The Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) implemented the Agenda for Change initiative in 1986 as a major research and development effort. The focus of the initiative is the continuous assessment and improvement of patient outcomes. Measurement of the delivery of care may be assessed both through patient outcomes and related processes of care. The Agenda for Change shifts the emphasis of evaluation from an organization's capability to provide good care to its actual performance.

The specific objectives of the Agenda for Change include: redirection of the Joint Commission standards, improvement in the survey process, and establishment of performance monitoring capabilities.

There are several major aspects in the establishment of a performance monitoring system. First, performance measures need to be developed and tested for reliability and validity. Second, a mechanism needs to be established for both the Joint Commission and the healthcare organization to support data collection, analysis, and feedback. Third, a national database needs to be established that incorporates standards compliance and performance data. It is intended that the information generated by the performance data base will contribute to the continuous improvement in patient care delivery by stimulating healthcare organizations to analyze and improve processes affecting patient outcome.