not used by all. Some states have set up their own alternative assessment procedures; the Joint Commission is not recognized for state licensure in the states of Oklahoma (except for hospital-based outpatient mental health services), Pennsylvania, and Wisconsin. In California, The Joint Commission is part of a joint survey process with state authorities. There are also other healthcare accreditation organizations in the U.S. unrelated to the Joint Commission. These include Accreditation Commission for Health Care, Inc. (ACHC), the American Osteopathic Association (AOA), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Community Health Accreditation Program (CHAP), the "Exemplary Provider Program" of The Compliance Team, the Healthcare Facilities Accreditation Program (HFAP), the National Commission on Correctional Health Care, Utilization Review Accreditation Commission (URAC), The National Dialysis Accreditation Commission and the Healthcare Quality Association on Accreditation (HQAA) who are recognised in the state of Ohio. The Healthcare Facilities Accreditation Program (HFAP) has been in operation since 1945. On September 26, 2008, the Centers for Medicare and Medicaid Services (CMS) granted deeming authority for hospitals to DNV Healthcare Inc. (DNVHC), an operating company of Det Norske Veritas (DNV), a Norwegian international company that has been operating in the U.S. since 1898. The Center for Improvement in Healthcare Quality (CIHQ), based in Round Rock, Texas, was granted deeming authority for hospitals by the CMS In July 2013. Goals and initiatives The stated mission of The Joint Commission is: "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value." The company updates its accreditation standards, expands patient safety goals on a yearly basis, and posts them on its web site for all interested persons to review making the information and process transparent to all stakeholders ranging from institutions and practitioners to patients and their advocates. Residential treatment centers and medical care facilities often share their accreditation status with their patients. The purpose of The Joint Commission's National Patient Safety Goals (NPSGs) is to promote specific improvements in patient safety. The NPSGs highlight problematic areas in health care and describe evidence and expert-based solutions to these problems. Recognizing that sound system design is intrinsic to the delivery of safe, high quality health care. The Goals focus on system-wide solutions, wherever possible. The NPSGs have become a critical method by which The