When Susan Carvalho, RN, BSN, took over as director of quality and Joint Commission coordinator at Memorial Hospital Miramar (MHM) in Florida, she encountered a trial by fire: three surveys in four months. Carvalho moved into the role from within the quality management department in October 2006. In November 2007, The Joint Commission (formerly JCAHO) arrived for the facility's unannounced lab survey. One month later,