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Become a Member
Become a member and receive career-enhancing benefits

Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.

Membership Benefits

Surgeons Can Champion Participation in ACS CoC Initiatives

Shankar Raman, MD, MBA, FACS, FASCRS, and Tracy Hull, MD, FACS, FASCRS

December 6, 2023


Drs. Shankar Raman (left) and Tracy Hull

The ACS is dedicated to improving patient care and supports numerous programs that promote quality care.

Many of these programs have standards for accreditation along with guidelines that must be met for a center to be designated by the ACS. Given the vast experience accrued by the ACS over multiple decades of setting standards and verifying individual hospital programs across the country, as well as the continued changes to managing disease processes, the standards are edited and streamlined as needed.

The standards follow a similar theme across the spectrum, starting with institutional administrative commitment, program scope, and governance, and then moving onto resources (i.e., facilities, equipment, personnel, services), followed by patient care standards and data surveillance. Standards pertaining to quality improvement (QI), education, and research complete the spectrum.

While there may be variations depending on the individual verification programs, the approach is similar—to make it easy for hospitals, administrators, physicians, quality personnel, site reviewers, ACS staff, and others to be on the same proverbial page in terms of how this information is developed and presented.

Such homogeneity within the standards eliminates confusion and elucidates what is expected of these programs when a site review is conducted. It is duly important to point out that institutional administrative commitment is at the beginning of each of the standards manuals. Without support from the leaders at the top of the institution, it is widely recognized that none of the Quality Programs will succeed.

QI Project Promotes Smoking Assessment in Cancer Treatment

Among the most recent initiatives from the ACS Cancer Programs are Just ASK and Beyond ASK. The Just ASK initiative was an elective QI project open to all Commission on Cancer (CoC)- and National Accreditation Program for Breast Centers (NAPBC)-accredited programs, using existing resources to address smoking in newly diagnosed cancer patients.1

Essentially, the project focused on asking all newly diagnosed cancer patients about their smoking status, with the aim of integrating smoking assessment as part of treatment for cancer patients. For the purpose of the Just ASK QI initiative, use of combustible cigarettes and other smoked tobacco products, such as cigars and pipes, were included whereas e-cigarettes and smokeless tobacco were excluded. Participation in the Just ASK initiative and completion of the clinical research study fulfilled CoC or NAPBC standards. Programs that had applied for CoC or NAPBC accreditation also were able to participate in this initiative.2

The Beyond ASK program is a year-long QI initiative that is focused on advising and assisting newly diagnosed cancer patients on smoking cessation.3 The project aims to offer cessation assistance to newly diagnosed patients who report combustible tobacco use.

Through this project, surgeons advise patients on the harmful effects of smoking and how that impacts cancer treatment as well as how smoking cessation can improve survival. Other components of the initiative are assisting patients with quitting smoking by counseling and medication and referring and/or connecting patients with institutional or community-based resources and smoking cessation quit lines.3 Participation in this initiative also helps programs meet CoC or NAPBC standards.

ACS Cancer Programs

Commission on Cancer
National Accreditation Program for Breast Centers
National Accreditation Program for Rectal Cancer
Cancer Research Program

American Joint Committee on Cancer
Cancer Surgery Standards Program
National Cancer Database

Benefits of Participating in CoC Accreditation Programs

The following are the reasons why institutions should consider participating in CoC accreditation programs and quality initiatives:

  • Accreditation ensures that programs have the resources, structure, and processes in place to deliver high-quality, patient-centered cancer care.
  • Participation in accreditation programs promotes best practices for delivering evidence-based, high-quality care.
  • The accreditation standards decrease variation in care by streamlining and standardizing the patient care pathway, which also is likely to decrease inequities in cancer care delivery.
  • Participation in accreditation programs requires use of the cancer registry whereby programs can track their own outcomes and identify opportunities for improvement.
  • Accreditation also provides programs working on QI initiatives with the framework and resources needed for driving these improvements.
  • Accredited institutions have achieved the public seal of trust, having demonstrated their commitment to quality.

While not a reality yet, a goal of accreditation is to help secure reimbursement from regulators, funders, and payers. Ultimately, accreditation programs aim to provide value to patients and healthcare institutions.

Surgeons have a powerful voice in achieving buy-in and support from administrators and other leaders for accreditation and other quality initiatives related to cancer care. The following may help initiate the conversation:

Share powerful stories.

A negative experience in a patient’s cancer journey can be a strong motivator for changing the status quo and starting the process for accreditation. For programs that have achieved accreditation, sharing patient testimonies that attest to a positive experience and outcomes helps with garnering ongoing support.

Focus on how achieving accreditation could provide a competitive business advantage in heavily competitive markets.

Institutions should focus on high-quality cancer care as a differentiator. We recommend working with business analysts to forecast an increase in volume that could justify upfront investment.

Present institutional cancer data periodically to the medical staff executive council, quality and safety committee, as well as to the governing board.

These data will help identify opportunities for improvement and obtain institutional support and commitment for resources to improve outcomes.

Explore how other opportunities might be available to engage in QI efforts.

For example, the Just ASK and Beyond ASK initiatives were focused on smoking. In most matrixed environments, such QI efforts might gain traction with institutional areas that are focused on population health. Ultimately, these QI efforts are aimed at improving the health of the population, as the transition to value-based care and capitation models become stronger. Such population health services organizations might be willing to invest in resources that support cancer center QI initiatives.

Recognize that collaboration is vital for success and that administrative support and commitment toward QI initiatives may not happen after a few meetings.

In reality, it takes multiple attempts for such initiatives to become a priority. Ensuring that the goals and priorities of the cancer clinicians are aligned prevents conflict among competing priorities.

Celebrate every win with your team, including administrative leaders.

With the current healthcare environment, there has been a significant turnover in the C-suite. Recognizing every win for cancer care staff mitigates the possibility of burnout among clinicians and nonclinicians.

Participating in CoC accreditation programs shows a commitment by the centers to delivering high-quality care. Achieving CoC accreditation is a strong and independent predictor of high hospital performance for quality measures relevant to breast and colon cancer. Studies have demonstrated improved performance in CoC-accredited hospitals when compared to nonaccredited hospitals.4,5 As the standards and initiatives are evidence based, accreditation ensures that programs have implemented processes that are aligned with clinical research.

Surgeons have always been at the forefront of innovation and quality in healthcare. In addition, surgeons are strong patient advocates, ensuring that healthcare is patient-centered. These clinicians bring a strong leadership presence and are uniquely positioned to effect change in the institutions and communities they are fortunate to serve. Therefore, it is only natural that surgeons lead their institutions to participate in CoC initiatives, including new accreditation programs and QI efforts. Our “why” for participation in such efforts has never been stronger. 


The thoughts and opinions expressed in this viewpoint article are solely those of the authors and do not necessarily reflect those of the ACS.

Dr. Tracy Hull is the vice-chair of faculty development within the Department of Colon and Rectal Surgery at the Cleveland Clinic in Ohio. Dr. Shankar Raman is a colorectal surgeon and market chair for surgical specialties at MercyOne Des Moines Medical Center in Iowa.


  1. American College of Surgeons. Cancer Programs. Just ASK Quality Improvement Project and Clinical Study. Available at: https://www.facs.org/quality-programs/cancer-programs/pdsa-just-ask. Accessed September 27, 2023.
  2. American College of Surgeons. Cancer Programs. Just ASK frequently asked questions. Available at: https://accreditation.facs.org/accreditationdocuments/cancer/JustASKFAQs.pdf. Accessed September 27, 2023.
  3. American College of Surgeons. Beyond ASK Quality Improvement Project. Available at: https://www.facs.org/quality-programs/cancer-programs/beyond-ask-quality-improvement-project. Accessed September 27, 2023.
  4. Schroeder MC, Gao X, Lizarraga I, et al. The impact of Commission on Cancer accreditation status, hospital rurality and hospital size on quality measure performance rates. Ann Surg Oncol. 2022;29(4):2527-2536.
  5. Shulman LN, Browner AE, Palis BE, et al. Compliance with cancer quality measures over time and their association with survival outcomes: The Commission on Cancer’s experience with the quality measure requiring at least 12 regional lymph nodes to be removed and analyzed with colon cancer resections. Ann Surg Oncol. 2019;26(6):1613-1621.