being added.

5. A code change

Accreditation 360 does not adopt a new version of NFPA 101 or 99. The healthcare industry still follows the 2012 editions, because that's what CMS has adopted into federal law. Changing codes would require an act of Congress — and that hasn't happened.

6. A one-size-fits-all rewrite

Accreditation 360 affects hospitals and critical access hospitals in 2026. Ambulatory surgery centers (ASCs) not under a hospital's CCN will continue using the current EC and LS standards until their chapter is updated.

7. A project you can ignore until 2026

While the process doesn't change, the documentation does. Hospitals should already be mapping their EC and LS programs to the new Physical Environment (PE) and National Performance Goals (NPG) structure. Use the Disposition Report and Crosswalk Compare Report from the Joint Commission's website — they show exactly where each EP landed.

Understanding Joint Commission Accreditation 360

In short:

• Accreditation 360 is a simplification, not a reinvention.
• It's about clarity, alignment, and consistency, not about rewriting the rules.
• If you were survey-ready before, you'll still be survey-ready now — as long as your documentation matches the new Accreditation 360 format.

Accreditation 360 Requirements: Key Takeaways for Facility Leaders

Keep your focus where it belongs:

• Maintaining code compliance and testing documentation
• Validating competencies and job qualifications
• Using the same survey tools you've always used
• And ensuring leadership understands this is not a new game — it's a new playbook.

For more information: Click here to watch a full Accreditation 360 discussion on the Healthcare Facilities Network with Joint Commission Field Director Jim Grana.

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